This journal is
indexed in Scopus
Year 2016 Vol. 24 No 3
GENERAL & SPECIAL SURGERY
S.N. EROSHKIN, M.G. SACHEK, L.E. KRISHTOPOV, S.D. FEDYANIN, E.S. EROSHKINA
POSSIBILITIES OF TIBIAL REVASCULARIZATION OSTEOTREPANATION IN TREATMENT OF PATIENTS WITH PYO-NECROTIC COMPLICATIONS OF DIABETIC FOOT SYNDROME
EE "Vitebsk State Medical University",
The Republic of Belarus
Objectives. To study the efficacy of the tibial revascularization osteotrepanation (ROT) in the complex treatment of patients with pyo-necrotic complications of diabetic foot syndrome (DFS).
Methods. The studies were carried out in patients (n=109) with a dry gangrene of the fingers. The research enrolled the patients with neuroischemic form of the disease, the inability of the direct revascularization of the limb and the absence of indications to the high limb amputation in emergency situations. The first group (n=42) consisted of patients underwent to ROT repeatedly within 6-12 months after the first operation. As for the second group (n=67) of the patients ROT was performed only once. In each group two subgroups were allocated depending on the preoperative indicators of acid-base balance (pO2, lactate concentration) in the venous blood. The first one included the patients with pO2 in the range of 30-60 mmHg and lactate concentration not higher than 2 mmoles / L.
The second group enrolled the patients in whom pO2 was outside the specified range, and lactate concentration was more than 2 mmol / L. The criterion of assess the efficacy was the number of high amputations of the lower limb.
Results. During the first two follow up years there were no reliable differences in incidence of amputations between the groups. 36 months after the treatment onset the number of high amputations performed in the first subgroup of the first group was significantly lower than in the same subgroup of the second group (p=0,016). The incidence of amputations in the second sub-groups was not differed (P>0,05).
Conclusion. Revascularization osteotrepanation of the tibia, carried out repeatedly within 6-12 months after the first operation, provides a more durable revascularization effect and improves the results of treatment in patients with pyo-necrotic complications of diabetic foot syndrome, in whom pO2 of the venous blood is in the range of 30-60 mm Hg and lactate concentration is not more than 2 mmol/L.
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210023, Republic of Belarus,
Vitebsk, pr. Frunze, d. 27, UO "Vitebskiy gosudarstvennyiy
kafedra gospitalnoy khirurgii s
kursami urologii i detskoy khirurgii, tel.office: 375 212 342-1-08,
Eroshkin Sergey Nikolaevich
Eroshkin S.N. PhD, an assistant of the hospital surgery chair with the courses of urology and pediatric surgery of EE "Vitebsk State Medical University".
Sachek M.G. MD, professor, a head of the hospital surgery chair with the courses of urology and pediatric surgery of EE "Vitebsk State Medical University".
Krishtopov L.E. PhD, an associate professor of the hospital surgery chair with the courses of urology and pediatric surgery of EE "Vitebsk State Medical University".
Fedyanin S.D. PhD, an associate professor of the hospital surgery chair with the courses of urology and pediatric surgery of EE "Vitebsk State Medical University".
Eroshkina E.S. A 6-year student of the medical faculty of EE "Vitebsk State Medical University".