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Year 2013 Vol. 21 No 3
GENERAL AND SPECIAL SURGERY
S.D. SHAPOVAL, I.L. SAVON, D.A. SMIRNOVA, M.M. SOFILKANYCH
CHARACTERISTIC OF MICROCIRCULATION OF THE LOWER EXTREMITIES IN PATIENTS WITH COMPLICATED DIABETIC FOOT
SE “Zaporozhye Medical Academy of Post-graduate Education”,
Objectives. Using laser Doppler flowmetry technique to study the blood flow in the lower extremities in patients with the complicated diabetic foot syndrome (DFS) and to reveal the specific microcirculatory disturbances for each clinical form.
Methods. 246 patients with the complicated DFS were investigated. Patients’ age was 59,4±3,3 years. There were 155 males (63%) and 91 females (37%). All the patients had diabetes mellitus (DM) of the 2nd type, the average duration of disease made up 12,3±1,5 years. In accordance with the classification of the International Working Group on the problems of diabetic foot (Netherlands, 1991), the patients were divided according to clinical forms. The study of microcirculation was carried out using laser Doppler flowmetry.
Results. At the neuropathic form of complicated DFS peripheral autosympathectomy results in loss of neurogenic control. Despite of increasing of arterial blood inflow due to the lack of sympathetic regulation of microcirculation an accelerated discharge of the blood through arteriovenous shunts occurs. At the ischemic form the microcirculation parameters indicate the blood stagnation in the arterioles and venular link. Increasing of the variable component of the microcirculation is due to both more intense functioning of mechanisms of the active control of microcirculation and as a result of increasing of cardiac and respiratory rhythms. At the mixed form more intense functioning of mechanisms of the active control of the microcirculation was revealed. Increasing of the neurogenic oscillations amplitude leads to the increase in the arteriolar tonus and myogenic vibrations that contributes to reduction of the peripheral resistance in the capillary network.
Conclusions. At the neuropathic form of the complicated DFS the loss of neurogenic control results in precapillary vasoconstriction, increase of intracapillary pressure and amplification of the blood flow through the arteriolovenular shunts. At the ischemic form the presence of irregularities associated with a decrease of arterial blood flow volume and sympathetic regulation. At the mixed form the disturbances in the regulation on account of reducing of endothelial secretion, activation of neurogenic and myogenic control mechanisms are registered.
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69096, Ukraina, g. Zaporozh'e, bul. Vintera, d. 20, GU "Zaporozhskaia meditsinskaia akademiia poslediplomnogo obrazovaniia", kafedra ambulatornoi, gnoino-septicheskoi khirurgii i ul'trazvukovoi diagnostiki,
Shapoval Sergei Dmitrievich
Shapoval S.D. MD, professor, the first vice-rector, a head of ambulatory, pyoseptic surgery and ultrasound diagnostics chair of SE “Zaporozhye Medical Academy of Post-graduate Education”.
Savon I.L. PhD, an applicant for Doctor’s degree of ambulatory, pyoseptic surgery and ultrasound diagnostics chair of SE “Zaporozhye Medical Academy of Post-graduate Education”.
Smirnova D.A. A clinical intern of ambulatory, pyoseptic surgery and ultrasound diagnostics chair of SE “Zaporozhye Medical Academy of Post-graduate Education”.
Sofilkanych M.M. An extramural post-graduate student of ambulatory, pyoseptic surgery and ultrasound diagnostics chair of SE “Zaporozhye Medical Academy of Post-graduate Education”.