Classification criteria and outcomes of treatment of necrotic-inflammatory foot lesions in patients with diabetes mellitus. Do we treat syndromes or patients?
Aim. To analyze the classification criteria and outcomes of treatment of surgical complications in patients with diabetic foot syndrome.
Material and Methods. The publications for the period 1987 - 2016 were analyzed. Thirty-six primary sources, showing the evolution of the classification criteria and outcomes of treatment of patients with diabetes mellitus, complicated by necrotic-inflammatory lesions of the foot, were selected.
Results and Discussion. The occurrence of necrotic-inflammatory lesions of the foot in patients with diabetes mellitus indicates the late stage of the disease, and the threat of mutual burden phenomenon. It requires emergency hospitalization to a specialized surgical department, the doctor's multidisciplinary knowledge and capability to define and perform a consecutive diagnostic program and optimal complete treatment. To save the patient's life, there is no alternative to adequate surgical intervention, particularly large amputation of the lower limb. The indications for the large amputation of lower limb should be determined immediately, considering the condition of peripheral limb hemodynamics, nature and prevalence of pathological focus, comorbidity, and the patient's general condition. The causes of unsatisfactory outcomes of treatment of necrotic-inflammatory foot lesions in patients with diabetes mellitus may include: insufficient volume of the first surgical intervention; presence of lower limb ischemia; proteinuria; anemia; and lymphocytopenia as burdensome prognostic factors.
Conclusions. The analysis of the literature shows the evolution of the classification criteria - from surgical complications of diabetic foot syndrome to gradual involvement of the signs of hypochromic anemia, caused by diabetic nephropathy, sepsis - SIRS or repeated surgical interventions and other complications of diabetes mellitus and comorbidities. Using assessment of severity of the patient's condition in diabetes mellitus, complicated by necrotic-inflammatory lesions of the foot, by a modified APACHE II system, allows us to estimate the severity of the patient's condition, to determine prognosis and appropriate treatment strategy.
Bielov S.H., Hirka E.I. Ways of improvement surgical treatment of pyo-necrotic complications at foot diabetic syndrome. Hospital surgery. 2014; 3; 57 - 59.
Briskin B.S, Dibirov M.D., Khamitov F.F. et al. Necrotic complications of diabetic foot syndrome and their reflection in the ICD - 10 and standarts of insurance medicine. Surgery. 2007; 1; 49 - 54.
Vasylyuk S.M., Vasylyuk M.D., Shevchuk A.G. et al. Surgical tactics in patients with diabetic foot syndrome. Hospital surgery. 2008; 2; 92 - 94.
Gazetov B.M., Kalinin A.P. Surgical diseases in patients with diabetes mellitus. Medicine, 1991; 194-212.
Gerasymchuk P.O., Kisil P.V. Comprehensive analysis of differential treatment of diabetic foot syndrome. Hospital surgery. 2012; 2; 10 - 14.
Horobeyko M.B., Hyryavenko O.J. Classification of diabetic foot, approved by an international working group of diabetic foot IDF and WHO. Clinical endocrinology and endocrine surgery. 2004; 1; 6; 83 - 86.
Gupalo Yu. M. The role of revascularization in saving the foot in patients with diabetes mellitus and occlusive-stenotic lesions of arteries of shank segment. Clinical surgery. 2006; 2; 37-40.
Guryeva I.V., Kuzina I.V., Voronin A.V. et al. Diagnosis and treatment of diabetic foot lesions. Surgery. 1999; 10; 39-43.
Desyateryk V.I., Yaremenko I.O., Mikno S.P. 10-years of experience treating patients with purulent-necrotic complications of diabetic foot syndrome. Hospital surgery. 2014; 3; 45 - 47.
Kolotilo O.B. The value of the risk factors for prognosis in patients with diabetic foot syndrome. Bukovinian medical herald. 2008; 12; 1; 90-96.
Kuleshov E. V. The diabetic gangrene. Surgical diseases and diabetes mellitus. Kyiv: Health. 1990; 29-35.
Liapis M.O., Gerasymchuk P.O. The diabetic foot syndrome. Ternopil "Ukrmedknyha". 2001; 275.
Stupin V.A., Goryunov S.V., Prividentsev A.I. Metabolic therapy at patients with a syndrome of diabetic foot. Surgery. 2013; 10; 25 - 31.
Tamm T.I., Bielov S.H., Hirka E.I. et al. Peculiarities of diagnosis and treatment of patients with diabetic foot syndrome, complicated with sepsis. Clinical surgery. 2011; 11; 47 - 48.
Fedorenko V.P. The necrotic-inflammatory lesions of the foot in patients with diabetes mellitus. Terminology and classification. Clinical surgery. 2000; 8; 53-55.
Fedorenko V.P., Fedorenko A.V., Smereka A.V. et al. The surgeon's competence and responsibility in treatment of patients with diabetes mellitus complicated by necrotic-inflammatory lesions of the foot. Clinical Surgery. 2002; 7; 38 - 42.
Fedorenko V.P., Zagorodniy O.V., Mota Yu. S. Assessment of severity of the patients with diabetes mellitus, complicated with necrotic-inflammatory lesions of the foot, by the modified APACHE II system. Hospital surgery. 2014; 2; 5 - 8.
Chur N.N., Grishin I.N., Kozlovskiy A.A. et al. Etiology, pathogenesis, classification and surgical treatment of diabetic foot syndrome. Surgery. 2003; 4; 42-46.
Shapoval S.D., Ryazanov D.Yu., Savon I.L. et al. Original clinical classification of complicated diabetic foot syndrome. Clinical Surgery. 2011; 1; 44 - 48.
Shain M. Common sense in emergency abdominal surgery. Trans. from English. Ed. B.D.Savchuk, M .: GEOTAR - Med, 2003; 32-36.
Shore N.A., Zelenyi I.I. Surgical treatment of patients with purulent-necrotic complications of diabetic foot syndrome. Bulletin of urgent and regenerative medicine. 2010; 11; 4; 486 - 488.
Apelqvist J., Bergqvist D., Eneroth M. et all The diabetic foot. Optimal prevention and treatment can halve the risk of amputation. Lakartidningen. 1999; 1-2; 37-41.
Armstrong D.G. The University of Texas Diabetic Foot Classification System. Ostomy Wound Magane. 1996; 42; 60-61.
Armstrong D. G., Stacpoole-Shea S, Nguen H. et al. Lengthenind of the Achilles tendon in diabetic patients who are at high risk for ulceration of the foot. J. Bone Joint Surg. 1999; 81; 4; 535-538. https://doi.org/10.2106/00004623-199904000-00011
Barry D. C., Sabaemski K. A. Habershaw, G. M. et all Tendo achillis procedures for chronic ulceration in diabetic patients with transmetatarsal amputation. J. Amer. Podiat. Med. Assoc. 1993; 83; 96-100. https://doi.org/10.7547/87507315-83-2-96
Critical leg ischaemia: its pathophysiology and management. Eds. J.A. Dormandy, G. Stock. Berlin. Heideberg: Springer - Verlag. 1990; 172.
Edmonds M. Management of the diabetic foot . The Int. J. Vasc. Med. 1990; 1; 1; 5-13.
Knaus W.A., Draper E.A., Wagner D.P., Zimmelman J.E. APACHE II: A severity of disease classification system. Crit. Care Med. 1985;13; 818-829. https://doi.org/10.1097/00003246-198510000-00009
Lin S. S., Lee T. H., Wapner K. L Plantar forefoot ulceration with equinus deformity of the ankle in diabetic patients: the effect of tendo - Achilles lengthening and total contact casting. Orthopedics. 1996; 19; 465-475.
Lin Z., Lo Z.J., Teo R.M. et al. Diabetic foot limb salvage - an Asian experience. International symposium. CX Abstract Book. 2016; 86.
Noronen K., Saarinen E., Alback A. et al. Delay designates disaster in the treatment of diabetic foot ulcers. International symposium. CX Abstract Book. 2016; 125.
Orus M.P.V., Soria T.I., Arri E.A. e al. The wound, ischaemia and foot infection classification system reloaded in a fragile diabetic population. CX Abstract Book. 2016; 86.
PEDIS: Perfusion, Extent (size), Depth (tissue loss), Infection and Sensitisation. International Working Group on the Diabetic Foot. Brussels: International Diabetes Foundation. 2003.
Peters EJ, Lavery LA Effectiveness of the diabetic foot risk classification system of the International Working Group on the Diabetic Foot . Diabetes Care. 2001; 24; 1442-1447. https://doi.org/10.2337/diacare.24.8.1442
Troisi N., Chisci E., Ercolini L. et al. Pedal arch patency and not direct-angiosome revascularization affects outcomes in diabetic patients with foot wounds undergoing endovascular revascularization. International symposium. CX Abstract Book. 2016; 115.
Wagner F. W. The diabetic foot. Orthopedics. 1987; 10; 165-171. https://doi.org/10.3928/0147-7447-19870101-28
This work is licensed under a Creative Commons Attribution 4.0 International License.