COMPARATIVE ANALYSIS OF THE RESULTS OF COMPLEX OPERATIVE-MEDICAL TREATMENT OF PATIENTS WITH COMPLICATED FORMS OF THE DIABETIC FOOT SYNDROME
1Department of General Surgery № 2, Avicenna Tajik State Medical University, Dushanbe, Tajikistan
Objective: Conduct a comparative evaluation of the effectiveness of the surgical and medicamentous treatment of the complicated forms of the diabetic foot syndrome (DFS).
Methods: The results of complex diagnostics and treatment of 310 patients with the complicated form of DFS for the period 2013-2016, hospitalized in the Surgical Department of the State Clinical Hospital № 3 in Dushanbe, were analyzed. The men were 132 (42.5%), women – 178 (57.5%). The age of the patients variated from 38 to 84 years. Duration of treatment from the moment of its fluctuation from 2 to 21 years. The absolute majority of patients who suffered from serious forms of diabetes mellitus (DM): DM type I – 8.2%, DM type II – 91.8%.
Results: With the purpose to distalize the level of amputation to support function of the foot, against the background of appropriate conservative therapy, a two-stage operational tactic was used. At the first stage, opening rots and small surgical interventions on the foot were carried out, on the second stage the plastical substitution of shortcoming tissue of foot and forming of the stump on the level of under the one-third of the shin. A reduction of the lethality has come after amputation to 1.9%, in total lethality to 7.1%. Metatarsal resections and exarticulation of toes of foot in 92.5% of cases where the reason for the repeated hospitalization of patients with an ipsilateral limb in consequence of amiss orthopedical correction of the impaired supporting function.
Conclusions: The main point of the treatment for patients with complicated forms of DFS is the timeliness and correctness of the choice of methods of surgical and medicamentous treatment. At the same time, it is necessary to adhere to the organo-saving and functionallyeffortless tactics of the operative interventions.
Keywords: Diabetes mellitus, diabetic foot syndrome, suppurative complications, Vazaprostan.
- Maslova OV, Suntsov YuI. Epidemiologiya sakharnogo diabeta i mikrososudistykh oslozhneniy [Epidemiology of diabetes mellitus and microvascular complications]. Sakharnyy diabet. 2011;3:6-11.
- Suntsov YuI, Bolotskaya LL, Maslova OV, Kаzаkоv IV. Epidemiologiya sakharnogo diabeta i prognoz ego rasprostranyonnosti v Rossiyskoy Federatsii [Epidemiology of diabetes mellitus and prognosis of its prevalence in the Russian Federation]. Sakharnyy diabet. 2011;1:15-8.
- Zelenina TA, Zemlyanoy AB, Glazanova TV. Primenenie preparata polioksidoniy v compleksnom lechenii sindroma diabeticheskoy stopy [The use of polyoxidonium in the complex treatment of diabetic foot syndrome]. Khirurgiya. 2014;10:113-7.
- Yusupova ShYu, Nabiev MKh, Zokirov RA. Rasprostranyonnost’ oslozhnyonnykh form sindroma diabeticheskoy stopy v Respublike Tadzhikistan [The prevalence of complicated forms of the diabetic foot syndrome in the Republic of Tajikistan]. Vestnik Avitsenny [Avicenna Bulletin]. 2015;4:13-8.
- Petrova VV, Spesivtsev YuА, Larionovа VI. Patogeneticheskie i klinicheskie osobennosti techeniya gnoyno-nekroticheskikh oslozhneniy sindroma diabeticheskoy stopy [Pathogenetic and clinical features of the course of purulent-necrotic complications of the diabetic foot syndrome]. Vestnik Khirurgii. 2010;2:121-4.
- Dinh TL, Veves A. Treatment of diabetic ulcers. Dermatol Ther. 2006;6: 348- 55.
- Kruse L, Edelman S. Evaluation and treatment of diabetic foot ulcers. Clinical Diabetes. 2006;24(2):91-3.
- Gaibov AD, Mukhammadieva KhS, Kalmykov EL, Baratov AK, Sadriev ON. Vozmozhnosti luchevoy diagnostiki okklyuzionno-stenoticheskikh porazheniy arteriy nizhnikh konechnostey [Capabilities of radiologic diagnostics of occlusive-stenotic lesions of the lower limb arteries]. Vestnik Akademii meditsinskikh nauk Tadzhikistana. 2016;3:3-11.
- Оsintsev EYu, Slobodskoy AB, Меlsitov VА. Оptimizatsiya aspiratsionnopromyvnogo drenirovaniya gnoynykh ran [Optimization of aspiration-flushing drainage of purulent wounds]. Vestnik Khirurgii. 2012;5:61-4.
- Duboshina TB, Yaylakhnyan КS. Оptimizatsia lecheniya bol’nykh s oslozhnyonnymi formami sindroma diabeticheskoy stopy [Optimization of surgical treatment of patients with complicated forms of diabetic foot]. Vestnik Khirurgii. 2008;2:98-100.
- Clayton W, Elasy T. A review of pathophysiology, classification and treatment of foot ulcers in diabetic patients. Clinical Diabetes. 2009;27(2):52-8.
- Vinnik YuS, Sаlmina АB, Теplyakova ОV. Dinamika lokal’noy ekspressii konneksina-43 i retseptorov osnovnogo faktora rosta fibroblastov u bol‘nykh s gnoyno-vospalitel’nymi zabolevaniyami kozhi i myagkikh tkaney na fone sakharnogo diabeta [Dynamics of local expression of connexin-43 and receptors of the main fibroblast growth factor in patients with pyoinflammatory diseases of the skin and soft tissues on the background of diabetes mellitus]. Vestnik Khirurgii. 2014; 4:47-52.
- Аbdulloev DА, Yusupova ShYu, Begakov UM, Nabiev MKh, Saidov КМ. Differentsirovannoe lechenie sindroma diabeticheskoy stopy, oslozhnyonnogo gnoyno-nekroticheskimi protsessami [Differential treatment of diabetic foot syndrome, complicated by purulent necrotic processes Vestnik Avitsenny [Avicenna Bulletin]. 2014;2:69-73.
- Abrahamian FM, TalanDA, Moran GJ. Management of skin and soft-tissue infections in the emergency department. Infect Dis Clin N Am. 2008;22 (1):89-116.
- Sreeramoju P, Porbandarwalla NS, Arango J. Recurrent skin and soft tissue infections due to methicillin-resistant Staphylococcus requiring operative debridement. Am J Surg. 2011;201(2):216-20.
- Voynov АV, Bedrov АYa, Voinov VА. Sindrom diabeticheskoy stopy [Syndrome of the «diabetic foot]. Vestnik Khirurgii. 2012;3:106-9.
- Cardoso CR, Salles GF. Macro and microvascular complications are determinants of increased infections-related mortality in Brazilian type2 diabetes mellitus patients. Diabetes Res Colin Pract. 2007;75(1):51-8.
Yusupova Shoira, Doctor of Medical Sciences, Full Professor, Professor of the Department of General Surgery № 2, Avicenna TSMU
Nabiev Muzaffar Kholnazarovich, Candidate of Medical Sciences, Head of the Department of General Surgery № 2, Avicenna TSMU
Sayhunov Kutbiddin Jamolovich, Applicant of the Department of General Surgery № 2, Avicenna TSMU
Address for correspondence:
Nabiev Muzaffar Kholnazarovich
Candidate of Medical Sciences, Head of the Department of General Surgery № 2, Avicenna TSMU
734003, Republic of Tajikistan, Dushanbe, Rudaki Ave., 139
Tel.: (+992) 987 256060
Materials on the topic:
- POSSIBILITIES OF SURGICAL TREATMENT OF PATIENTS WITH ACUTE PANCREATITIS OF THE HEAVY DEGREE IN CONDITIONS OF SPECIALIZED DEPARTMENT OF REGIONAL CLINICAL HOSPITAL
- SURGICAL APPROACH IN ACUTE CHOLECYSTITIS COMPLICATED BY BOTH CHOLEDOCHOLITHIASIS AND OBSTRUCTIVE JAUNDICE
- SOME ASPECTS OF PATHOGENESIS OF THE VENTRAL HERNIAS
- CLINICAL AND MORPHOLOGICAL CHARACTERISTICS OF MULTINODULAR EUTHYROID GOITER