Tratamentul defectelor posttraumatice la nivelul membrului pelvin la pacienții diabetici

Abstract

Introducere. Riscul de fractura a piciorului la persoanele cu diabet zaharat este legat de existenta neuropatiei diabetice periferice, ce reprezintă un factor important in dezvoltarea defectelor piciorului, infecțiilor si amputațiilor de membre inferioare Scop. Analiza defectelor posttraumatice in asociere cu polineuropatia diabetica a membrului pelvin si posibilități de acoperire a acestora. Material și metodă. Cei 15 pacienți au fost împărțiți in 4 categorii: lambouri de vecinătate, lambouri la distanta, plastie cu piele libera despicata, amputație. Parametrii urmăriți sunt: vârsta, sex, tipul diabetului zaharat, localizarea. Rezultate. 4 femei si 11 bărbați au fost repartizați in 4 categorii după tipul intervențiilor chirurgicale: plastii cu lambouri de vecinătate 4, lambouri la distanta 2, plastie cu piele libera despicata 7, amputație 2. Din lotul total de pacienți cu diabet zaharat tip II au fost 12 pacienți, iar 3 pacienți cu diabet zaharat insulin-dependent. Cei 15 pacienți, care au beneficiat de reconstrucții prin lambouri, au avut defecte la gamba distala si picior, iar pacienții care au suferit amputație per primam, au avut leziuni la nivelul gambei proximale, care au constat in necroze tegumentare si de părți moi, cu afectare osoasa si osteita, semn al gradului avansat al afectării vasculare. La pacienții care au beneficiat de plastie cu piele libera despicata, majoritatea defectelor au fost la nivelul gambei si erau prezente leziuni tegumentare. Concluzii. Defectele posttraumatice la pacienții cu polineuropatii diabetice a membrului pelvin pot fi rezolvate prin plastie cu piele libera despicata, reconstrucții prin lambouri, astfel rata amputațiilor scade.

Introduction. Leg fracture risk at people with diabetes is related to the existence of diabetic peripheral neuropathy, which is an important factor in the development of foot defects, infections and amputations of lower limb. Purpose. Analysis of the posttraumatic damage coupled with diabetic polyneuropathy of the pelvic limb and possibilities of healing the defects. Material and methods. The 15 patients were divided in 4 subgroups according to the type of surgical procedure performed: split skin grafts, the neighboring flaps, distant flaps, amputation at different levels. The descriptive parameters included: age, gender, the presence of type I or type II diabetes, the location. Results. 15 patients included in this study, out of which 4 women and 11 men were divided into four subgroups based on type of performed surgeries: the neighboring flaps - 4, distant flaps - 2, split skin grafts - 7, amputation in 2 cases. 12 patients had diabetes of type II, and the remaining 3 patients were insulin dependent. The 6 patients who had reconstruction through flaps, had distal defects (foot or ankle), whereas the patients who suffered per primam amputation had lesions at the ankle which were skin and soft tissue necrosis, with bone disease and osteitis, with signs of severe vascular disease. The majority of patients who had benefited from split skin grafts, suffered from skin lesion at the ankle level. Conclusions. Posttraumatic defects in patients with diabetic polyneuropathy of the pelvic limb can be treated through flaps or split skin grafts, so the amputation rate decreases significantly.