Year 2013 Vol. 21 No 6

GENERAL AND SPECIAL SURGERY

A.A. DMITRIENKO 1, V.V. ANICHKIN 2, M.F. KUREK 2, V.A. BUGAKOV 1, V.V. KONOVKOV 1, A.O. KUSHNER 1

DIFFERENTIATED SURGICAL TACTICS AT PURULENT COMPLICATIONS OF DIABETIC CHARCOT OSTEOARTHROPATHY

SME Gomel City Clinical Hospital 3 1,
EE Gomel State Medical University 2,
The Republic of Belarus

Objectives. To work out the tactical approaches to the differentiated diagnostics and treatment of purulent complications of diabetic Charcot osteoarthropathy.
Methods. During the period of 2011-2013 yrs. 16 patients with Charcot foot were being treated at the center Diabetic foot, Gomel. Osteoarthropathy course was complicated by a purulent process in 9 (56%) patients when it was impossible to exclude the development of the secondary osteomyelitis according the clinical and X-ray data. Complex assessment including foot X-ray, microbiological study of the wound secretions, computer tomography (CT), magnetic-resonance imaging (MRT), histological and bacteriological study of the bone tissue samples has been conducted.
Results. Patients with purulent complications of diabetic Charcot osteoarthropathy were subdivided into 3 groups. 3 out of 9 patients in whom the bone destruction in the purulent inflammation region was determined by X-ray made up the 1st group, though there were no signs of osteomyelitis according to the histological and microbiological investigation data. In the 2nd group 3 patients were included, microbiological study of the bone tissue samples was positive in all cases, although histological study didnt reveal osteomyelitis signs. Treatment in both groups was limited by dissection and drainage of the soft tissue abscesses. The outcome was recovery. 3 patients were in the 3rd group in whom the secondary osteomyelitis was verified by all previously mentioned study methods. Osteosequestrectomy was performed in 2 of them, one was subjected to amputation on the shin level due to the presence of the expanded purulent-necrotic limb lesion.
Conclusions. Solving the problem of purulent complications of the diabetic osteoarthropathy, including diagnostics and treatment of the secondary osteomyelitis demands on the complex of investigations. Correlation of clinical, instrumental methods with the results of microbiological and histological study permits to choose the correct treatment strategy and strictly substantiated and maximally sparing operative interventions allow achieving the best results.

Keywords: diabetic osteoarthropathy, purulent-necrotic complications, osteomyelitis, surgical treatment
p. 47 56 of the original issue
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Address for correspondence:
246000, Respublika Belarus', g. Gomel', ul. Il'icha, d. 286, GUZ Gomel'skaia gorodskaia klinicheskaia bol'nitsa 3, khirurgicheskoe otdelenie 3,
e-mail: dmitrienko-83@mail.ru,
Dmitrienko Anatolii Anatol'evich
Information about the authors:
Dmitrienko A.A. A surgeon of the surgical department 3 of SME Gomel City Clinical Hospital 3.
Anichkin V.V. MD, professor of the chair 3 of surgical diseases of EE Gomel State Medical University.
Kurek M.F. PhD, an assistant of the chair 3 of surgical diseases of EE Gomel State Medical University.
Bugakov V.A. A chief physician of SME Gomel City Clinical Hospital 3.
Konovkov V.V. A head of the surgical department 3 of SME Gomel City Clinical Hospital 3.
Kushner A.O. A surgeon of the surgical departmen 3 of SME Gomel City Clinical Hospital 3.
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