Experience of outpatient treatment of trophic foot ulcers complicating the course of diabetes

Abstract

The work was aimed at analysing the annual results of outpatient observation of patients with trophic ulcers (TU) on the background of diabetes mellitus while applying modern principles of general and differentiated local treatment in the Diabetic Foot Room (DFR) environment. The authors carried out a retrospective analysis in a cohort of patients with diabetic foot syndrome (DFS), who visited a practitioner to receive advice and treatment in the DFR in 2015–2017 (n = 570). Of which, only 308 people have been treated on an outpatient basis. Neuropathic form (n = 194): diabetic osteoarthropathy (DOAP) (A0) = 63, DOAP + TU = 34; TUs without DOAP = 131 (AI 105, BI 26). Neuroischemic form (n = 114), all had TUs (CI 107, D I 7). The patients received glucose-lowering therapy correction, feet relief and differentiated local effects on TUs in accordance with the wound process stages. All options of modern wound dressing were used for indications. As a result, out of 83 patients with neuropathic DFS form, who were regularly observed in DPT, 65 (78.3%) patients achieved healing within 1 year. Of 103 patients with the neuroischemic form regularly observed in DFR, 76 (73.8%) patients achieved epithelialization, 19 patients (18.4%) reported unhealed TUs, 3.9 and 3,9% of patients had small and high amputations, respectively. 96.1% of patients achieved preservation of the supporting limb. Differentiated treatment and dynamic observation in the DFR environment made it possible to reduce the number of high limb amputations in patients with diabetic TUs within 1 year of observation to the minimum.