Novosti
Khirurgii

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Year 2017 Vol. 25 No 2

GENERAL & SPECIAL SURGERY

S.G. BELOV 1, O.V. DANILOVA 2, I.A. TARABAN 3, D.I. GALATA 3, N.I. GORGOL 3, S.N. POTAPOV 3

MORPHOFUNCTIONAL FEATURES OF SOFT TISSUES IN NEUROISCHEMIC FORM OF DIABETIC FOOT SYNDROME

Kharkov Medical Academy of Post-Graduate Education1,
Kharkov Municipal Center "Diabetic Foot" 2,
Kharkov National Medical University 3,
Kharkov
Ukraine

Objectives. To determine the morphological features of the foot skin wounds in patients with neuroischemic form of diabetic foot syndrome (DFS) to optimize the surgical tactics and surgical treatment methods.
Methods. Morphological study of the foot soft tissues in patients (n=12) with purulent-necrotic complications of the neuroischemic form of DFS was performed using histological, histochemical and morphometric methods. The patients were divided into 2 clinical groups. The first group consisted of patients (n=6) with prevalence of the ischemic changes according to clinical, anamnestic and instrumental methods of investigation. The second group included patients (n=6) with prevalence of neuropathic changes in tissues.
Results. Heterogeneity of clinical, instrumental and morphological data was revealed in patients with purulent-necrotic complications of the neuroischemic form of DFS. In the observations of the first group the trophic disorders of the foot were clinically represented by dry gangrene. Severe circulatory disorders, thickening of the arterioles and capillaries with narrowing of lumen were morphologically markerd. Changes in peripheral nerves were characterized by a mild demyelination or absence of signs of myelin destruction. In the second group the trophic disorders of the foot were clinically represented by infected wounds, osteomyelitis and the soft tissue phlegmon. An extensive necrosis with overlay of fibrin and purulent exudate was histologically established. Also the reduction of the number of vessels, thickening of walls and narrowing of lumen were revealed. Changes in the peripheral nerves were characterized by the destruction of myelin even up to the total demyelination and complete degeneration of axons, and in some fields the studies have shown a complete loss of nerve fibers.
Conclusion. While the similarity of vascular disorders (macro- and microangiopathy) in both clinical groups, the performed research has convincingly showed morphological differences in the prevalence of neuropathic or ischemic component of the neuroischemic form of DFS. The revealed clinical-morphological features of neuroischemic form of DFS demonstrate the necessity of an individual approach to patients’ treatment, taking into account the prevalence of specific morphological changes.

Keywords: diabetic foot, diabetic complications, ischemic ulcer, diabetic peripheral neuropathy, arterial ischemia, neuroischemic form, morphological changes
p. 140-147 of the original issue
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Address for correspondence:
61022, Ukraine, Kharkov, Science pr.,
4, Kharkiv National Medical University,
Department of pathological anatomy.
Tel.:+ 38 095 219-53-53
E-mail: daryagalata@gmail.com
Daria I. Galata
Information about the authors:
Belov S.G. MD, Professor, department of surgery and proctology, Kharkov Medical Academy of Post-graduate Education.
Danilova O.V. Surgeon of Kharkov Municipal Center "Diabetic Foot".
Taraban I.A. MD, Professor, department of surgery N1, Kharkov National Medical University.
Galata D.I. PhD, Assistant, department of pathologic anatomy, Kharkov National Medical University.
Gorgol N.I. PhD, Ass. Professor, department of pathologic anatomy, Kharkov National Medical University.
Potapov S.N. PhD, Ass. Professor, deparment of pathologic anatomy, Kharkov National Medical University.
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