scholarly journals The Role of Physical Therapy in the Combined Treatment of Patients with Lower Extremities Diabetic Angiopathies

2021 ◽  
Vol 20 (2) ◽  
pp. 80-87
Author(s):  
Denis V. Frolov
Keyword(s):  
Diabetes Mellitus ◽  
Physical Therapy ◽  
High Mortality ◽  
Physical Training ◽  
Diabetic Foot ◽  
Vascular Complications ◽  
Lower Extremities ◽  
Diabetic Polyneuropathy ◽  
Diabetic Foot Syndrome ◽  
Diabetic Angiopathies

One of the most disabling complications of diabetes mellitus is angiopathy of the lower extremities. Diabetic polyneuropathy and diabetic foot syndrome are closely associated with vascular complications of diabetes mellitus, which significantly aggravate the course of the disease and contribute to high mortality. Diabetic polyneuropathy and diabetic foot syndrome are closely associated with the diabetes mellitus vascular complications that significantly aggravate the course of the disease and contribute to high mortality. Despite the improvement in the results of pharmacotherapy of diabetes mellitus, the problem of treating its vascular complications is far from being solved. Traditionally, therapeutic physical training is used among the methods of non-drug treatment of diabetes mellitus and its complications. As a method of pathogenetic focus on many risk factors for the development of diabetes and its complications, physical therapy exercises contribute to the correction of the syndrome of hypodynamia, obesity, and muscle atrophy. At the same time, there is insufficient data on how exercise therapy affects the quality of life of patients, functional characteristics of walking and objective indicators of blood flow in the lower extremities. This review identifies the main approaches to the application, advantages and disadvantages of individual methods of therapeutic physical training in the correction of functional disorders in patients with lower extremities diabetic angiopathies. We can currently talk about the proven safety of the physical therapy use in patients with diabetic angiopathies. Meanwhile, the scientific data on the high efficiency of this method is still insufficient.

scholarly journals 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

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.

scholarly journals The process of repair of trophic ulcers in patients with diabetes

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)

scholarly journals HEMORHEOLOGICAL FAILURE IN THE PATHOLOGY OF CARDIO-VASCULAR COMPLICATIONS IN PATIENTS WITH DIABETIC FOOT SYNDROME

2016 ◽  
Vol 6 ◽  
pp. 57-62
Author(s):  
Еlina Кorobko
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Foot ◽  
Blood Circulation ◽  
Vascular Complications ◽  
Cardiovascular Complications ◽  
Diabetic Foot Syndrome ◽  
Steady Growth ◽  
Myocardium Infarction ◽  
The World ◽  
Cardio Vascular

The literature that includes the study of cardiovascular complications in patients with diabetic foot syndrome was analyzed. The topicality of this problem is caused by the steady growth of diabetes mellitus morbidity among people. For today there are more than 170 mln people throughout the world with diabetes mellitus, among them 65–80 % have cardiovascular complications (myocardium infarction, acute disorder of brain blood circulation and so on). It is established for today, that pathogenesis of diabetic foot syndrome is multi-factor one and the development of purulent-necrotic stages of DFS is connected with the combination of different factors, especially microcirculation disorder. In this article we’ll consider the mechanisms of diabetic angiopathy development, the state of platelet-vascular hemostasis link in this category of patients.

Technique of Atypical Amputation of the Foot in Patients with a Complicated Course of Diabetic Foot Syndrome

2015 ◽  
Vol 22 (3) ◽  
pp. 43-49 ◽  
Author(s):  
Гвазава ◽  
T. Gvazava
Keyword(s):  
Diabetes Mellitus ◽  
Blood Flow ◽  
Diabetic Foot ◽  
Blood Circulation ◽  
Lower Extremities ◽  
Duplex Ultrasound ◽  
Diabetic Foot Syndrome ◽  
Control Group ◽  
Ultrasound Study ◽  
Complicated Course

Abstract. Introduction. Diabetes mellitus is one of the most common and socially important diseases in the world. The diabetic foot syndrome is one of the most complex diseases with a view to pathogenesis and one of the most serious complications of diabetes mellitus. This syndrome is characterized by disorders and changes of all structures of lower extremities, causes the ulcerous and necrotic processes. At the current moment, a traditional method in treatment of complications of the diabetic foot syndrome is amputation of lower extremities. Due to the large number of postoperative complications, the most preferable are economic amputations at the level of foot step. In modern conditions in the first stage of complex treatment of patients with purulent-necrotic process in the lower extremities, the recovery of main arterial blood circulation of the lower extremities in the form of open or endovascular angioplasty is effective. The most effective method is revascularization performed according to angiosomes areas of blood flow in footstep. Purpose of this study is to carry out a comparative assessment of the effectiveness of typical and atypical amputations at the level of footstep in patients with the most complicated course of the diabetic foot syndrome. Material. The objects of this study were patients with diabetes mellitus (DM) type 2 with purulent-necrotic complications of diabetic foot, treated at the surgical department department of the National N.I. Pirogov Surgical and Medical Center of the Saint- Petersburg of the SPb Clinical centre for the period 2010-2013. The main group included 68 patients. These patients were performed atypical interventions according to angiosomes blood flow to the tissues of the foot. Operative interventions at the level of footstep were carried out to 47 patients of the control group. Methods. An objective study to assess the local status, laboratory tests (clinical blood test, basic coagulogram, carbohydrate metabolism indexes) and duplex ultrasound study (USDI) of vessels of lower extremities were carried out. Obligatory angiography was performed in all patients. Surgical intervention in the form of dissection, drainage of purulent focus was carried out on an emergency basis prior to angiography only in patients with acute purulent processes in the lower extremities. In all other cases, the individual peculiarities of blood circulation disorder in lower extremities determined the choice of tactics of operative treatment. In 76% and 46% accordingly for each group after angiography, a balloon angioplasty was carried out for reconstruction of the main blood flow. Results and discussion. The average duration of the in-patient treatment in study group was 14,4±2,3. In the control group - 18,2±3,1. Duration of hospitalization differed significantly (p<0.05), but significant group of patients (31 and 18, respectively) were re-hospitalized during the period from 2 to 6 weeks after discharge from the hospital for the purpose of autodermoplasty for closure of surgical wounds. There were no significant differences between the postoperative healing time of wounds and wound surfaces after reconstructive interventions. This indicates the correct choice and method of operation, as well as indications for secondary wound closure. The authors note the difference in number of re-operations for recurrent purulent-necrotic process (2 patients in the study group and 9 patients in the control group). Re-operation was considered in the case of a destructive process to heal the original wound. Relapse necrotic phenomena was the main cause of the increase in terms of the impossibility of independent movement and 6.3±1,2 and 13.1±3.4 days, respectively (p<0.05). The authors explain these results by the fact that the leading role belongs to the qualitative blood circulation of paravulnar tissues in the postoperative wound healing in patients with diabetic foot syndrome. Conclusions. 1. Preoperative angiography is prescribed to patients with purulent-necrotic complications of diabetic foot syndrome. If required, angioplasty before performing surgery on the tissues of the feet. 2. The application of the principle angiosomes blood flow on the basis of the duplex ultrasound study (USDI) of arteries and angiography allows to choose the most rational tactics of surgical treatment. 3. The use of atypical technique of amputations in the foot after preoperative examination can reduce the number of postoperative complications and the duration of inpatient treatment, to improve postoperative mobility and difficulty walking patients.

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 DIABETIC FOOT SYNDROME

2021 ◽  
pp. 139-143
Author(s):  
H.A. Bliznets ◽  
◽  
I.A. HadjiIsmail ◽  
A.C. Shuleiko ◽  
V.M. Shyshko ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Foot ◽  
Premature Mortality ◽  
Cost Effective ◽  
Diabetic Foot Syndrome ◽  
Vascular Lesions ◽  
Modern World ◽  
Common Disease ◽  
Cost Effective Treatment ◽  
Working Age

In the modern world, diabetes mellitus is a common disease with multiple consequences, the main complications are vascular lesions (macroangiopathy) and nerves, which are the cause of many complications, such as chronic renal failure and blindness and amputations in patients of working age, which leads to early disability and premature mortality. In the treatment of diabetes mellitus, most of the costs are for the treatment of complications, and the most cost-effective treatment is still treatment for ulcers of the feet. The article defines the essence and classification of diabetic foot syndrome, highlights the stages of diagnosis, as well as the main approaches to its treatment, describes the basics of prevention.

scholarly journals Orthoses in diabetic foot treatment and prevention

2013 ◽  
Vol 94 (4) ◽  
pp. 536-541
Author(s):  
I V Klyushkin ◽  
K A Koreyba
Keyword(s):  
Diabetes Mellitus ◽  
Elastic Material ◽  
Diabetic Foot ◽  
Silver Ions ◽  
Cost Effective ◽  
Diabetic Foot Syndrome ◽  
Treatment And Prevention ◽  
Positive Treatment ◽  
Orthopedic Shoes

Aim. To define the role of orthoses in the treatment and rehabilitation of patients with diabetic foot syndrome. Methods. The review of the literature addressing the use of special orthopedic shoes in the treatment and rehabilitation of patients with complicated diabetes mellitus was performed. Results. The common requirements for orthopedic shoes for patients with complicated diabetes mellitus are the following: (1) rigid sole with an artificial curvature; (2) boot-tree elevated by 8 mm due to arch supporter, adequate volume, wide sole, removable insole; (3) insole without functional memory; (4) thermally variable elastic material, advisably with silver ions, for the lining; (5) minimal number of sutures at the lining; (6) no elastic material at the front of the shoe and at the lining at the toes; (7) increased volume and enough space for the toes; (8) front slant of 15°; (9) potential ability to adjust the inner volume of the shoe; (10) hard counter - stabilizing hard back with additional softening at the lining side; (11) heel with a front slant or a solid sole without a heel; (12) smooth non-traumatic surface suitable for scrubbing including cleansing with antiseptics. The indications for orthopedic relief in patients with diabetic foot syndrome are explained. Economic superiority of organ-preserving approaches in such patients is shown. There is an opposition for conservative methods of treatment of patients with diabetic foot syndrome, nevertheless, an amputation can not be estimated as a positive treatment outcome in such patients. Almost 70-90% of ulcers in this group of patients are healed without amputation. Limb-saving treatment and the use of specially selected shoes are cheaper and more cost-effective compared to the limb loss. Conclusion. The use of orthopedic shoes in patients with diabetic foot syndrome is used both for treatment and rehabilitation. This technique can reduce the risk of ulceration and prevent organ-sparing surgeries.

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