Possibilities of combined surgical treatment of pyonecrotic lesions in the neuroischemic form of diabetic foot syndrome

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.