Modern diagnostic methods in diabetic foot syndrome

Abstract

Presented was the comparative characteristic of modern methods of diagnosing tissue viability in the diabetic foot syndrome with the assessment of their advantages and disadvantages. An analysis of articles was conducted devoted to diagnostic methods that are used in diabetic foot syndrome. Doppler ultrasound investigation of lower extremity arteries makes it possible to determine the level of trophic disturbances, the degree of stenosis, the type of blood flow, however the informativeness of the method decreases during distal forms of lesions, mismatch of indicators of regional ischemia and hemodynamic severity with the clinical picture is possible. Duplex scanning makes it possible to evaluate the hemodynamics, the condition of the arterial wall, the presence of atherosclerotic plaques, gives an idea about the state of small vessels including collaterals, but does not always provide an opportunity to solve the problem of topical diagnosis. The method of radiopaque angiography and duplex scanning with contrast is not suitable for routine control of the vascular bed condition because of the invasiveness, toxicity of contrast agents and radiation exposure to the patient. In assessing the speed and volume of the out-flowing peripheral lymph and blood using rheolymphovasography the volume of the limbs and the development of subcutaneous fat, the ambient temperature, the psycho-emotional condition of the patient - all have a significant impact on the result. Impedance measurement can clearly identify the trophic disorders in the soft tissues, but can not be used to evaluate the bones. Thermal imaging study is characterized by its rapidness and objectivity, however, makes it impossible to determine the boundaries of trophic disorders. The state of the peripheral innervation can be assessed by electromyography, and chronaxiemetry electro-diagnosis. The first method is not widely used due to high equipment cost, complexity and lack of selectivity, the second one is still poorly understood. Laser Doppler flowmetry makes it possible to evaluate the level of macro- and microcirculation, even in preclinical stages, but it requires specially trained personnel. Biopsy of soft tissues with histological, histochemical, ultrastructural studies make is possible to assess the latent forms of diabetic foot syndrome; limitations are due to the invasiveness of the methods. In order to improve the quality of diagnosis of the diabetic foot syndrome is necessary to develop new methods of medical imaging, which should have the advantages superior to those of the traditional methods and have a minimum of contraindications.