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Khirurgii

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Year 2013 Vol. 21 No 3

GENERAL AND SPECIAL SURGERY

S.N. EROSHKIN1, A.P. KUTKO2, V.P. BULAVKIN1

EFFICACY OF LOWER LIMBS REVASCULARIZATION METHODS IN PATIENTS WITH PURULENT-NECROTIC FORMS OF DIABETIC FOOT SYNDROME

EE “Vitebsk State Medical University” 1,
ME “Vitebsk Regional Clinical Hospital” 2,
The Republic of Belarus

Objectives. To compare the short-term results of treatment of patients with purulent-necrotic forms of diabetic foot syndrome (DFS) by using various methods of the peripheral blood flow improvement in the limbs (medical, direct and indirect revascularization).
Methods. Analysis of data on the treatment of 100 patients with purulent-necrotic forms of diabetic foot syndrome (DFS) is presented; the following various types of revascularization were applied: medical one (n=47); percutaneous balloon angioplasty (n=35); a revascularizating osteotrepanation of the tibia using the method of F.N. Zusmanovich (n=18). Critical ischemia of the lower limb was confirmed by ultrasound duplex results of angioscaning and angiography. To assess impact of various revascularization methods on the lower limb blood supply the partial pressure of oxygen, carbon dioxide and lactate content in the venous blood of the affected limb was determined; dermal thermometry was conducted. The main clinical criteria of efficacy were considered to be the trophic ulcers closure, the number of the resection interventions on the foot and the number of amputations performed above the talocrural joint gap.
Results. Statistically reliable enhancement of the Doppler ultrasound parameters in relation to the preoperative level was obtained only after the percutaneous balloon angioplasty (three investigated groups). Reduction of lactate, increase of the oxygen partial pressure in the venous blood of the limb as well as increase of dermal temperature in the limb after revascularization was registered both after the percutaneous balloon angioplasty and after the revascularizating osteotrepanation. No reliable changes of the given parameters were obtained after the conservative treatment. The percentage of amputations performed in the recent period above the talocrural joint gap after medical revascularization made up 19,1%, after the percutaneous balloon angioplasty – 2,8% and after the revascularizating osteotrepanation – 11,1%.
Conclusions. Efficacy of the conservative treatment aimed to enhancement of the blood flow in the lower limb at DFS remains low. The percutaneous balloon angioplasty is considered to be the optimal method of the limb revascularization at the purulent-necrotic forms of DFS. In cases of impossibility to perform the percutaneous balloon angioplasty due to peculiarities of the vascular bed lesions, the revascularizating osteotrepanation is justified with the aim of limb revascularization.

Keywords: diabetic foot syndrome, lower limb revascularization, oxygen partial pressure, blood lactate, resection of the foot
p. 61 – 68 of the original issue
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Address for correspondence:
210023, Respublika Belarus', g. Vitebsk, pr-t Frunze, d. 27, UO "Vitebskii gosudarstvennyi ordena Druzhby narodom meditsinskii universitet", kafedra gospital'noi khirurgii s kursami urologii i detskoi khirurgii,
e-mail: eroshki@rambler.ru,
Eroshkin Sergei Nikolaevich
Information about the authors:
Eroshkin SN. Assistant of the hospital surgery chair with the courses of urology and pediatric surgery of EE “Vitebsk State Medical University”.
Kutko AP. A head of the angiography study of ME “Vitebsk regional clinical hospital”.
Bulavkin VP. PhD, associate professor of surgery chair of the faculty of training and retraining of the staff of EE “Vitebsk State Medical University”.
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