Novosti
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Year 2012 Vol. 20 No 6
EXCHANGE OF EXPERIENCE
J.G. SHAPKIN, E.V. EFIMOV, A.V. KHOROSHKEVICH, A.J. KHROMYKH
SURGICAL TREATMENT OF DIABETIC FOOT SYNDROME COMPLICATED BY PURULENT-NECROTIC PROCESSES
State Budgetary Educational Establishment of Higher Professional Education “Saratov State Medical University named after V.I..Razumovsky”,
The Russian Federation
Objectives. To summarize the experience of treating patients with diabetic foot syndrome complicated by purulent necrotic process.
Methods. This report is based on the results of examination and treatment of 160 patients with diabetic foot at the age from 45 to 80, who had developed the phenomena of purulent-necrotic process in the shin and foot. General clinical examination methods, assessment of blood coagulation, the qualitative determination of microflora (aerobic and anaerobic) by conventional methods were included in the examination complex. The patients were subjected to complex conservative and operative treatment. The analysis of the nearest treatment results was performed.
Results. 5 patients underwent finger removal with the resection of metatarsal bone heads, with a mandatory closure of wounds with soft tissue over the bone stump with the running drainage. Because of inability to save limbs in 77 patients, high amputations were done. In 27 patients, the resection of the foot according to Sharp was carried out, in 50 – at the hip level. Complications in the form of wound suppuration occurred after foot resections in 3 patients and after hip resections – in 6. Mortality rate in the operated patients with diabetic foot syndrome made up 7,8% (6 people), the overall mortality rate – 3,75%.
Conclusions. The basis of successful treatment of diabetic foot syndrome complicated by purulent-necrotic process is the correction of carbohydrate metabolism and accompanying pathology as well as additional intensive medical therapy supplemented with antibiotics of the bactericidal action. The terms of operative interventions in patients with diabetic foot depend on the severity and character of purulent-necrotic process, the degree of endotoxemia syndrome that in the number of cases demands preoperative correcting therapy.
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410012, Rossiyskaya Federatsiya, g. Saratov, ul. Bolshaya kazachya, d. 112, GBOU VPO «Saratovskiy gosudarstvennyiy meditsinskiy universitet», kafedra obschey khirurgii,
e-mail: khoroshkevich.av@yandex.ru,
Khoroshkevich Anna Vasilevn
Shapkin J.G. Doctor of medical sciences, professor, head of the general surgery chair of SBEE HPE “Saratov State Medical University named after V.I.Razumovsky”
Efimov E.V. Candidate of medical sciences, assistant of the general surgery chair of SBEE HPE “Saratov State Medical University named after V.I.Razumovsky”
Khoroshkevich A.V. Candidate of medical sciences, assistant of the general surgery chair of SBEE HPE “Saratov State Medical University named after V.I.Razumovsky”
Khromykh A.J. A 3-year student of the medical faculty of SBEE HPE “Saratov State Medical University named after V.I.Razumovsky”.
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