Endocrine Abstracts

Background

The development of purulent-necrotic complications of the lower extremities is one of the most dangerous complications of diabetes. According to the Internationale Diabetes Federation, the number of hospitalized patients with foot lesions due to diabetes is 25–47%, and subsequently causing high amputations in 12% of such patients. That is why the comprehensive approach of the surgeon and endocrinologist is the key to successful treatment of such patients. The purpose of the study is to improve the quality of surgical treatment of patients with diabetic foot syndrome by improving the method of surgical treatment of the stump and fixation of the skin after phalangeal amputation.

Materials and methods

The analysis of the results of treatment of 88 patients, age from 46 to 72 years treated in the surgical department with purulent-necrotic complications lesions of toes with type II diabetes mellitus was done.

Results

The methods of surgical treatment of the foot and the fixation of the skin flap proposed by us improve the existing other methods, where the execution of amputation of the dead part of the phalanx of the finger or even the heads of the metatarsals is carried out using a cut-off metal disk rotating at a speed of 20.000 rpm (revolutions per minute), followed by gradual polishing of the cutoff point of healthy bone tissue. The fixation of the skin flap is carried out by seamless method after preliminary treatment with certain aqueous solutions of antiseptics and an even distribution of the amorphous component, which is formed as a result of mechanical treatment of the stump with a corundum grinding nozzle up to 10 mm in diameter in the form of a layer for 1–2 minutes at a speed of 10.000 rpm.

Conclusions

The proposed method of amputation of the phalanx of the finger is characterized by rapid and qualitative cut off of the dead part of the phalanx, absence of additional traumatization of the stump of the bone and surrounding tissues. This approach to treatment of purulent-necrotic wounds in patients with diabetic foot syndrome provides significant acceleration of wound healing, reduces the risk of implantation infection, eliminates additional tissue injuries during overlaying and sewing, and, accordingly, reduces the patient’s stay in hospital treatment to 5 to10 days.