Open AccessCOMPREHENSIVE TREATMENT OF DIABETIC FOOT SYNDROME
Author(s) -
M. G. Honchar,
О. V. Pyptiuk,
V. D. Skrypko,
I. K. Chuprii,
S. B. Telemukha,
I. Ya. Mykhaloiko,
V. O. Pyptiuk
Publication year - 2019
Publication title -
klìnìčna anatomìâ ta operativna hìrurgìâ
Language(s) - English
Resource type - Journals
eISSN - 1993-5897
pISSN - 1727-0847
DOI - 10.24061/1727-0847.18.4.2019.15
Subject(s) - medicine , soft tissue , reconstructive surgery , anastomosis , gangrene , amputation , surgery , revascularization , bone tissue , pathology , myocardial infarction
The aim was to develop a comprehensive treatment of DFS, using reconstructive surgeries and indirect revascularization methods. Our work is based on 25 year experience of treatment of 1107 patients with DFS, who were treated in Ivano-Frankivsk Central hospital. Patients were examined on admission: common clinical methods, angiography, densitometry, electronic microscopy and histochemical examination of limb tissues, TcpO2 and regional cytokine reaction. Results showed that reconstructive operations on limb arteries, in case if it was possible, were the best method of treatment. Indications for surgery were TcpO2≤25 mm.hd. Mekenberg sclerosis III was contraindication for reconstructive surgery. Tissue vitality, its future regeneration possibility depends on succinate dehydrogenase and acid phosphatase. In vital mussels of the hip, shin and foot succinate dehydrogenase range was 3-5 points, in dead tissues- 0. Acid phosphatase in vital 0-1 points, in dead tissues- 4-5. Surgical tactic algorithm was developed ccording to electronic microscopy and histochemistry. It was based on tissue vitality and gave us an answer to what part of limb must be amputated. Indication for amputation was high level of acid phosphatase, bone tissue destruction, massive purulent destructions of soft tissues, gangrene. Bone trepanation causes decreasing of internal bone tissue, decreasing of intraossal receptor irritation, increases local microcirculation. For elimination of myelodepresion and erythropoiesis stimulation we offered intraspongious automyelotransplantation which caused to extra anatomical connection’s between intraossal and muscular neoangiogenesis. Topical treatment of trophic ulcers was performed by auto desmoplastic and cultures of fibroblasts which can cover defect as by themselves and as causes to better skin autotransplant healing. We get a positive effect of prolonged intraarterial antibiotic therapy with erytrocytal containers which make antibiotic exposition in infection localization up to 36 hours.