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Year 2013 Vol. 21 No 4
GENERAL AND SPECIAL SURGERY
THE LONG-TERM TREATMENT RESULTS OF PYONECROTIC FORMS OF DIABETIC FOOT SYNDROME DEPENDING ON THE USED METHODS OF REVASCULARIZATION
EE “Vitebsk State Medical University”
The Republic of Belarus
Objectives. To compare the long-term treatment results of patients with pyonecrotic forms of diabetic foot syndrome (DFS) at applying of various methods of improving the peripheral blood flow in the lower extremities (medical, direct and indirect revascularization).
Methods. The results of treatment of 100 patients with pyonecrotic forms of DFS have been analyzed; various methods of revascularization have been applied: medical one (n=47); percutaneous balloon angioplasty (PBA) (n=35); revascularizing osteotrepanation (ROT) of the tibia in the manner of F.N. Zusmanovich (n=18). Critical ischemia of the lower limb was confirmed by the results of duplex ultrasound angioscanning and angiography. The main clinical efficacy criterion was considered to be the number of the lower limb amputations performed above the knee joint.
Results. 12 months after the beginning of observation the application of χ2 criterion showed a significant increase of the frequency of high amputations of the lower limb in the group of patients treated with a conservative method in comparison with patients undergoing angioplasty (p=0,011) while in relation to the group of patients undergoing ROT the increase of the frequency of amputations turned out to be unreliable (p=0,067). During the inspection 24 months after the start of observation there was a reliable increase of the frequency of high limb amputation in patients receiving only conservative treatment with the respect as to the second group (p=0,023) and the third one (p=0,043).
Conclusions. Conservative treatment efficacy aimed to improve the lower limb blood flow at DFS remains rather low in the long-term period. The optimal method of limb revascularization at the pyonecrotic forms of DFS is percutaneous balloon angioplasty (PBA). However, 2 years after the beginning of observation the number of high amputations in the endovascular angioplasty and revascularizing osteotrepanation (ROT) become comparable. The frequency of amputations in the long-term period after ROT was significantly lower than after the conservative treatment. In cases of impossibility of percutaneous balloon angioplasty performance the revascularizing osteotrepanation is justified for the limb revascularization.
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210023, Respublika Belarus', g. Vitebsk, pr-t. Frunze, d. 27, UO «Vitebskii gosudarstvennyi meditsinskii universitet», kafedra gospital'noi khirurgii s kursami urologii i detskoi khirurgii,
Eroshkin Sergei Nikolaevich
Eroshkin S.N. An assistant of the hospital surgery chair with the course of urology and pediatric surgery of EE “Vitebsk State Medical University”.