Dijabetesno stopalo i hirurško lečenje

Abstract

Diabetic foot (DF) is a complication resulting from long-term, inadequately treated diabetes mellitus (DM). The foundation of diabetic foot lies in the presence of chronic complications on the foot associated with DM. Significant challenges in addressing the complex issue of DF pose a challenge to better understanding and optimizing DF treatment. Diabetes leads to a reduction in blood flow in arterial blood vessels, resulting in decreased perfusion to all tissues. This leads to reduced vitality and functionality of all tissues, particularly noticeable in the feet, which are the most distal parts of the body exposed to load. Changes in DF manifest with diverse clinical presentations, ranging from local to systemic, and vary in extent from subtle and barely noticeable to gangrene. Diagnosis is generally straightforward and based on medical history, clinical presentation, laboratory testing, and radiography. Treatment can be preventive, primarily through patient education about possible diabetes complications and lifestyle changes. Treatment for existing foot changes is based on foot offloading, medications, and surgical intervention in cases of significant complications, deformities, necrosis, and infection. Surgical treatment can be preventive and reconstructive. Preventive surgical treatment involves establishing better anatomical relationships to evenly distribute pressure on soft tissues. Reconstructive surgical treatment encompasses all procedures and surgical techniques aimed at preserving anatomical integrity, function, and reducing disability. A multidisciplinary approach to addressing the complex issue of DF yields the best results and significantly reduces mortality and the need for radical surgical interventions such as below-knee and above-knee amputations. Timely intervention with appropriate medication and surgical therapy, along with continuous monitoring, is essential to avoid additional complications, shorten treatment duration, and reduce the extent and radical nature of surgical procedures.