scholarly journals Sepsis as a cause of fatal cases after the lower limbs amputation at the hip level due to gangrene in patients with a diabetic foot syndrome

2019 ◽  
Vol 41 part 1 (2) ◽  
pp. 29-35
Author(s):  
A. V. Kapshitar ◽  
A. A. Kapshitar
Keyword(s):  
Myocardial Infarction ◽  
Lower Limb ◽  
Diabetic Foot ◽  
Lower Limbs ◽  
Diabetic Foot Syndrome ◽  
Limb Amputation ◽  
Pathological Changes ◽  
Educational Work ◽  
Severe Diabetes ◽  
Patients With Diabetes

Purpose of the study. To study frequency of fatal sepsis, the causes and severity of diabetes patients complicated by diabetic foot syndrome of the gangrene limb, after amputation of the lower limb at the hip level. Material and methods. Amputation of the lower limb at the hip level was performed in 180 patients with diabetic foot, gangrene of the limb. 15 (8,3%) died. Results. From the 15 patients who died, 9 died from sepsis. The age was 54–78 years old. On admission, sepsis was diagnosed in 5 and septic shock – in 4 patients. After examination and preparation, emergency surgeries were performed in 4 patients and urgent surgeries – in 5. Two- and three-step surgeries were performed in 5 patients. They first performed the removal of the toes of the gangrene, osteomyelitis, opened deep phlegmon of the foot and the lower leg was completed by amputation of the lower limb. Primary amputations were performed in 4 patients. Sepsis was the cause of death in 5 patients from 11 to 60 days and the combinations of sepsis with acute myocardial infarction or repeated myocardial infarction – in 4 from 5 to 17 days. During the autopsy, pathological changes of severe diabetes, complicated diabetic foot syndrome, its mixed form, sepsis with manifestations of septicemia or septicopyjemia, and all organs and systems were revealed. Conclusions. The unsatisfactory organization of medical care for patients with diabetes and diabetic foot syndrome at the pre hospital stage, ineffective sanitary and educational work, systemic pathological changes led to sepsis and death after the amputation of the lower limb at the hip level. Keywords: sepsis, diabetic foot syndrome, limb amputation, mortality.

scholarly journals Predictors of major lower limb amputation in type 2 diabetic patients referred for hospital care with diabetic foot syndrome

2018 ◽  
Vol Volume 11 ◽  
pp. 313-319 ◽  
Author(s):  
Nawaf J Shatnawi ◽  
Nabil A Al-Zoubi ◽  
Hassan M Hawamdeh ◽  
Yousef S Khader ◽  
Khaled Gharaibeh ◽  
...  
Keyword(s):  
Lower Limb ◽  
Diabetic Foot ◽  
Hospital Care ◽  
Lower Limb Amputation ◽  
Diabetic Foot Syndrome ◽  
Limb Amputation ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Type 2 Diabetic

scholarly journals The use of NPWT in combination with silver dressing in diabetic foot syndrome – case report

2014 ◽  
Vol 1 (1) ◽  
Author(s):  
Dominik Andrzej Walczak ◽  
Rajmund Jaguścik ◽  
Karolina Ptasińska ◽  
Leokadia Kozaczek ◽  
Piotr Wojciech Trzeciak
Keyword(s):  
Case Report ◽  
Diabetic Foot ◽  
Negative Pressure Wound Therapy ◽  
Lower Limbs ◽  
Diabetic Foot Syndrome ◽  
Healthy Individuals ◽  
Wound Therapy ◽  
Present Case Report ◽  
Increased Risk ◽  
Patients With Diabetes

Patients with diabetes mellitus are at increased risk of angiopathy, neuropathy and infection compared with healthy individuals and that may lead to foot disorders. Treatment is difficult challenging and if it is not successful it often run to lower limbs amputations.We present case report of 63 years old man after amputation of big toe and part of metatarsus due to diabetic foot syndrome, successfully treated with negative pressure wound therapy in combination with silver dressing. The literature regarding this issue was also reviewed.

scholarly journals A Review of Diabetic Foot Ulcer Infections and Lyophilized Wafer Formulation

2021 ◽  
pp. 13-25
Author(s):  
Rupalben Kaushalkumar Jani ◽  
Goswami Kaushal Puri ◽  
Shrestha Ubana
Keyword(s):  
Lower Limb ◽  
Diabetic Foot ◽  
Chronic Wounds ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Drug Release Profile ◽  
Scanning Calorimetry ◽  
Patients With Diabetes

Diabetic foot difficulties are the most usually occurring problems globally, resulting in economic disasters for the patients, families, and society. In patients with diabetes, the risk of emerging foot ulcers is 25% high. It has also been in the record that one lower limb amputation occurs every 30 seconds in patients with diabetes worldwide. Novel methods of drug delivery and wound dressing have to develop to solve the lower limb amputation crisis. One such novel method is "Lyophilized wafer formulation." It is an upcoming medicated dressing material that can enhance wound healing and the potential to ingest vast quantities of exudates from Chronic wounds. That can have been formulating by lyophilizing hydrogel of absorbent polymers such as Calcium Alginate, Carrageenan, Thiolated Chitosan, and plasticizer to enhance flexibility withstand the day to day mechanical stress, covered with some adhesive and protective backing layer. Unless it passes evaluation tests such as Fourier-transform infrared spectroscopy (FTIR), Differential scanning calorimetry (DSC), Scanning electron microscopy (SEM), Exudate handling property, Folding endurance, In-vitro, In-vivo drug release profile, and Gamma-irradiation sterilizes wafer formulation, and it should not administrate directly. Lyophilized wafer formulation will be the most acceptable medicated dressing material in the future that will be useful to treat the normal wound. The wound formation because of diabetic foot ulcer (DFU) infections as there will be site-specific delivery of the drug, packed with an advantage to self administer and easy termination of the drug that can achieve just by removing the wafer case of drug toxicity.

scholarly journals Epidermis of amputated limbs in patients with diabetes mellitus - immunohistochemical study

2014 ◽  
Vol 95 (2) ◽  
pp. 244-249
Author(s):  
G N Gorshunova ◽  
R A Dzamukov ◽  
V V Valiullin
Keyword(s):  
Diabetic Foot ◽  
Epidermal Cells ◽  
Lower Limbs ◽  
Diabetic Foot Syndrome ◽  
Nuclear Antigen ◽  
Healthy Controls ◽  
Color Intensity ◽  
Patients With Diabetes ◽  
Apoptotic Activity ◽  
Skin Samples

Aim. To examine the skin morphological changes in different areas of the amputated lower limbs of patients with diabetes mellitus. Methods. Skin samples of lower limbs of 6 patients with diabetic foot syndrome were studied using immunohistochemistry methods. Proliferation of epidermal cells, their resistance to apoptosis, as well as the degree of cells differentiation (using antibodies to proliferating сell nuclear antigen, Bcl-2 anti-apoptotic activity marker, epidermal cells terminal differentiation marker cytokeratin 1) were assessed. The color intensity was assessed using ImageJ software and was displayed as «mean greyscale intensity» (an integral value summarizing color intensity of three basic colors - red, green and blue - by V=0,299R+0,587G+0,114B formula, where V - mean intensity of a mean pixel, R, G, B - color intensity of red, green and blue pixels appropriately). Results. Patients with diabetic foot syndrome had reduced proliferative activity of epidermal cells as they approach the sphacelous area of the affected limb, together with decreased resistance to apoptosis in the same areas. The share of cells positive for proliferating cell nuclear antigen was 58.74±4.8% in skin samples from the area of necrosis (n=6) compared to 77.41±3% (p 0.005) in skin samples of the healthy controls. The study of Bcl-2 marker expression by cells of the sphacelous area (n=6) revealed that mean greyscale intensity in patients with diabetic foot syndrome was 57.74±4.3, which was significantly lower compared to skin samples of the healthy controls (n=6, 89.69±3.4, p 0.005). Based on the expression of cytokeratin, it was shown that suprabasal layers of the epidermis cells were less differentiated in case of diabetic foot syndrome compared to the same cells of the epidermis of the control group. Conclusion. In advanced stages of diabetes, the combined effect of the disease is reduced number of epidermis proliferating cells, the reduction of their anti-apoptotic activity and loss of skin as an organ.

Lower limb biomechanical characteristics in patients with diabetic foot: Analysis and efficacy of modified orthopedic insoles

2021 ◽  
Vol 11 (12) ◽  
pp. 1951-1957
Author(s):  
Yutao Kong ◽  
Xianzhong Ma ◽  
Zhen Ma ◽  
Hongxia Tao ◽  
Yanning He ◽  
...  
Keyword(s):  
Lower Limb ◽  
Diabetic Foot ◽  
Intervention Group ◽  
Lower Limbs ◽  
Control Group ◽  
Maximum Pressure ◽  
Patients With Diabetes ◽  
Left And Right ◽  
Orthopedic Insoles ◽  
One Year

We studied biochemical characteristics of the lower limbs of patients with diabetic foot (DF) to develop custom orthopedic insoles. In this study of 88 patients with diabetes, 58 had a normal foot appearance, 18 had plantar calluses, and 12 had valgus feet. The maximum pressure applied to the left and right plantar of patients with DF is under the third metatarsal, and the peak areas of the left and right feet are below the first metatarsal. Pain and American Orthopedic Foot and Ankle Society scores were reduced after one year of wearing modified orthopedic insoles versus unmodified insoles. After one year of wearing the insole, the pressure was reduced in the left and right feet of both groups, but the intervention group showed a more significant reduction than the controls. The swing time was shorter in the intervention group and the incidence of DF ulcers was 6.81% higher in the control group. Thus, lower limb biomechanics differ in patients with DF, most of who experience calluses and hallux valgus. Modified orthopedic insoles provide improved sole pain, ankle-foot joint function, and distribution of plantar pressure, and incidence of DF ulcers.

Treatment Strategies Against Diabetic Foot Ulcer: Success so far and Road Ahead

2020 ◽  
Vol 16 ◽  
Author(s):  
Ankit Awasthi ◽  
Sachin Kumar Singh ◽  
Bimlesh Kumar ◽  
Monica Gulati ◽  
Rajesh Kumar ◽  
...  
Keyword(s):  
Lower Limb ◽  
Diabetic Foot ◽  
Treatment Strategies ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Arterial Disease ◽  
Current Status ◽  
Limb Amputation ◽  
Bibliographic Databases ◽  
Inflammatory Phase

Background: Diabetic foot ulcer (DFU) is one of the leading complications of type-2 diabetes mellitus. It isassociated with neuropathy and peripheral arterial disease of the lower limb in patients with diabetes. Basically, there are four stages of wound healing namely hemostasis phase, inflammatory phase, proliferative phase and maturation phase. In case of DFU, all these stages are disturbed which lead to delay in healing and consequently to lower limb amputation. Traditionally the dosage forms like tablets, creams, ointments, gels and capsules have been used for the treatment of diabetic foot ulcer from many years. Introduction: In this review the global prevalence as well as etiopathogenesis related to diabetic foot ulcer has been discussed. Potential role of various synthetic and herbal drugs as well as their conventional dosage form for the effective management of diabetes foot ulcer has been highlighted. Methods: Structured search of bibliographic databases for previously published peer-reviewed research papers was explored and data was culminated in terms of various approaches that are used for the treatment of diabetic foot ulcer. Results: About 142 papers including both, research and review articles, were included in this review in order to produce a comprehensive as well as readily understandable article. A series of herbal and synthetic drugs have been discussed along with their current status of treatment in terms of dose and mechanism of action. Conclusion: DFU has become one of the most common complications in patients having more than ten years of diabetes. Hence, understanding the root cause and its successful treatment is a big challenge because it depends upon multiple factors such as judicious selection of drug as well as proper control of blood sugar level. Most of the drugs that have been used so far either belong to the category of antibiotics, antihyperglycaemics or, they have been repositioned. Moreover, in clinical practice, much focus has been given towards dressings that have been used to cover the ulcer. The complete treatment of DFU is still a farfetched dream to be achieved and it is expected that a combination therapy of herbal and synthetic drug with multiple treatment pathway could be able to overcome the disease.

scholarly journals Study of the influence of vacuum therapy on the wound process in patients with diabetic foot syndrome

2019 ◽  
Vol 74 (4) ◽  
pp. 283-288
Author(s):  
Petr A. Gerasimchuk ◽  
Alexander V. Shidlovskyi ◽  
Dmitriy B. Fira ◽  
Andrey V. Pavlyshyn
Keyword(s):  
Diabetes Mellitus ◽  
Negative Pressure ◽  
Diabetic Foot ◽  
Chronic Wound ◽  
Lower Limbs ◽  
Diabetic Foot Syndrome ◽  
Vacuum Therapy ◽  
Social Significance ◽  
Number Of Patients ◽  
Bed Days

Background: According to the International Diabetes Federation (IDF), the number of patients on diabetes mellitus is now more than 415 million people on Earth, until 2030 it will increase to 439 million, and by 2035 ― will reach 592 million. Throughout life, 4.625% of patients with diabetes mellitus develops a diabetic foot syndrome with the formation of wounds, whose treatment, can not yet be considered satisfactory, since in 1525% of patients are the direct cause of high amputations of the lower limbs. This requires finding new effective methods for treating wound defects in patients with diabetic foot syndrome, one of which can be vacuum wound therapy. Aims: To study the effectiveness of vacuum therapy in the treatment of acute and chronic wound process in patients with diabetic foot syndrome, depending on the pathogenetic form of the lesion. Materials and methods: The effect of vacuum therapy on the course of acute and chronic wound process in 231 patients with neuropathic and ischemic form of diabetic foot syndrome was studied during 20142017. Evaluation of the dynamics of the wound process was carried out on the basis of clinical, planimetric, microbiological, morphological methods, as well as microcirculation indices in the area round the wound. Results: Vacuum therapy of acute and chronic wounds in patients with different pathogenetic forms of diabetic foot syndrome, allows to stabilize the course of wound process, stimulate regenerative processes in the wound, improve local microcirculation (p0.05). This, in turn, allows a shorter time to prepare a wound for closure by one of the methods of plastic surgery or create favorable conditions for its independent epithelization. In patients with ischemic lesions (chronic arterial insufficiency of the third degree), the carrying out of vacuum therapy by standard method leads to an intensification of the pain syndrome. This causes the need to apply an initial negative pressure in the system in the range of 7080 mm Hg, which makes it possible to stop pain during the day. At 23 days of the postoperative period, negative pressure is established at standard values. Conclusions: Vacuum therapy of wounds in patients with diabetic foot syndrome is an effective method of treatment that allows the doctor to reduces the duration of treatment of patients in hospital with a neuropathic form of diabetic foot syndrome on average (4.31.7) bed-days, and patients with ischemic form ― on average (4.11.9) bed-days, which has both medical and social significance.

scholarly journals Possibilities of combined surgical treatment of pyonecrotic lesions in the neuroischemic form of diabetic foot syndrome

2009 ◽  
Vol 12 (1) ◽  
pp. 8-13
Author(s):  
Valeriy Afanas'evich Mitish ◽  
I A Eroshkin ◽  
Gagik Radikovich Galstyan ◽  
Lyudmila Petrovna Doronina ◽  
Yu S Paskhalova ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Diabetic Foot ◽  
Lower Extremities ◽  
Lower Leg ◽  
Diabetic Foot Syndrome ◽  
Diagnostic Tools ◽  
Critical Ischemia ◽  
Adequate Treatment ◽  
Patients With Diabetes ◽  
Foot Lesions

Aim. To present results of combined surgical treatment of the ischemic form of diabetic foot syndrome complicated by pyonecrotic process. To show thatthe use of modern diagnostic tools and the choice of adequate treatment strategy permits to substantially reduce the number of above-the-knee amputations. Materials and methods. A total of 140 patients with diabetes mellitus and critical ischemia of lower extremities were under observation during 2004-2008.All of them had purulent and/or necrotic foot lesions. The patients were examined by X-ray, computed and magneto-resonance tomography of the feet,duplex scanning of lower leg vasculature, transcutaneous measurement of PO2, pelvic and lower leg arterial angiography. Results. A strategy of surgical treatment was developed to be used depending on the patients health status, clinical features and severity of pyonecroticprocesses in the foot, and the degree of involvement of the main blood vessels of lower extremities. Conclusion. Combination of endovascular surgery with various methods for plastic wound closure permits to extend the range of possibilities for the treatmentof high-risk patients, such as those with pyonecrotic lesions and neuroischemic form of diabetic foot syndrome. This approach opens up prospects fora significant decrease of percentage of above-the-knee amputations and improves the quality of life in these patients.

scholarly journals Prevalence and Risk Factors for Diabetic Lower Limb Amputation: A Clinic-Based Case Control Study

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Beverly T. Rodrigues ◽  
Venkat N. Vangaveti ◽  
Usman H. Malabu
Keyword(s):  
Risk Factors ◽  
Lower Limb ◽  
Diabetic Foot ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Indigenous Australians ◽  
Haemoglobin A1c ◽  
Foot Clinic

Objective.The aim of the study was to evaluate the prevalence of and risk factors for lower limb amputation in a specialist foot clinic-based setting.Methods.A retrospective quantitative study was conducted, using clinical and biochemical profiles of diabetic foot patients attending the High Risk Foot Clinic at The Townsville Hospital, Australia, between January 1, 2011, and December 31, 2013.Results.The total study sample included 129 subjects, comprising 81 males and 48 females with M : F ratio of 1.7 : 1. Twenty-three subjects were Indigenous Australians, representing 17.8% of the study population. The average age of the cohort was 63.4 years ± 14.1 years [CI 90.98–65.89]. Lower limb amputation was identified as a common and significant outcome (n=44), occurring in 34.1%, more commonly amongst the Indigenous Australians (56.5% versus 29.2%;p=0.94, OR 0.94). Risk factors most closely associated with amputation included diabetic retinopathy (p=0.00, OR 4.4), coronary artery bypass graft (CABG) surgery (p=0.01, OR 4.1), Charcot’s arthropathy (p=0.01, OR 2.9), and Indigenous ethnicity (p=0.01, OR 3.4). Although average serum creatinine, corrected calcium, and glycosylated haemoglobin A1c (Hba1c) levels were higher amongst amputees they were statistically insignificant.Conclusions.Lower limb amputation is a common outcome and linked to ethnicity and neurovascular diabetic complications amongst subjects with diabetic foot ulcer. Further research is needed to identify why risk of lower limb amputation seems to differ according to ethnicity.

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