Surgery management in diabetic foot

Abstract

Introduction: The present problem of the diabetic foot is valid everywhere by Sent Vincent declaration, received in 1989. Here especially we can find the problem of increasing incidence of diabetes and the importance of through studies of diabetic foot. But the problem of surgical diabetic foot remains still open. This complication is ended with mutilating amputations in 80-83% cases. The goal of this study was to determine the surgical tactics in patients with diabetic foot, as well as the level of amputation. Materials and Methods: 98 diabetic patients were studied for the main complaint of diabetic foot, being admitted to the septic surgery of the municipal hospital No. 1 in 2011. Patients ranged from age 42 to 78. Ration men-women, was practically equal 1:1. Type 1 diabetes was recorded in 91% patients. Record character of plantar conditions were as follows: the plantar gangrene or two and more fingers - in 44 cases (44.8%), dry gangrene of one or more fingers-20 (20.1%), phlegmon - in 25 cases (25.5%), and trophic ulcers of the plant and calacaneus-9 (7.5%). Results: Patients in the study group were treated by means of different methods: in 16 cases we used the open method of treatment of the infected wound, dressings daily, necrectomies and medication in order to improve the blood circulation. 82(83.7%) patients were operated in the study group. The following surgery was performed: (I) Processing of surgical phlegmon with repeated necrectomies -25 (30.4%) of 82 operations; (II) Wide amputation at the thigh and ankle - 14 (17.0%); (III) Lower amputations (exarticulations of fingers, partial amputation of the foot sole - 30 (36.8%); (IV) Reconstructive operations on vessels (deep plastic surgery, by pass ileo-femoral) - 7 (0.8%); (V) Transplantation of skin was performed in order to cover defects-6 (0.7%). 4(0.4%)died patients in the study group,two of them with poliorganic background failure were not operated. 72 (73.6%) patients were discharged in a satisfactory condition and 22 (26.0%) continued their treatment in out- patient department Unoperated patients were discharged after 12-18 days in a satisfactory condition, when wounds were healed or were in the process of grain, to extend the outpatient treatment. Conclusions: Patients with serious complications of diabetes, diabetic plantar is hospitalized in specialized sections later, when they have gangrene or necrosis and flegmons. For reasons of, reconstructive operations are quite low (0.8%). In the study group prevailed mostly, wide and low amputations (53.8%). Diabetic phlegmon, requiring debridement and daily necrectomies with a recovery rate of 15 - to 32 days.