Novosti
Khirurgii
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Научно-практическая конференция с международным участием и
XXVIII Пленум Правления Белорусской ассоциации хирургов
«Актуальные вопросы и современные подходы в оказании
хирургической помощи в Республике Беларусь»
18-19 ноября 2021 года в г. Минск.






Year 2015 Vol. 23 No 1

REVIEWS

DOI: http://dx.doi.org/10.18484/2305-0047.2015.1.97   |  

A.I. RUNDO

SOME MODERN ASPECTS OF ETIOLOGY AND PATHOGENESIS OF DIABETIC FOOT SYNDROME

EE "Vitebsk State Medical University",
The Republic of Belarus

The analysis of the literature devoted to studying of etiology and pathogenesis of diabetic foot syndrome is carried out. Relevance of this problem is caused by the steady growth of diabetes mellitus incidence (DM). Nearly 25% of patients with diabetes mellitus suffer from the diabetic foot syndrome (DFS). The dietary disturbances, innervation, neuroendocrine status, development of pyo-necrotic infection are the most favorable for disease development – trophic ulcers which are rather difficult to treat and thereby considerably reduce the quality of life.
Probability of high amputations in case of the deep pyo-necrotic tissue lesions reaches 30-70%, thus, the mortality rate fluctuates from 28 to 40%, and only 25-40% 5-year survival of patients.
Pyo-necrotic process of the the lower limbs in patients with DFS leads to early disability– the risk of the limb amputation is 20-40-fold higher than in a person without diabetes mellitus. The mortality rate due to diabetic foot gangrene is 20-30%, the incidence of latter development comprises 7-11%. Furthermore, diabetic foot results in prolonged hospitalization, rehabilitation, and increased need for home care and social services.
Preservation of a functioning extremity is becoming a relatively common and important problem among diabetic patients. In this regard, studying of etiology and pathogenesis of diabetic foot syndrome is considered to be extremely actual as well as the search of alternative option to treat this severe pathology.

Keywords: diabetes mellitus, diabetic foot syndrome, pyonecrotic process, angiopathy, neuropathy, hyperglycemia, aerobic and anaerobic microflora
p. 97-104 of the original issue
References
  1. Mezhdunarodnoe soglashenie po diabeticheskoi stope [An international agreement on the diabetic foot]. Sostavlen Mezhdunarodnoi rabochei gruppoi po diabeticheskoi stope. Moscow, RF: Bereg; 2000. 96 p.
  2. Antsiferov NB, Tokmakova AIu, Galastian GR, Udovichenko OV. Atlas dlia vrachei-endokrinologov: sindrom diabeticheskoi stopy [Atlas for endocrinologists: diabetic foot syndrome]. Moscow, RF: Papasha Grizli; 2002. 80 p.
  3. Antsiferov MB, Galstian GR, Tokmakova AIu, Dedov II. Sindrom diabeticheskoi stopy [Diabetic foot syndrome]. Sakharnyi Diabet. 2001;(2):2-8.
  4. Udovichenko OV. Lechenie iazvennykh i gnoino-destruktivnykh porazhenii pri sindrome diabeticheskoi stopy [Treatment of ulcerative and suppurative destructive lesions of diabetic foot]. Diabeticheskaia stopa / pod red NM Grekova. Moscow, RF: Prakt Meditsina, 2010;(Gl. 9):123-76.
  5. Smirnova OM, Gorelysheva VA. Pokazateli perekisnogo okisleniia lipidov i aktivnost' antioksidantnykh fermentov v limfotsitakh perifericheskoi krovi pri debiute IZSD [Lipid peroxidation and antioxidant enzyme activity in peripheral blood lymphocytes at the onset of IDDM]. Sakharn Diabet. 1999;(2):7-9.
  6. Chur NN, Grishin IN. Sindrom diabeticheskoi stopy [Diabetic foot syndrome]. Bel Akad Med Nauk. Minsk, RB: Khata; 2000. 172 p.
  7. Andersen H, Gjerstad MD, Jakobsen J.Atrophy of foot muscles: a measure of diabetic neuropathy. Diabetes Care. 2004 Oct;27(10):2382-85.
  8. Argoff CE, Cole BE, Fishbain DA, Irving GA.Diabetic peripheral neuropathic pain: clinical and quality-of-life issues. 2006 Apr;81(4 Suppl):S3-11.
  9. Bakharev IV, Red'kin IuA. Sindrom diabeticheskoi stopy: diagnostika, lechenie, profilaktika. Kachestvo zhizni [Diabetic foot syndrome: diagnosis, treatment, prevention. Quality of life]. Meditsina. 2003;(1):35-38.
  10. Aleksandrov AA. Statiny i sakharnyi diabet: stabilizatsiia raspadaiushchikhsia bliashek [Statins and diabetes: the stabilization of decaying plaques]. Consilicum Medicum. 2003;5(9):515-19.
  11. Andreeva NV. Osobennosti patogeneza mikroangiopatii u bol'nykh sakharnym diabetom 2 tipa raznogo vozrasta [Pathogenesis of microvascular complications in patients with type 2 diabetes of all ages]. RMZh. 2006;(6):470-71.
  12. Antsiferov MB, Volkovoi AK, Komeliagina EIu. Porazheniia nizhnikh konechnostei u bol'nykh sakharnym diabetom [Lesions of the lower limbs in patients with diabetes]. RMZh. 2006;14(13):972-76.
  13. Bulavkin VP, Okulich VK, Shilenok DV, Konopel'ko EA, Zykova VV. Osobennosti antibakterial'noi terapii v kompleksnom lechenii gnoino-nekroticheskikh porazhenii miagkikh tkanei i gangreny nizhnikh konechnostei u bol'nykh sakharnym diabetom [Features of antibacterial therapy in treatment of necrotic lesions of the soft tissues and gangrene of the lower limbs in patients with diabetes]. Immunopatologiia, Allergologiia, Infektologiia. 1999;(1):114-19.
  14. Mokhort TV, Romeiko D.I. Diabeticheskaia polineiropatiia [Diabetic neuropathy]: Metod rekomendatsii. NIKI RM i E. Minsk, RB: PoliBig; 2000. 40 p.
  15. Bulavkin VP, Zykova VV, Shilenok DV. Sakharnyi diabet. Sindrom diabeticheskoi stopy (diagnostika, lechenie, profilaktika) [Diabetes mellitus. Diabetic foot syndrome (diagnosis, treatment, prevention)]: Metod rekomendatsii. Vitebsk, RB: VGMU; 2000. 28 p.
  16. Eroshkin SN. Otdalennye rezul'taty lecheniia patsientov s gnoino-nekroticheskimi formami sindroma diabeticheskoi stopy v zavisimosti ot ispol'zovannykh metodov revaskuliarizatsii [Long-term results of treatment patients with pyo-necrotic forms of diabetic foot depending on the revascularization methods]. Novosti Khirurgii. 2013;21(4):62-70.
  17. Galastian GR. Osobennosti porazhenii arterii nizhnikh konechnostei u bol'nykh sakharnym diabetom [Features lesions of lower limb arteries in patients with diabetes]. Bolezni Serdtsa i Sosudov. 2006;(2):13-16.
  18. Dedov II, Udovichenko OV, Galastian GV. Diabeticheskaia stopa [Diabetic foot]. Moscow, RF: 2005. 175 p.
  19. Balabolkin MI, Klebanova EM, Kreminskaia VM. Patogenez i mekhanizmy razvitiia angiopatii pri sakharnom diabete [Pathogenesis and mechanisms of development of angiopathy in diabetes]. Kardiologiia. 2000;(10):74-87.
  20. Balabolkin MI, Kreminskaia VM. Diabeticheskaia nevropatiia [Diabetic neuropathy]. Zhurn Nevrologii i Psikhiatrii im Korsakova. 2000;100(10):54-77.
  21. Zhidkov SA, Kuz'min IuV, Gombalevskii DV. Primenenie miorelaksantov tsentral'nogo deistviia v kompleksnom lechenii i profilaktiki oslozhnenii diabeticheskoi angiopatii nizhnikh konechnostei [The use of centrally acting muscle relaxants in treatment and prevention of complications of diabetic angiopathy of lower extremities]. Bel Med Zhurn. 2004;(1):13-18.
  22. Shestakova MV, Iarek-Martynov IR, Koshel' LA. Profilaktika sosudistykh oslozhnenii sakharnogo diabeta: reshennye i nereshennye voprosy [Prevention of cardiovascular complications of diabetes: resolved and unresolved questions]. Consilicum Medicum. 2002;(10):527-30.
  23. Ismail K, Winkley K, Stahl D, Chalder T, Edmonds M. A cohort study of people with diabetes and their first foot ulcer: the role of depression on mortality. Diabetes Care. 2007 Jun;30(6):1473-79.
  24. Jeffcoate W, Keith G. Diabetic foot ulcers. The Lancet. May 2003;361(23):1545-51.
  25. Morbach S, Müller E, Reike H, Risse A, Rümenapf G, Spraul M. Diabetic foot syndrome. Exp Clin Endocrinol Diabetes. 2014 Jul;122(7):416-24.
  26. Blatun LA. Polivinilpirrolidon-iod pri sindrome diabeticheskoi stopy [Polyvinylpyrrolidone-iodine for diabetic foot syndrome]. Consilicum Medicum. Khirurgiia. 2005;(3):67-70.
  27. Tkachuk ZU, Frolov VM,, Zelyoniy II,, Afonin DN, Tyutyunnik AA. Influence of Preparation Nucleх on the Cytokine Profile of the Patients with Diabetes Type 2 and Neuropathic Form of Diabetic Foot. Abstract. 2013; 2(2):21-26.
  28. Parikh NI, Hwang SJ, Larson MG, Levy D, Fox CS. Chronic kidney disease as a predictor of cardiovascular disease (from the Framingham Heart Study). Am J Cardiol. 2008 Jul 1;102(1):47-53.
  29. Chur NN, Grishin IN, Kozlovskii AA, Kokoshko IuI. Etiologiia, patogenez, klassifikatsiia i khirurgicheskoe lechenie sindroma diabeticheskoi [Etiology, pathogenesis, classification and surgical treatment of diabetic]. Khirurgiia. Zhurn im NI Pirogova. 2003;(4):42-46.
  30. Alavi A, Botros M, Kuhnke L, Armstrong D, Papia G, at al. Diabetic foot: Disease, complication or syndrome. Diabetic Foot Canada. 2013;1(1):13-17.
  31. Allison MA, Criqui MH, Wright CM. Patterns and risk factors for systemic calcified atherosclerosis. Arterioscler Thromb Vasc Biol. Feb.2004; 24(2):331-36.
  32. Strbova L, Krahulec B, Waczulikova I, Gaspar L, Ambrozy E, Bendzala M, Dukat A.Influence of infection on clinical picture of diabetic foot syndrome. Bratisl Lek Listy. 2011;112(4):177-82.
  33. Kosinets AN, Zen'kov AA. Sindrom diabeticheskoi stopy [Diabetic foot syndrome]: Monografiia. Vitebsk, RB: VGMU; 2003. 214 p.
  34. Leonovich SI, Kondratenko GG, Bezvoditskaia AA, Taganovich DA. Sindrom diabeticheskoi stopy – aktual'nost' problemy sokhraniaetsia [Diabetic foot syndrome - urgency of the problem persists]. Bel Med Zhurn. 2003;(1):8-11.
  35. Galstian GR, Udovichenko OV, Tokmakova AIu, Antsiferov MB. Diabeticheskaia neiropatiia: epidemiologicheskie i klinicheskie aspekty [Diabetic neuropathy: epidemiological and clinical aspects]. Sakharnyi Diabet. 2000;(1):22-24.
  36. Pavlova MG, Gusov TV, Lavrishcheva NV. Sindrom diabeticheskoi stopy [Diabetic foot syndrome]. Trudnyi Patsient. 2006;(1):25-28.
  37. Udovichenko OV, Grekova NM. Diabeticheskaia stopa. Patogenez i klassifikatsiia sindroma diabeticheskoi stopy [Diabetic foot. Pathogenesis and classification of diabetic foot syndrome]. Moscow, RF: Prakt Meditsina. 2010. 271 p.
  38. Bruhn-Olszewska B, Korzon-Burakowska A, Gabig-Cimińska M, Olszewski P, Węgrzyn A, Jakóbkiewicz-Banecka J. Molecular factors involved in the development of diabetic foot syndrome. Acta Biochim Pol. 2012;59(4):507-13.
  39. Troskot N, Duvancić T, Kolić M. Diabetic foot syndrome--dermatological point of view. Acta Clin Croat. 2013 Mar;52(1):99-106.
  40. Gur'eva IV, Kotukhova IaI, Meleshkevich TA. Diabeticheskaia stopa. Vozmozhno li effektivnoe predotvrashchenie. [Diabetic foot. Is it possible to prevent effectively?]. RMZh. 2001;9(24):1122-25.
  41. Esato K, Hamano K, Li TS, Furutani A, Seyama A, Takenaka H, Zempo N.Neovascularization induced by autologous bone marrow cell implantation in peripheral arterial disease. Cell Transplant. 2002;11(8):747-52.
  42. Svetukhin AM, Zemlianoi AB, Istratov VG. Voprosy patogeneza i taktiki kompleksnogo khirurgicheskogo lecheniia gnoino-nekroticheskikh form sindroma diabeticheskoi stopy [Pathogenesis and tactics of complex surgical treatment of necrotic forms of diabetic foot]. Khirurgiia. 2003;(3):85-88.
  43. Kholodova EA, Ulashchik VS, Mokhort TV. Sindrom diabeticheskoi stopy: diagnostika, profilaktika, lechenie [Diabetic foot syndrome: diagnosis, prevention, treatment]: Minsk, RB: 2000.
  44. Romeiko DI, Shepel'kevich AP. Osteoartropatiia Sharko: kliniko-diagnosticheskie i lechebno-profilakticheskie podkhody k vedeniiu bol'nykh [Charcot osteoarthropathy: clinical, diagnostic and therapeutic and preventive approaches to the management of patients]. Bel Med Zhurn. 2003;(3):17-21.
  45. Ignatovich IN, Kondratenko GG. Khirurgiia i angiologiia diabeticheskoi stopy [Surgery and angiology of diabetic foot]: Monografiia. Minsk, RB: BGMU; 2013. 304 p.
  46. Komeliagina EIu, Mitish VA, Antsiferov MB. Antibakterial'naia terapiia pri sindrome diabeticheskoi stopy [Antibiotic therapy for diabetic foot syndrome]. Farmateka. 2006;(4):13-14.
  47. Sergeev AIu, Ivanov OL, Sergeev IuV, Larionova VN, Kamennykh PV. Sistemnaia terapiia onikhomikozov [Systemic therapy of onychomycosis]. Klin Mikrobiologiia i Antimikrob Khimioterapiia. 2001;3(Pril.1):17-18.
  48. Lipsky BA, Berendt R, Cornia B, Edgar J, David G,at al. 2012 Infectious Diseases Society of America Clinical Practice Guideline for the Diagnosis and Treatment of Diabetic Foot Infections. IDSA Guidline for Diabetic Foot Infections CID. 2012:54 (15 June):el3-73.
  49. Armstrong DG, Lipsky BA. Diabetic foot infections: stepwise medical and surgical management. Int Wound J. 2004 Jun;1(2):123-32.
  50. Shor NA. Khirurgicheskaia taktika pri diabeticheskoi angiopatii nizhnikh konechnostei s gnoino-nekroticheskimi porazheniiami [Surgical tactics in diabetic angiopathy of lower extremities with pyo-necrotic lesions]. Khirurgiia. 2001;(6):29-33.
  51. Tevs DS, Kalutskii PV, Lazarenko VA. Narushenie tsitokinovogo i gumoral'nogo zven'ev adaptivnogo immuniteta i ikh korrektsiia u bol'nykh khronicheskim osteomielitom kostei stopy [Violation of cytokine and humoral adaptive immunity and their correction in patients with chronic osteomyelitis of the foot bones]. Vestn Eksper i Klin Khirurgii. 2013;6(2):213-16.
  52. Novikova IA, Bulavkin VP. Sovremennye aspekty immunodiagnostiki i immunokorrektsii v gnoinoi khirurgii [Modern aspects of immunodiagnostic and immunomodulation in purulent surgery]. Vitebsk, RB: VGMU; 2001. 140 p.
  53. Kosinets AN, Zen'kov AA. Immunologicheskie narusheniia i ikh korrektsiia u bol'nykh s sindromom diabeticheskoi stopy [Immunological disorders and their correction in patients with diabetic foot syndrome]. Vestn VGMU; 2004;(1):16-26.
Address for correspondence:
210023, Respublika Belarus,
g. Vitebsk, pr. Frunze, d. 27,
UO "Vitebskiy gosudarstvennyiy meditsinskiy universitet",
kafedra operativnoy khirurgii i topograficheskoy anatomii,
tel. office: + 375 033 645 1201,
e-mail: qlex2007@yandex.ru,
Rundo Aleksey Ivanovich
Information about the authors:
Rundo A.I. An assistant of the operative surgery and topographic anatomy chair of EE "Vitebsk State Medical University".
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