Diabetic foot syndrome: importance of calf muscles MR spectroscopy in the assessment of limb ischemia and effect of revascularization

Aim. To propose a pathogenetically substantiated infusion therapy based on the results of a comprehensive evaluation of lower limb ischemia in diabetic foot syndrome. Methods. Energetic Doppler sonography of the blood vessels of the lower extremities in its distal part and electrothermometry in 32 patients with diabetic foot syndrome and critical limb ischemia was conducted in addition to the general clinical imaging studies (radiography, ultrasonography in the «gray scale» mode). Considering the obtained data the treatment strategy in these patients (conservative or surgical) was determined together with a physician-endocrinologist. Results. Presented is an example of tactics formation for conservative infusion therapy of a patient with diabetes mellitus, which is complicated by the diabetic foot syndrome with critical limb ischemia. Compiled was an individual treatment algorithm. At the initial stage crystalloid solutions (slow drip, followed by urination stimulation) were administered. Next prescribed were vitamins from group B (cyanocobalamin 0.25 mg and pyridoxine 50 mg) in order to regulate the metabolism of key neuromediators and amino acids. The complex of treatment included the nonsteroidal anti-inflammatory drug diclofenac (25 mg). This was followed by administration of dextran solutions (reopolyglukine), in combination with an antiplatelet solution (pentoxifylline). At the final stage of therapy administered was prostaglandin E1 (alprostadil, 3-4 infusions per course). Local treatment: osmotic agents were applied to the right foot as semi-alcohol compresses to relieve swelling, improve microcirculation and promote closure of the fistulas. After the conducted treatment noted was an improvement in general condition, pain symptoms subsided, the fistula closed, the soft tissue on the foot had no signs of inflammation. Recovery of the parameters of microcirculation signify the relief of arterial and venous stasis. Conclusion. This treatment scheme will make it possible to improve the course of the disease, reduce the time of treatment and disability of patients, will also improve their quality of life.

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Detection of skin microvascular vasodilation disorders in patients with diabetic foot syndrome during the local heating test

Regional blood circulation and microcirculation ◽

10.24884/1682-6655-2015-14-3-27-33 ◽

2015 ◽

Vol 14 (3) ◽

pp. 27-33 ◽

Cited By ~ 1

Author(s):

N. A. Zubareva ◽

S. Y. Podtaev ◽

A. A. Parshakov

Keyword(s):

Wavelet Analysis ◽

Diabetic Foot ◽

Healthy Subjects ◽

Local Heating ◽

Diabetic Polyneuropathy ◽

Limb Ischemia ◽

Diabetic Foot Syndrome ◽

Time Frequency ◽

Plantar Surface ◽

Heating Test

Introduction and purpose. The aim of investigation was to evaluate the possibility of using the method of wavelet analysis of skin temperature during the local heating test for the study of the microvascular tone regulation in patients with diabetic foot syndrome (DFS). Materials and methods. The study was performed in 15 healthy subjects and 10 patients with neuro-ischemic form of DFS complicated by trophic ulcers. The temperature of the plantar surface of the hallux was recorded by «Microtest» (Perm, Russia) with temperature resolution 0,002°C. Time-frequency analysis of temperature fluctuations was performed using wavelet analysis. For the reconstruction of the oscillations in endothelial (0.02-0.0095 Hz), neurogenic (0.05-0.02 Hz) and myogenic (0.05-0.14 Hz) frequency ranges we used inverse wavelet transform. Results. In healthy people, indexes of vasodilation (relative changes in the oscillation amplitudes) in the myogenic, neurogenic, and endothelial frequency ranges were 3.04, 4.01 and 2.25 respectively. In patients with DFS the values were significantly lower than in healthy subjects (0.60, 0.67 and 0.51, respectively). Conclusion. In contrast to healthy subjects, the combination of diabetic polyneuropathy with endothelial dysfunction and macroangiopathy in patients with neuro-ischemic form of DFS leads to the progression of mutually aggravating pathological processes and lower limb ischemia. Further implementation of the local heating test at the early stages of diabetic foot is of interest for the prognosis of the disease, evaluating the effectiveness of conservative treatment and endovascular interventions.

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Antiplatelet agents in complex medication therapy in diabetic foot disease

Russian Medical Inquiry ◽

10.32364/2587-6821-2020-4-7-457-462 ◽

2020 ◽

Vol 4 (7) ◽

pp. 457-462

Author(s):

K.A. Koreyba ◽

Keyword(s):

Conservative Treatment ◽

Diabetic Foot ◽

Clinical Guidelines ◽

Limb Ischemia ◽

Antiplatelet Agents ◽

Diabetic Foot Syndrome ◽

Medication Therapy ◽

Diabetic Foot Disease ◽

Foot Disease ◽

Chronic Limb Ischemia

The urgency of the problem concerning treatment of diabetic foot disease is due to the following reasons: pathogenesis ambiguity of this pathology, tendency to trophic defects relapse and increase in volume during the conservative treatment, resistance to conservative treatment, deterioration of the life quality of patients, treatment complexity and duration, and significant economic costs for treatment and rehabilitation. The patterns of complex medication therapy effects include insufficient evidence for most drugs, the lack of generally accepted regimens and the low efficacy of existing ones. Given the own experience and using a mathematical model, it was proved that the benefits of using Cilostazol as part of combined medication therapy regimen for patients with diabetic foot syndrome and stage IIA, IIB chronic limb ischemia according to the classification of Fontaine-Leriche-Pokrovsky. The need to adhere to National Clinical Guidelines was justified.KEYWORDS: diabetic foot syndrome, national clinical guidelines, disaggregants, pulse oximetry, chronic limb ischemia, oxygen saturation,outcomes assessment.FOR CITATION: Koreyba K.A. Antiplatelet agents in complex medication therapy in diabetic foot disease. Russian Medical Inquiry. 2020;4(7):457–462. DOI: 10.32364/2587-6821-2020-4-7-457-462.

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Ways to reduce the frequency of high amputations, post-amputation complications and mortality in diabetic foot syndrome

Wounds and wound infections The prof B M Kostyuchenok journal ◽

10.25199/2408-9613-2021-8-1-12-23 ◽

2021 ◽

Vol 8 (1) ◽

pp. 12-23

Author(s):

V. M. Bensman ◽

A. G. Baryshev ◽

S. N. Pyatakov ◽

K. G. Triandafilov ◽

V. N. Ponomarev ◽

...

Keyword(s):

Critical Limb Ischemia ◽

Diabetic Foot ◽

Soft Tissues ◽

Comparison Group ◽

Lower Extremities ◽

Limb Ischemia ◽

Main Group ◽

Diabetic Foot Syndrome ◽

Wound Complications ◽

Comparison Groups

Despite the success in treatment, currently 30.0% of patients with diabetic foot syndrome (DFS) still undergo high amputations with a mortality rate of up to 54.0–68.0 %. The causes of high low limb amputations in 28.0 % of patients are infection, and in 46.0 % – arterial insufficiency in the stage of critical limb ischemia.Objective: to improve the results of patients treatment by reducing the number of high amputations of the lower extremities, reducing the occurrence of complications and deaths of the disease.Materials and methods. To study the results of treatment of patients with DFS, they were divided into two comparison groups and two main groups. From 1982 to 2019, the frequency of amputations, mainly at the hip level, was 71.0 % (177 amputations in 248 patients). These patients formed the first comparison group of observations. The second comparison group (1988–1994) included 58.3 % of patients in whom amputations were performed according to more stringent indications (157 amputations in 269 patients). The first main group of observations (1995–2013) included 9.9 % of patients with DFS who were amputated only for wet gangrene, incurable critical limb ischemia, and infection with a systemic inflammatory response (130 amputations out of 1312 patients). In ischemia with preserved blood flow through the deep artery of the thigh, amputation of the lower leg was performed in a sequential-two-flap method with removal of the soleus muscle. Amputations were completed with the imposition of drainage removable muscle-fascial sutures. The second main group (2014) consisted of 11.4 % of patients who underwent amputations only for sepsis or wet gangrene (124 amputations in 1083 patients). The difference between the second main group and the first was the division of the high amputation intervention into 2 stages.Results. Comparison of the treatment results in the main groups and in the comparison groups revealed a 6-fold decrease in the number of high amputations (from 64.6 to 10.69 %) and a significant improvement in the main quality indicators. This concerns a 6-fold decrease in mortality, which was a consequence of the introduction of a two-stage tactic for high amputation treatment of the most severe patients and the limitation of indications for amputation of the hip. Using of removable drainage muscle-fascial sutures decreased postoperative wound complications from 51.9 to 13.0 %, and the number of re-amputations decreased in 17th times.Conclusion. Amputation of the lower extremities for irreversible critical limb ischemia can be performed with a decrease in TcP02 of the stitched stump tissues to no more than 30 mm Hg. Preserving the knee joint improves the possibilities of prosthetics, which allows older diabetics to lead an active life. Methods of performing parallel- or sequential-two-flap high amputation improve the conditions for cutting out racquet-shaped wound flaps, which provides free displacement of the soft tissues of the stump connected by removable drainage sutures.

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