Management of lower limb fractures in patients with diabetes

Abstract

Purpose: Analysis of the posttraumatic damage coupled with diabetic polyneuropathy of the pelvic limb and possibilities of healing the defects. Material and methods: A retrospective study was carried out over a period of two years (2014-2016) and included 15 patients with diabetic polyneuropathy. The patients were treated at the Clinic of Plastic Surgery and Reconstructive Microsurgery. The selection criteria included: - Diagnosis of diabetes with skin and soft tissue ulceration. - Non-healing traumatic or surgical wounds, with no tendency of healing in diabetic patients. 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. Additionally, the post-surgery complications were monitored. 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.