International Medical Journal, Vol. 21., Iss. 3, 2015, P. 13−15.
SURGICAL TACTICS AND METHODS OF SURGICAL MANAGEMENT OF COMPLICATED DIABETIC FOOT
V. N. Karasin Kharkiv National University, Ukraine
A steady increase in the incidence of diabetes mellitus (DM) has been observed recently. According to the WHO, in 2025 the number of patients will reach 334 million that is 6.3 % of the world population. According to the Ministry of Health, 1.2 million DM patients were registered in Ukraine at the beginning of 2011. At present the questions of timing radical surgery on the foot, the boundaries of amputations and methods for their completion has not been solved. The aim of the work was improving the results of surgical treatment of patients with diabetic foot syndrome by improving the techniques of surgery as well as decrease in the proportion of high amputations and prevention of post−operative complications. The study involved 260 patients with DFS and necrotic processes of the lower extremities. neuropathic form was verified in 161 (62 %) patients, ischemic in 59 (22.7 %), and mixed in 40 (15.3 %). Type II diabetes prevailed (223 patients (86 %), type I diabetes was present in 37 (14 %). Purulent involvement of the soft tissue was diagnosed in 116 patients (44.6 %). 34 patients had local purulent−destructive process. 82 patients (70.6 %) had foot phlegmon. With combination of passive and active drainage infectious complications of surgical wounds were not observed. Four patients with osteomyelitic destructions of the distal foot parts (11.1 %) developed partial eruption of sutures. Mortality rate in patients with bone destruction feet made 6.25 % (9 patients). All lower limb amputations were performed at the level of the tibia 33 (12.7 % of the total number of operated patients). Overall mortality was 8 % (21 patients). In order to improve the effectiveness of surgical treatment of complicated DFS, surgery should be performed as an urgent procedure, under general anesthesia, with obligatory prior complex of diagnostic procedures, an individual approach is required in each case. The use of adequate surgical treatment of soft tissue, bone structures, removable skin−fascia−muscle sutures, combination of active and passive wound drainage, the use of liquid and ointment antiseptics reduces the number of postoperative infectious complications to 11.8 and mortality to 8 %.
Key words: diabetic foot syndrome, complicated forms, surgical treatment.