Form Of Diabetic Foot Syndrome Research Articles

Indicators of endothelial dysfunction and the rate of thrombotic complications in patients with type 2 diabetes mellitus at different periods after COVID-19

Introduction. Damage to the vascular endothelium and hypercoagulation are two of the main causes of post-­COVID-19 complications. The aim of our study was to evaluate endothelial dysfunction and thrombotic complications at different periods after COVID-19 in patients with type 2 diabetes mellitus. Patients and methods. We conducted a cross-­sectional study of 135 patients with type 2 diabetes mellitus who applied for inpatient treatment at the RSSPMCE clinic (Tashkent, Uzbekistan) in the period from 3 to 24 months after the acute period of COVID-19. The following laboratory parameters were assessed: fibrinogen, INR, APTT, D-dimer, von Willebrand factor, and cell adhesion molecules (VCAM-1, ICAM-1). Results. Despite normal or near-normal INR, APTT and fibrinogen levels, many patients had elevated levels of D-dimer (41.4 % of cases), von Willebrand factor (27.6 % of cases) and vascular cell molecules up to 24 months after infection. The concentrations of ICAM-1 and VCAM-1 did not have statistically significant correlations with the degree of compensation of diabetes mellitus (HbA1c level). At various times after COVID-19, cases of ischemic forms of diabetic foot syndrome and thrombosis affecting the cavernous sinus and upper extremities were recorded. Conclusion. Taking into account the results obtained, patients with type 2 diabetes mellitus after SARS-CoV-2 infection require careful monitoring, and, in addition to assessing standard coagulation parameters, determining the level of cell adhesion molecules may have diagnostic value.

Investigating the joint application of negative pressure wound treatment and tissue therapy for chronic wounds in patients with diabetes.

This study aimed to investigate the effectiveness of combined negative pressure wound therapy (NPWT) and human amniotic membrane in patients with chronic wounds associated with diabetes. A total of five patients with type 2 diabetes, including ischemic and mixed forms of diabetic foot syndrome, presenting with ischemic wounds of the lower extremities were included in this study. Patients with uncorrected limb ischemia were excluded. The treatment protocol included diabetes compensation (treatment with fractional insulin therapy), anticoagulant, metabolic therapy and angiotropic therapy, physical treatment methods, osteoporosis therapy with calcium preparations, and wound-specific interventions. The primary treatment approach involved the application of a vacuum bandage to the transplanted human amniotic membrane, which improved the adaptation of the flap to the wound surface, allowed the removal of excess wound exudate, and stimulated angiogenesis and reparative properties. The combined approach of NPWT and biotherapy was a safe and effective cure for diabetic wounds, promoting faster wound healing, reducing the need for autodermoplasty, and possibly reducing the necessity for high-level amputations.

Multidisciplinary approach in the treatment of patients with diabetic foot syndrome. Experience of Almazov National Medical Research Centrе

Objective Evaluate the effectiveness of the multidisciplinary specialists team in Almazov National Medical Research Centrе to the treatment of patients with the neuroischemic form of diabetic foot syndrome in a multi-field hospital.Materials and methods We made retrospective analysis of the multidisciplinary approach to the treatment of patients with a neuroischemic form of diabetic foot syndrome who were hospitalized to Almazov National Medical Research Centrе during the period from January 2018 to July 2020 (inclusively). The patients were treated in the clinic of the Almazov National Medical Research Centrе during one hospitalization period. The investigation includes patients over 18 years old with a diabetes mellitus who were performed revascularization at the vascular surgery clinic Almazov National Medical Research Centrе. Patients with a secondary diabetes mellitus, immunosuppressive therapy were excluded from the study. 51 patients with neuroischemic form of diabetic foot syndrome were specifically selected for analysis. We gathered all information about them till August 2022. So, the period of observation was from 2 years 8 months (32 months) to 4 years 8 months (56 months). The mediana time was 44 months (3.67 years). All inclusive patients had a diabetic ulcer on the foot. The outcomes of this study were the healing or non-healing of diabetic foot ulcers, major amputation or death (from all causes).Results Successful healing of ulcers or postoperative wounds at the time of contact with the patient or his relatives, was with 45 patients (88.3 %). In more than half of the patients (56.86 %) healing of ulcers and wounds was occurred in the 3 months after operation.70.59 % (n = 36) patients were performed orthopedic organ-preserving reconstructions on the feet in the hospital. 6 patients (11.7 %) were performed initially revascularization according to the “less affected pathway” principle which didn’t heal the ulcers in the postoperative period and leaded to repeated surgery to restore blood flow according to the angiosomal principle. For 9 patients (17.64 %) it was required to perform repeated orthopedic intervention on the foot during the current hospitalization. The causes of complications were: stent thrombosis (n=3), intimal dissections (n = 2) and distal embolism (n = 1). The reasons for repeated orthopedic surgery were marginal necrosis in the postoperative wounds. Optimal revascularization wasn’t achieved with 10 (19.6 %) patients. Despite this in 4 (7.84 %) cases ulcers was healed. In two cases, 3.92 % (n = 2) suboptimal revascularization was associated with the lack of technical possibility in revascularization of the lower leg arteries with satisfactory revascularization of the femoral-popliteal segment. Indirect revascularization with no effect was performed in 4 cases (7.84 %). 6 major amputations (11.7 %) were performed during the observation period, 1 major amputation during the current hospitalization and 5 in the long-term period. The Kaplan-Mayer three-year survival rate was 80 %.Conclusion The analysis of the results of a multidisciplinary approach to the treatment of patients with diabetic foot syndrome demonstrated an improvement in the preservation of the limbs, reduced of bone-plastic reconstructions, reduсtion of hospitalization time and improving the lives of patients.

ULTRASONIC CRITERIA FOR ASSESSING TREATMENT OUTCOMES IN PATIENTS WITH ISCHEMIC FORM OF DIABETIC FOOT SYNDROME WHO UNDERWENT ENDOVASCULAR RESTORATIVE SURGICAL OPERATIONS

The article highlights the effectiveness of ultrasound monitoring of outcomes of the endovascular restorative surgical interventions in patients with the ischemic form of diabetic foot syndrome, which resulted from occlusive-stenotic lesions of the popliteal-tibial segments. The purpose of the study was to investigate the findings of ultrasound monitoring following the endovascular treatment with various methods of occlusive-stenotic lesions of the popliteal and tibial arteries in patients with the ischemic form of diabetic foot syndrome and to assess the effectiveness of the treatment. The study included 112 patients, who received the inpatient treatment for the complicated ischemic form of diabetic foot syndrome at the Department of Vascular Surgery, Poltava Regional Clinical Hospital, for 2017-2021. The ultrasound and angiographic examination revealed significant hemodynamical occlusive-stenotic lesions of the popliteal and tibial arteries. These patients were indicated to have restorative endovascular surgical interventions. Depending on the methods of the interventions, patients were divided into two study groups. The first group included 58 (51.8%) patients, who underwent balloon angioplasty of the tibial arteries according to general standard techniques. The second group included 54 (48.2%) patients, who underwent staged dosed balloon angioplasty of the tibial arteries according to the technique we elaborated by ourselves. When analyzing the findings obtained by colour ultrasound scanning of the arteries of the lower extremities before performing endovascular operations and on the 2nd and 7th day of the postoperative period, we have found out that the blood flow has improved significantly that is confirmed by a reliable acceleration of the peak blood flow rate and the humeral index. This is quite pronounced in the patients of the second group, who underwent step-by-step dosed balloon angioplasty of the tibial arteries. The positive changes are supported by the occurrence of fewer thromboses in the operated sections of the arteries in the early postoperative period in the patients of the second group compared to patients in the first group.

Strategy of complex treatment of the neuroischemic form of diabetic foot syndrome in critical ischemia and in presence of resistant forms of purulent infection pathogens using bacteriophages on the example of clinical observation

The article presents a clinical observation illustrating the multi-stage treatment of purulent-necrotic lesions of the diabetic foot syndrome in the presence of resistant flora and critical ischemia of the affected limb. The importance of teamwork in providing medical care to this category of patients, as well as the need to use adjuvant therapy, in particular, bacteriophages, in the complex treatment, is demonstrated

ОПЫТ ПРИМЕНЕНИЯ ДОНОРСКИХ СОСУДИСТЫХ ГРАФТОВ В ХИРУРГИИ МАГИСТРАЛЬНЫХ АРТЕРИЙ НИЖНИХ КОНЕЧНОСТЕЙ

Today, in surgery of the arteries of the lower extremities in diabetes mellitus and atherosclerosis, the autovein is the gold standard. It does not require any selection, conservation, or other preparation methods necessary for its application. However, its use in some cases is limited due to their parametric characteristics (length, diameter), loss of time for their preparation, and their absence. For these categories of patients, the method of choice is the use of vascular allografts. The article presents the experience of 25 cases of post-mortem donor vascular grafts in 24 patients with lower limb revascularization with critical ischemia. All patients were divided into 2 groups: 13 patients were included in the first group with neuroischemic form of diabetic foot syndrome, and 11 patients were included in the second group with obliterating atherosclerosis of vessels (arteries) of the lower extremities. Positive results were noted in 20 patients (83.3%). In the immediate and long-term periods after revascularization with a donor graft (1 - artery, 3 - vein), high amputations were performed in 4 (16.7%) cases, all patients with diabetes mellitus.

THE USE OF 5-AMINOLEVULINIC ACID GEL IN THE TREATMENT OF DIABETIC FOOT SYNDROME

Background. Diabetes mellitus affects almost all body systems, but the most dramatic complications occur in the lower extremities. Diabetic foot syndrome takes the leading position in the list of complications of diabetes mellitus, leading to early disability and mortality.
 At present, a new technology - photodynamic therapy is being intensively developed worldwide. This technique can be used in many different fields of medicine, including purulent surgery.
 This study aimed to investigate the possibility of using 5-aminolevulinic acid as an photosensitizer in photodynamic therapy in the complex treatment of chronic wounds in patients with ischemic and mixed forms of diabetic foot syndrome.
 Materials and Methods. In 2021, 10 patients with type 2 diabetes mellitus and ischemic and mixed forms of diabetic foot syndrome of both sexes, aged 52 to 75 years, were observed. As a preparation for photodynamic therapy, daily dressings with hydrogel were applied (3-5 days). During this period, limb revascularization was performed, the aim of which was to restore the blood flow to the foot, preferably through the anterior or posterior tibial artery. After the restoration of the main blood flow, photodynamic therapy was performed: after sanitation of the wound surface with physiological NaCl solution, Levuderm gel (6% gel phosphate of 5-aminolaevulinic acid) was applied and covered with occlusive dressing for 2 hours, after which the gel remains were removed and irradiation with Korobov photonic matrices "Barva Flex" with 660 nm wave length was carried out. Energy applied to the wound averaged 30-40 J/cm2. The light power density was between 0.1-1.0 W/cm2, and the exposure time varied according to the wound area.
 Results. After photodynamic therapy on days 2-3, perifocal oedema decreased. By days 5-7, the quality of granulation and the degree of wound epithelialization significantly improved. The wound healing rate on days5-7 of treatment was 1,58±0,44, and on days 10-12 - 4,72±0,63 (p <0,01). The evaluation of the wound healing rate showed good and satisfactory results: By day 32, the wound in the study group was completely epithelialized in the majority of patients (88.9%).
 Conclusions. The method we have developed for treating chronic wounds using photodynamic therapy is pathogenetically feasible and highly effective compared to conventional therapies. Combined light exposure using photosensitizer stimulates the formation of reactive oxygen species, increasing the effect of phagocytic cells, which is manifested in the activation of neutrophil chemotaxis, adhesion, and endocytosis. photodynamic therapy using aminolaevulinic acid as a photosensitizer, enhances molecular mechanisms of intercellular interaction at all stages of primary immunity activation.

Molecular genetic polymorphisms C786T of the eNOS gene and LYS198ASN of the END1 gene in diabetic foot syndrome

Background. Diabetic foot syndrome is one of the complications of diabetes mellitus, which could result inthe development of purulent-necrotic lesions of soft tissues or amputation. Nitric oxide and endothelin-1 plays key role in endothelium dysfunction, thus contributing to the pathogenesis. Objective. To evaluate the frequency of genotypes of the C786T polymorphism of the eNOS gene and the LYS198ASN polymorphism of the END1 gene in a group of patients with diabetic foot syndrome and a group of healthy donors living in the Trans-Baikal Territory. Design and methods. In 100 healthy individuals and 198 patients with a mixed form of diabetic foot syndrome, polymorphisms were studied by PCR. The statistical significance of differences was assessed using Pearson’s chi-square test. Results. The C/C and T/T genotypes of the C786T polymorphism of the eNOS gene were more common in patients (1.2 times and 2.1 times, respectively), while the incidence of the C/T genotype was 1.4 times lower. The LYS/LYS genotype of the LYS198ASN polymorphism of the END1 gene was more frequently observed in the control group, while K/N and ASN/ASN genotype was detected 1.7 and 2.2 times more often in the patients, respectively. Conclusion. Frequency differences in genotypes of the polymorphisms of eNOS and END1 genes in patients with diabetic foot syndrome and healthy individuals confirm their contribution to the endothelial dysfunction.

Significance of Inflammation, Angiogenesis and Cardiovascular Risk Factors in the Development of Neuroischemic Form of Diabetic Foot Syndrome

Annotation: People with type 2 diabetes mellitus (T2DM) are at increased risk of many complications, which are mainly related to complex and interrelated mechanisms such as hyperglycemia, insulin resistance, mild inflammation, and accelerated atherogenesis. [1].

STIMULATION OF THE WOUND PROCESS IN LONG-TERM UNHEALED WOUNDS IN PATIENTS WITH DIABETIC FOOT SYNDROME

The purpose of the work. Compare the effectiveness of PRP and general accepted methods of local therapy for long-term unhealed wounds in patients with diabetic foot syndrome.
 Materials and methods. A study was performed in 33 long-term patients unhealed wounds on the foot and leg in the neuropathic form of diabetic foot syndrome. Patients were divided into two groups depending on the nature of the received therapies - PRP and local therapy according to generally accepted principles. The effectiveness of therapy was assessed by the nature of changes in the microflora and c wound cell composition, as well as wound surface area on the 1st day, 8th and 22nd after starting treatment.
 Results. The use of PRP allowed to observe on the 8th day regenerative-inflammatory type of cytogram, have manifestations of vascularization and epithelialization, reduce the number of patients with infected wounds by 2.7 times and reducing the wound surface area by 1.7 cm, which is 3.4 times more than in the second group (0.5 cm). The introduction of the second dose of PRP is even more stimulating reparative changes in the wound, manifested by the regenerative type of cytogram, reducing the number of infected wounds by 8 times, and reducing the area wound surface 2 times from the first measurement, while in the second group only on the 22nd day there were positive changes that were characteristic of the first group on the 8th day.
 Conclusion. Thus, the use of PRP in therapy is long unhealed wounds in diabetic foot syndrome, is a promising area of ​​regenerative therapy. PRP is a way to obtain a natural concentration of internal factors of growth with minimal invasiveness and low costs. Proposed method of biological therapy in such patients is simple and affordable for both patient and for the doctor.

"The State of Central Hemodynamics in Patients with Neuroischemic Form of Diabetic Foot Syndrome is Associated with Chronic Heart Failure"

"The State of Central Hemodynamics in Patients with Neuroischemic Form of Diabetic Foot Syndrome is Associated with Chronic Heart Failure"

Recurrent foot ulcers in patients with diabetes mellitus in out-patient care

OBJECTIVE. Relapses of diabetic foot ulcers are an urgent problem of outpatient surgery, however, risk factors for relapse, as well as the definition of relapse itself remain a subject of discussion. The presented study investigates the frequency of relapses of ulcerative foot defects in diabetes mellitus, the risk factors for their development and treatment outcomes, based on the definition of relapse as the development of a repeated defect in the same place as the healed defect.METHODS AND MATERIALS. The data of 1714 patients with foot ulcers (2213 ulcerative defects) from 01.2012 to 01.2017 were studied. Patients were divided into two groups: with relapses (n=239, 13.9%) and without them (n=1475). Risk factors for relapse, characteristics of patients and ulcerative defects, and treatment outcomes were evaluated.RESULTS. Relative risk for relapse: type 1 diabetes mellitus (1.36); Charcot foot (1.65); history of amputation of the great toe (1.35); severe polyneuropathy (1.25); neuropathic foot (1.37). Relapses/single ulcer (%): superficial lesion 72.8/63.3 (р<0.01); primary healing: 61.1/52.7 (p=0.025); healing after surgery (amputations excluded): 4.2/4.5 (ns); amputations: 7.1/6.6 (ns) of which major 5.9/20.6 (p=0.01); non-healing (%): 11.7/5.5 (р=0.001); loss of follow-up (%): 15.9/30.7 (р=0.0001). Median duration of the treatment (days) of relapses/single ulcer: conservative 147/114; healing after surgery (amputations excluded) 241/170; after amputation 286/182. Revascularization in relapses – 7 (100%), with single ulcers – 66 (59.5% of patients with critical ischemia).CONCLUSION. 5-years relapse rate was 13.9 %. Patients with Charcot foot, postoperative deformities and with neuropathic form of diabetic foot syndrome are more prone for foot reulceration. Recurrent ulcers are characterized with longer duration of the treatment however their primary healing rate is higher compared with single ulcer group. The results of the study were significantly influenced by the high frequency of loss of follow-up in both groups.

BLOOD FLOW CONDITION IN LOWER EXTREMITY VESSELS AND ENDOTHELIAL DYSFUNCTION IN PATIENTS WITH TYPE 2 DIABETES MELLITUS DEPENDING ON DISEASE DURATION

The purpose of the study. Study arterial blood flow and blebbing of the plasma membrane of lymphocytes in the neuroischemic form of diabetic foot syndrome (SDS) depending on the age of the disease.
 Material and methods. In a prospective study, 150 patients of type 2 DM were examined, of which 50 people with a neuroischemic form of SDS. Blood flow condition on vessels of lower extremities and plasma membrane of lymphocytes was examined. There were 30 women (60%), 20 men (40%). Vascular channel condition was evaluated by ultrasound dopplerography of lower extremity arteries, degree of diabetes mellitus compensation was determined by glycated hemoglobin level, lymphocyte membrane condition was evaluated by phase contrast microscope imaging results.
 Results of the study. 72% of patients had complete occlusion of the tibia-foot segment of the arteries of the lower extremity, 28% had stenosis. The glycated hemoglobin level averaged 10.3 [8.5; 14.3]%, i.e. all observed patients had insufficient compensation for carbohydrate metabolism disorders. The total and terminal lymphocyte blebbing was 30.1 [25.4; 33.2]% and 15.8 [11.8; 18.4]%, which was 3 and 5 times higher than the control group, respectively. A high positive correlation between the duration of DM disease and the total (rS=0,72; p = 0.001) and terminal (rS=0,78; p = 0.001) blebbing of lymphocyte membrane.
 Conclusion. The high correlation between the timing of DM disease and the blebbing of the lymphocyte plasma membrane allows these indicators to be used as markers of endothelial dysfunction in neuroischemic and ischemic forms of SDS. The level of summary and terminal blebbing can be considered as a prognostic marker of the development of macroangiopathy in patients with type 2 DM.

Recombinant interleukine-2 in treatment of diabetic foot syndrome

The experience of using Roncoleukin® – recombinant interleukin-2 (rIL-2) in the complex treatment of diabetic patients with various forms of diabetic foot syndrome is summarized. The use of rIL-2 contributed to the positive dynamics of laboratory and immunological parameters and improved the results of surgical treatment, this was manifested in a decrease in the frequency of purulent-septic complications, the frequency of amputations, a decrease in the mortality rate, reducing the time of hospitalization and an improvement in long-term treatment results.

Опыт лечения синдрома диабетической стопы в клинике общей хирургии Военно-медицинской академии им. С.М. Кирова

We examined 180 patients with purulent-necrotic complications of diabetic foot syndrome, in whom the proposed diagnostic algorithm was used. Magnetic resonance imaging of the feet, ultrasound Doppler with duplex angioscanning, magnetic resonance and computed angiography of the lower extremities, as well as assessment of transcutaneous oxygen tension were performed. Surgical treatment tactics depended on the form of the diabetic foot syndrome, as well as the severity of the disease. As a local treatment, physical methods were used to accelerate the course of the wound process. The proposed diagnostic algorithm for the diagnosis and selection of surgical treatment for various forms of diabetic foot syndrome has made it possible to reduce the number of “high” amputations and maintain a supporting limb. Purpose of the study is to improve treatment outcomes for purulent-necrotic complications of diabetic foot syndrome by developing and applying a diagnostic algorithm and differentiated treatment tactics. The main group consisted of 180 patients with purulent-necrotic complications of diabetic foot syndrome, in whom the developed diagnostic algorithm and differentiated tactics of surgical treatment were used, as well as physical methods of influencing the wound process (ultrasonic cavitation and local ozonation) were used as local treatment. The control group included 40 patients with purulent-necrotic complications of diabetic foot syndrome, whose treatment involved the use of drugs that improve the rheological properties of blood and tissue microcirculation (rheopolyglucin, trental, actovegin) according to conventional schemes. Local treatment included sanitation and treatment of wound and ulcerative surfaces with antiseptic solutions and ointments, depending on the phase of the wound process. Data analysis in this group was carried out based on a retrospective study of case histories and an assessment of long-term results of treatment by follow-up examinations and telephone interviews. Control group included 25 (63%) men and 15 (37%) women; the average age was 67.3±10.3 years. The developed unified approaches in diagnosing and treating patients with purulent-necrotic complications of diabetic foot syndrome, who, in complex treatment, underwent staged necrectomy with simultaneous ultrasonic cavitation of purulent wounds and their ozonization, can reliably reduce the number of ulcer recurrences from 28% to 2.7%, high amputations by 34%, and the number of re-amputations ― 10 times. The use of minimally invasive surgical technologies for the rehabilitation of deep purulent foci of the foot, in comparison with the classical principles of treatment of purulent wounds, makes it possible to achieve a complete cleansing of wounds, preparation for plastic surgery, and an increase in the number of functional supportable lower limbs by 42.7%. According to the data obtained, it is optimal to perform sanitizing operations after revascularization of at least one artery no earlier than 3–4 days, which makes it possible to increase their efficiency and reduce the number of repeated surgical interventions. The approach to managing patients with diabetic foot syndrome at all stages of treatment and rehabilitation should be interdisciplinary and include the following specialists: endocrinologist, orthopedist, surgeon, psychologist, trained nursing staff.

Використання вакуум-терапії в лікуванні ран у хворих на синдром діабетичної стопи

Вступ. Гострі та хронічні ранові дефекти нижніх кінцівок виникають у 15–25 % хворих на цукровий діабет, слугуючи безпосередньою причиною високих ампутацій нижніх кінцівок у 12 % цих пацієнтів. Одним із сучасних і перспективних напрямків лікування ран є вакуум-терапія. Мета. Вивчити вплив вакуумної терапії на перебіг гострого та хронічного ранового процесу у хворих на синдром діабетичної стопи залежно від патогенетичної форми ураження та на підставі отриманих даних покращити результати хірургічного лікування вищеозначеної патології. Матеріали та методи. Обстежено 239 хворих на ускладнені форми синдрому діабетичної стопи. Моніторинг перебігу ранового процесу доповнено клінічними, цитологічними, мікробіологічними та морфологічними критеріями. В лікуванні хворих використано апарат вакуумної терапії фірми «Агат-Дніпро». Вакуумну терапію ран проведено в режимах від’ємного тиску в межах 80–125 мм рт.ст. Результати. На 2-гу — 3-тю добу лікування вакуумом спостерігалося вірогідне зменшення місцевих проявів гострого запального процесу. Поряд із цим відзначалося й вірогідне зменшення об’єму ранових дефектів. Відбувались позитивні зміни зі сторони мікробної контамінації ранових дефектів. Використання постійної вакуумної терапії в лікуванні ранових дефектів дозволило значно покращити показники місцевої мікроциркуляції. Висновки. Використання вакуумної терапії в комплексному лікуванні гострих і хронічних ран у хворих на синдром діабетичної стопи спричиняє місцеву та системну дію, що дозволяє стабілізувати перебіг ранового процесу, стимулювати регенераторні процеси, ліквідувати прояви ендогенної інтоксикації і порушення імунологічної реактивності.

АКТУАЛЬНЫЕ АСПЕКТЫ ДИАГНОСТИКИ И ЛЕЧЕНИЯ АТЕРОСКЛЕРОЗА АРТЕРИЙ НИЖНИХ КОНЕЧНОСТЕЙ У ПАЦИЕНТОВ С СИНДРОМОМ ДИАБЕТИЧЕСКОЙ СТОПЫ

Atherosclerosis of lower-extremity arterial disease is a common pathology in diabetes mellitus, contributing to the development of ischemic and neuroischemic forms of diabetic foot syndrome. Early diagnosis of vascular lesions helps to reduce the number of cardiovascular complications, performed amputations and improves the quality of life in these patients.The review presents the current arsenal of modern comprehensive examinations of patients with diabetic foot syndrome, including clinical and functional screening, non-invasive and invasive methods of radiological diagnosis, as well as specific assessment scales and new classifications that allow detailing and systematizing trophic foot changes with the ability to predict the course of the pathological processoccurring at sites. The using of open revascularization methods helps to achieve the healing of diabetic ulcers in a large percentage of cases, but the point is the problems associated with the localization of the lesion, the choice of conduit for bypass surgery and technical aspects significantly limit the possibilities of this treatment method. Recent technological advances in the development of endovascular surgery have expanded the indications for successful revascularization. The article highlights the results of shunting and endovascular methods in the treatment of atherosclerotic process in infrainguinal area in patients with diabetic foot syndrome.

Biomedical cell products in patients with diabetic foot syndrome using feasibility (literature review)

Today, the rapid and cost-effective treatment of patients with diabetic foot syndrome (DFS) is still challenging. The use of biomedical cell products (BCP) in this patients category has a clear pathogenetic orientation, but it remains not fully understood and generally accepted. The review presents the results of numerous studies confirming the efficacy of BCP for the treatment of predominantly superficial trophic defects in patients with neuropathic DFS. However, these technologies are still classified as adjuvant therapies. There are no clear algorithms and regulations for the use of BCP. It has been shown that their use accelerates the reparative processes in superficial trophic defects in patients with neuropathic DFS in combination with standard therapy and shortens the time of wound epithelialization. Considering the laboriousness and high cost of BCPs, the possibility of their use for the treatment of patients with neuroischemic form of DFS of various grades according to the WIfI classification should be considered.

Mini-invasive revascularization operations in the complex treatment of neuroischemic and ischemic forms of diabetic foot syndrome

Objective: Diabetic foot syndrome is the most dramatic complication of diabetes mellitus. The treatment success is impossible without improving blood circulation and the elimination of hemodynamic disorders in the affected limb.The study aim was to evaluate mini-invasive revascularization operations effectiveness on the lower limbs peripheral arteries in neuro-ischemic and ischemic diabetic foot syndrome forms.
 Materials and methods: The study enrolled 104 patients with purulent-necrotic complications of diabetic foot syndrome. 54 (51.9%) patients underwent stenting and balloon angioplasty (the main group). The comparison group included 50 (48.1%) patients, undergoing indirect revascularization surgeries in complex treatment.
 Results and discussion:After endovascular interventions, the API index increased by 47.6% (p<0.01) after 20 days compared to the admission index, the average blood flow rate increased by 1.8 times (p<0.01), and the tPo2 value improved by 67.8% (p<0.01). In the control group, the tPo2 value increased by 40.3% after 20 days, and API – by 34.4%. In the main group, the swelling disappearance in the foot wounds area was by 3.7±0.5 days faster (p<0.001), wounds purification by 4.1 days (p<0.001), granulation appearance by 3.5±0.4 days (p<0.001), wound margins infiltration disappearance happened 3.3±0.9 days earlier (p<0.001), and the wound epithelization was 2.9 days earlier (p<0.01) than in the control group patients.
 Conclusion: Foot support function at discharge from hospital was preserved in 94.4% of the main group and in 84% of the control group.
 Bangladesh Journal of Medical Science Vol.20(4) 2021 p.817-825

Features of organ-saving foot amputation associated with ozone therapy, local application of autologous platelet-rich plasma and vacuum sanitization of postoperative wound in patients with ischemic-gangrenous form of diabetic foot syndrome

Improvement of reparative process of the chronic wounds with the insufficiency of peripheral blood suppling in patients suffering from diabetes mellitus is an important issue requiring further investigation. An optimal choice of surgery, effective renewal of blood supply and active stimulation of tissue repair on the cellular level are essential components of success treatment of this problem.Objective of research: From 2017 to 2020, the efficiency of one of the variants of organ-saving surgery performed on 210 patients with an ischemic-gangrenous form of diabetic foot syndrome was studied.Materials and methods. Control group included 104 patients (49.52%), were the treatment carried out in accordance with the standard scheme. The main group (106 patients - 50.47%) in addition to the standard therapy have used regional ozone therapy, vacuum sanitization and local application of autologous platelet-rich plasma (APRP).Results. These proposed measures reduced the period of clinical treatment to 24±1,2 days in the main group compared to 37±2,4 in the control one. 2 years later, patients of the main group confirmed the formation of a foot stump functionally adapted for walking with angular dislocation of fragments of the cuboid and scaphoid bones.Two years after foot amputation due to the ischemic-gangrenous form of diabetic foot syndrome (DFS), the amount of repeated above knee amputations was 1.8 times higher in the control group in comparison with the main group, which is indicative of a reasonable use of the complex of activate a reparative process in the wound.Conclusions: The suggested modification of the organ-saving and partial foot amputation in patients with IV degree of ischemia and DFS is indicative of a possibility to perform such kind of surgery as a variant of choice.The complex of proposed additional measures including regional ozone therapy, vacuum sanitization and local administration of autologous platelet-rich plasma activates a reparative process of a chronic foot wound and promotes an effective treatment of patients with ischemic-gangrenous form of DFS.