Особливості хірурґічної обробки та фіксації шкірного клаптя після малих ампутацій у хворих з синдромом стопи діабетика

Abstract

Aim. Based on the proposed methods, 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 114 patients treated in the surgical department of the TL of Ternopil during 2014-18 years for purulent-necrotic lesions of toes in type II diabetes mellitus was carried out. The age of patients ranged from 44 to 75 years. The following methods are supported by patents for utility model. Results and Discussion. Usually, during small amputations, the necrotic part of the bone phalanx of the finger is removed with the help of Liuer or Liston cutters. The indicated methods have certain disadvantages, as they cause additional traumatization of healthy tissue within which amputation is carried out. Removing necrotic tissue with manual mechanical amputation tools requires the application of force and compression, which leaves microcracks and splinters at the immediate location of the instrument on the healthy residual bone tissue and also injures the surrounding tissue, adversely affecting the wound healing process and treatment as a whole. However, the fixation of the skin after the amputation of the phalanx of the finger is preceded by the removal of the necrotic part of the phalanx or the entire phalanx, the cleansing of the open wound surface of fine particles of destructive tissue, treatment of the wound with an antiseptic on a water basis (chlorhexidine, decasan), removal of liquid tissues, blood, lymph and amorphous component, wound tamponade, or seam fixation. 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.  Conclusion. 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. The method of fixing the skin flap after the amputation of the phalanx of the finger allows preserving the liquid tissues on the wound surface that provide nutrition and fixation of the transplanted skin flap closing the wound. 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.