Peculiarities Of Treatment Of Purulent-Necrotic Complications In Patients With Diabetic Foot Syndrome

The number of patients with diabetes mellitus in the Andijan region who were registered according to endocrinologists from 2000 to 2015 increased almost fourfold from 26,000 to more than 110,000 in 2016 (14). This also shows that the number of patients with various purulent-necrotic complications of diabetes mellitus also increases proportionally, in addition, there is an increase in patients with severe purulent-septic complications of these processes, with widespread, deep purulent-necrotic fasciitis [3]. Of patients in the department of surgical infection of the ASMI clinic, patients with purulent-necrotic complications of diabetes mellitus account for almost 78%, which indicates a significant increase in the number of these patients. This tendency continues and goes up every year. According to the WHO, by 2030 every 15 people will have diabetes, and by 2050 this figure will be equal to every 6 people.

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

Annals of the Russian academy of medical sciences ◽

10.15690/vramn1067 ◽

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.

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Morphological research of the effectiveness of perioperative local use of anesthetics and antiseptics in patients with purulent-necrotic lesions of lower extremities in diabetes mellitus

Reports of Morphology ◽

10.31393/morphology-journal-2021-27(3)-03 ◽

2021 ◽

Vol 27 (3) ◽

pp. 22-28

Author(s):

Yu.M. Babina ◽

D.V. Dmyrtriiev ◽

O.A. Nazarchuk ◽

P.P. Hormash

Keyword(s):

Diabetes Mellitus ◽

Wound Healing ◽

Granulation Tissue ◽

Diabetic Foot ◽

Povidone Iodine ◽

Local Treatment ◽

Lower Extremities ◽

Diabetic Foot Syndrome ◽

Patients With Diabetes ◽

Infiltration Anesthesia

Ulcer-necrotic lesions of the feet are detected in 5-15% of patients with diabetes mellitus (DM). According to the literature today in Ukraine, patients with DM perform high amputation of the lower extremities with diabetic foot syndrome with a frequency of 19.6-42.6%, at the same time, mortality ranges from 8.9% to 25.0%, and the total mortality rate at the DM varies from 6.6% to 13.5%, often associated with the occurrence of postoperative complications. The aim of the work was to study morphological indicators of reparation of soft tissues of the lower extremities in patients with diabetic foot syndrome on the background of local treatment during the perioperative period. We investigated changes in histologic structure and character of reactions of skin tissues, muscles and fascia during the period of visceral disease in patients with diabetes mellitus after different types of local treatment. Then, samples of skin tissues, muscles and fascia were photographed and analyzed using a light microscope OLIMPUS BX 41. In the first group of the comparison, which used standard methods of anesthesia and local antiseptic povidone-iodine, granulation tissue was characterized by the complete absence of fibrous structures (collagen fibers) and the presence of a small number of newly formed small diameter vessels with blistered endothelium. Vessels of young granulation tissue were dilated, full-blooded, the endothelium was swollen, there was significant perivascular edema. In the second group of patients (where povidone-iodine and infiltration anesthesia with 2% lidocaine solution anesthetic was used locally) there were almost no remains of necrotic tissues in the affected tissues. It should be noted that there was better granulation development with fewer inflammatory-cell elements, more young forms of fibroblasts and a moderate pathological vascular reaction. In the first (control) group, wound healing by 3-7 days is characterized by somewhat slow regeneration. Wound healing was most favorable in patients of the second group, where infiltration anesthesia was used by local anesthetic and antiseptic povidone-iodine.

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THE PREVALENCE OF MODIFIABLE RISK FACTORS IN THE POPULATION AND IN PATIENTS WITH DIABETES MELLITES, INCLUDING DIABETIC FOOT SYNDROME

Tavricheskiy Mediko-Biologicheskiy Vestnik ◽

10.37279/2070-8092-2020-23-2-85-91 ◽

2020 ◽

Vol 23 (2) ◽

pp. 85-91

Author(s):

T. Yu. Kravtsova ◽

M. F. Zarivchatskiy ◽

P. S. Lukin ◽

S. F. Blinov ◽

M. V. Bacheva

Keyword(s):

Physical Activity ◽

Diabetes Mellitus ◽

Risk Factors ◽

Diabetic Foot ◽

Age Groups ◽

Social Study ◽

Diabetic Foot Syndrome ◽

Modifiable Risk Factors ◽

Patients With Diabetes ◽

Poor Nutrition

Goal of work - identify modifiable risk factors for chronic non-infectious diseases in patients with type 2 diabetes mellitus and in the formation of diabetic foot syndrome. Material and methods. A comparative medical and social study was conducted - a survey of patients in clinics of the city of Perm, suffering and not suffering from diabetes. The study involved 230 people who were assigned according to the presence/absence of diabetes mellitus. The first group included 178 patients with an average age of 45.8 (30.0; 59.0). The second group included 27 patients with diabetes mellitus, with an average age of 61.7 years (50.0; 62.0). The third group included 25 patients with diabetic foot syndrome, whose average age was 64.72 years (61.0; 69.0). Women predominated in all groups. Original and generally accepted questionnaires were used to study the presence of common risk factors for chronic diseases among respondents. Results. The analysis of the studied materials showed a clear qualitative and quantitative pattern of accumulation of risk factors in the age exponent. Most risk factors tend to grow up to 54-65 years. Risk factors such as smoking, alcohol abuse, poor nutrition and overweight, depression and hypertension predominate (р<0,05) in older age groups of respondents. In patients with diabetes mellitus, low physical activity, poor nutrition, and obesity predominate (р<0,05). In patients with diabetic foot syndrome, the same risk factors were identified as in patients without this pathology. At the same time, in respondents with diabetic foot syndrome, physical activity was minimal, and body mass index values were much higher (р<0,05); in addition, patients with diabetic foot syndrome are more likely (р<0,05) to be depressed and perceive their health as «very poor.»

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FEATURES OF MANAGEMENT IN PATIENTS WITH OSTEOPOROSIS AND DIABETES MELLITUS

PROBLEMS OF ENDOCRINE PATHOLOGY ◽

10.21856/j-pep.2021.3.16 ◽

2021 ◽

Vol 77 (3) ◽

pp. 111-119

Author(s):

Larysa Zhuravlyova ◽

Mariia Oliinyk ◽

Yulia Sikalo

Keyword(s):

Diabetes Mellitus ◽

Diagnostic Methods ◽

Complications Of Diabetes ◽

Diagnosis Of Osteoporosis ◽

Treatment And Prevention ◽

Literary Sources ◽

Number Of Patients ◽

Patients With Diabetes ◽

Prevention Of Osteoporosis

The number of patients with diabetes mellitus in the world has been progressively increasing in recent years, therefore, the fight against complications of diabetes mellitus is an important problem of our time. The purpose of our review is to analyze the literature data on the risks of osteoporosis in patients with diabetes mellitus, effective diagnostic methods, as well as current recommendations for the treatment and prevention of osteoporosis in this category of patients. Results. We have processed and analyzed literary sources and internationalrecommendations, which identify the main mechanisms and risk factors that contribute to the development of osteoporosis in patients with type 1 and 2 diabetes mellitus; methods for the timely diagnosis of osteoporosis are indicated, methods for correcting the condition of patients with diabetes mellitus, which can help prevent the development of osteoporosis in this group of patients, are given. The current recommendations for the treatment of osteoporosis in men and women are presented. Conclusions. Taking into account the data of the analysis of literary sources, osteoporosis can be considered one of the complications of diabetes mellitus. Today, densitometry and fracture risk assessment FRAX are quite sensitive methods for early diagnosis of osteoporosis in patients with type 1 diabetes mellitus, but not sufficient for patients with type 2 diabetes mellitus, therefore there is a need to determine the trabecular bone index during densitometry, as well as additional actions when assessing the risk of fractures on the FRAX scale. Therapy of patients with osteoporosis with concomitant diabetes mellitus should be based on the achievement of target glycemic levels and the use of bisphosphonates with target level of calcium and vitamin D.

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Integrated surgical management of neuroischemic diabetic foot syndrome, abdominal aortic aneurysm and renal artery lesionsin patients with diabetes mellitus type 2

Diabetes Mellitus ◽

10.14341/2072-0351-5826 ◽

2011 ◽

Vol 14 (4) ◽

pp. 100-106

Author(s):

Sergey Anatol'evich Terekhin ◽

Victor Afanas'evich Kalashnikov ◽

Valeriy Afanas'evich Mitish ◽

Lyudmila Petrovna Doronina ◽

Alla Yur'evna Tokmakova ◽

...

Keyword(s):

Diabetes Mellitus ◽

Chronic Kidney Disease ◽

Abdominal Aortic Aneurysm ◽

Surgical Management ◽

Diabetic Foot ◽

Diabetes Mellitus Type 2 ◽

Diabetic Foot Syndrome ◽

Abdominal Aortic ◽

Patients With Diabetes

The article presents a clinical example of integrated surgical management in patient with multifocal atherosclerosis, chronic kidney disease andneuro-ischemic form of diabetic foot syndrome

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Diabetic foot syndrome

Orvosi Hetilap ◽

10.1556/oh.2011.29168 ◽

2011 ◽

Vol 152 (29) ◽

pp. 1171-1177 ◽

Cited By ~ 1

Author(s):

Gábor Szabad

Keyword(s):

Diabetes Mellitus ◽

Diabetic Foot ◽

Wound Care ◽

Diabetic Foot Syndrome ◽

Foot Ulceration ◽

Complications Of Diabetes ◽

Treatment Regimes ◽

Increased Risk ◽

Multi Level

Diabetes mellitus contributes to a number of disorders that can affect the quality of life. Amongst this diabetic foot syndrome and diabetic foot ulceration are serious secondary complications of diabetes mellitus. Persons with diabetic foot ulceration have an increased risk of amputation. In the first part of this review the author focuses on the pathophysiology of diabetic foot ulceration. The second part covers the topics of current and future therapies. The reader will understand the need and modes for preventive measures, the importance of multi level education in this topic, and the need for specialized wound care centers. As emphasized by the author, diabetic foot syndrome and ulceration are serious complications of diabetes mellitus, which can lead to devastating lower-extremity amputations and possible death. Specialized wound care centers, multi level education and proper adherence to standard treatment regimes can potentially prevent the need for amputation. Orv. Hetil., 2011, 152, 1171–1177.[Formula: see text]

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The process of repair of trophic ulcers in patients with diabetes

Problems of Endocrinology ◽

10.14341/probl11391 ◽

2004 ◽

Vol 50 (2) ◽

pp. 34-38

Author(s):

N. A. Myskina ◽

A. Yu. Tokmakova ◽

M. B. Antsiferov

Keyword(s):

Diabetes Mellitus ◽

Blood Flow ◽

Diabetic Foot ◽

Neurological Disorders ◽

Sharp Increase ◽

Lower Extremities ◽

Late Complications ◽

Diabetic Foot Syndrome ◽

Industrialized Countries ◽

Patients With Diabetes

In the last 30 years, there has been a sharp increase in the incidence of diabetes mellitus (DM), especially in industrialized countries, and its prevalence tends to further increase [3]. The main cause of disability and death of patients are late complications of this disease. Among them, it is especially important to identify developing diabetic foot syndrome (DFS), which is defined as infection, ulcer and / or destruction of deep tissues, associated with neurological disorders and decreased main blood flow in the arteries of the lower extremities of varying degrees severity (International Diabetic Foot Agreement, Netherlands, 1999)

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Severe Vitamin D3 Deficiency in the Majority of Patients with Diabetic Foot Ulcers

Hormone and Metabolic Research ◽

10.1055/a-0648-8178 ◽

2018 ◽

Vol 50 (08) ◽

pp. 615-619 ◽

Cited By ~ 9

Author(s):

Joachim Feldkamp ◽

Karsten Jungheim ◽

Matthias Schott ◽

Beatrix Jacobs ◽

Michael Roden

Keyword(s):

Diabetes Mellitus ◽

Diabetic Foot ◽

Cell Function ◽

Glycosylated Hemoglobin ◽

Diabetic Foot Syndrome ◽

Foot Ulcers ◽

Control Group ◽

Diabetic Foot Ulcers ◽

Healthy Humans ◽

Patients With Diabetes

AbstractDiabetic foot ulcers are a severe complication in patients with diabetes mellitus. Vitamin D is associated with impaired β-cell function and insulin resistance, and is necessary for wound healing and bone metabolism. We measured the serum concentrations of 25-hydroxyvitamin D3 in 104 patients (63 inpatients, 41 outpatients) with diabetic foot ulcers and compared them to 99 healthy humans (control) and 103 patients with diabetes mellitus type 2 without diabetic foot ulcers. Calcium, creatinine, and parathyroid hormone were measured in patients with diabetic foot ulcers. The data were analysed together with glycosylated hemoglobin A1c and the severity of diabetic foot lesions according to the Armstrong classification. Levels of 25-hydroxyvitamin D3 were lower (11.8±11.3 ng/ml, p<0.001) in patients with diabetic foot ulcers (mean age 70±12 years) than in the control group (27.2±12.2 ng/ml). No difference was found between in- and outpatients. Fifty-eight (55.8%) of patients with diabetic foot ulcers had a severe 25-hydroxyvitamin D3 deficiency with levels below 10 ng/ml. Only 12% of the patients had 25-hydroxyvitamin D3 levels above 20 ng/ml. Secondary hyperparathyroidism was found in 27.9% of patients and 11.5% of the patients were hypocalcemic. There was a negative correlation (r=–0.241) (p<00.1) between Armstrong classification and 25-hydroxyvitamin D3 status. In conclusion, patients with diabetic foot syndrome are at high risk of 25-hydroxyvitamin D3 deficiency. Thus, any patient with diabetic foot syndrome should undergo 25-hydroxyvitamin D3 measurement and supplementation, if values are found to be decreased.

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The clinical effectiveness of cryopreserved human amniotic membrane in diabetic foot syndrome

Cell and Organ Transplantology ◽

10.22494/cot.v9i2.129 ◽

2021 ◽

Vol 9 (2) ◽

Author(s):

A. Ustymenko ◽

◽

P. Nemtinov ◽

S. Bolgarska ◽

L. Zaika ◽

...

Keyword(s):

Diabetes Mellitus ◽

Blood Glucose ◽

Amniotic Membrane ◽

Diabetic Foot ◽

Diabetic Foot Syndrome ◽

Human Amniotic Membrane ◽

Glucose Levels ◽

Blood Glucose Levels ◽

Patients With Diabetes

Diabetic foot syndrome with long-term unhealed wounds is the most common complication and cause of limb amputation in diabetes. The search for effective therapeutic agents and their inclusion in treatment protocols is a priority due to the increase in the number of cases of this socially significant disease and disability among the working population every year. The aim of the study is to evaluate the effectiveness of cryopreserved human amniotic membrane in the treatment of long-term non-healing wounds of the lower extremities in diabetic foot syndrome. Materials and methods. The pilot clinical study described 4 clinical cases of treatment of patients with diabetes mellitus type I and II (1 woman and 3 men aged 52 to 68 years) with long-term unhealed wounds of the limbs under standard therapy. After previous wound sanation the applications of the cryopreserved human amniotic membrane were performed. Once a week after the application, the dynamics of wound healing was assessed. Blood glucose levels were determined before amniotic membrane treatment and two hours after the procedure. Results. As a results of weekly applications of human amniotic membrane there was a gradual decrease in the area of the wound from the original size and increase the rate of healing. Thus, at the time of the second visit (after 7 days) the reduction in the area of the ulcer from the initial size in patient 1 was 33 %, patient 2 – 25 %, patient 3 – 33 % on the sole and patient 4 – 3 %, and the healing rate – 4.7 %, 3.6 %, 4.7 % and 0.43 % per day, respectively. The use of human amniotic membrane did not affect blood glucose levels when comparing values before application and two hours after the procedure. Regular follow-up visits of patients 3, 6, 9 and 12 months after the start of the study showed no recurrence of ulcers. Conclusions. It has been shown that the use of cryopreserved human amniotic membrane in patients with diabetes mellitus and diabetic foot syndrome with long-term unhealed wounds results in complete healing of ulcers with stable remission during the year of observation.

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The morphological characteristic of tissue repair in patients with neuropathic and neuroischemic forms of diabetic foot syndrome

Diabetes Mellitus ◽

10.14341/dm7587 ◽

2015 ◽

Vol 18 (4) ◽

pp. 72-78 ◽

Cited By ~ 3

Author(s):

Ekaterina L. Zaitseva ◽

Ludmila P. Doronina ◽

Roman V. Molchkov ◽

Iya A. Voronkova ◽

Alla Y. Tokmakova

Keyword(s):

Diabetes Mellitus ◽

Granulation Tissue ◽

Diabetic Foot ◽

Tissue Repair ◽

Diabetic Foot Syndrome ◽

Inflammatory Infiltration ◽

Intense Staining ◽

Repair Processes ◽

Patients With Diabetes ◽

Immunohistochemical Studies

Aim. To evaluate the morphological and immunohistochemical features of granulation tissue formation in patients with diabetic foot syndrome.Materials and methods. We analysed the histological (light microscopy) and immunohistochemical (CD31, CD68, osteopontin, MMP-9 and TIMP-1) features of tissue repair processes in patients with diabetes mellitus. The study involved 63 patients with diabetic foot syndrome after surgical debridement.Results. We found severe intercellular oedema, poorly organised extracellular matrix, small amounts of fibroblast-like cells and expressed inflammatory infiltration, along with the presence of young granulation tissue. According to the results of the immunohistochemical studies, there were a moderate number of macrophages (immunopositive with antibodies to CD68), intense staining of MMP-9 and weak staining of TIMP-1 and osteopontin.Conclusion. According to the findings of the histological and immunohistochemical studies, tissue repair processes in patients with diabetes mellitus are decelerated.

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