ASSESSSMENT OF SEVERITY STATE OF THE PATIENTS BY DIABETES MELLITUS, COMPLICATED WITH NECROTIC-INFLAMMATORY LESIONS OF THE FOOT AT THE SURFACE OF OPERATION AT LOWER EXTREMITIES

Abstract

Introduction. In the patients with diabetes mellitus (DM), the complicated anatomical structure of the foot in combination with severe necrotic-purulent process without clear limits of defect does not allow to achieve the radicals of surgical sanation during one surgical intervention, and therefore it often has a multi-stage.

Materials and methods. The ball assessment of the severity state of 106 patients with DM, complicated by necrotic-inflammatory lesions of the foot was performed before high amputation of the lower limb, as the first, second, third or subsequent operations.

Results. It was established that the state of the patients worsened, depending on which stage performed a high amputation of the lower limb.

Discussion. Indications for performing a high amputation of the lower limb should be determined immediately, but not after numerous repeated operations on the foot, against the background of a progressive deterioration of the patient's state.

Conclusion. The treated classification of necrotic-inflammatory lesions of the foot in patients with DM, application of a ballroom assessment of the state severity of patients with the modified APACHE II system, allows to determine the prognosis and justify treatment tactics.

Keywords: diabetes mellitus; complication; necrotic-inflammatory lesion of foot; surgical treatment.

Author Biographies

O. V. Zahorodniy, Lviv Regional Clinical Hospital

Doctor surgeon, Department of General Surgery No. 1, The Regional Clinical Hospital in Lviv

7 Chernihivska str., 79010, Lviv, Ukraina, tel.: +380(32) 272-76-52

ozagorodnij@ukr.net

V. P. Fedorenko, Lviv National Medical University named of Danylo Halytsky

Doctor of medical sciences, professor

Professor of the Department of Surgery No. 2, Lviv National Medical University by Danylo Halytsky

69 Pekarska str., 79010, Lviv, Ukraina, tel.:  +38 (032) 275-76-32

prof.v.fedorenko@gmail.com

O. S. Shchepitko, Lviv National Medical University named of Danylo Halytsky

Intern surgeon, Department of Surgeon and Endoscopy of FPDO on the basis of the Lviv Regional Clinical Hospital

7 Chernihivska str., 79010, Lviv, Ukraina, tel.: +380(32) 272-76-52

olegshchepitko@gmail.com

References

1. Herasymov HM. Khirurhichna taktyka i sposoby operatyvnoho likuvannia uskladnenoho syndromu diabetychnoi stopy. Mizhnarodnyi medychnyi zhurnal. Kharkiv. 2015;21(3):13-5. [In Ukrainian].

2. Herasymchuk PO, Vlasenko VH, Pavlyshyn AV. Sepsys u khvorykh na uskladneni formy syndromu diabetychnoi stopy. Scientific Journal “ScienceRise”. 2015;11.3(16):30-3. [In Ukrainian].

3. Zheliba MD, Burkovskyi MI, Tsariuk YuS, Verba AV. Bezposeredni i viddaleni rezultaty likuvannia hniino-nekrotychnykh protsesiv syndromu stopy diabetyka. Ukrainskyi Zhurnal Khirurhii. 2009;4:55-9. [In Ukrainian].

4. Marchenko OV. Shliakhy korektsii modyfikovanykh faktoriv ryzyku v likuvanni syndromu diabetychnoi stopy. Mizhnarodnyi endokrynolohichnyi zhurnal. 2015;5:110-5. [In Ukrainian].

5. Palamarchuk VI, Markov KV, Siriachenko VH. Likuvannia syndromu diabetychnoi stopy v umovakh viddilennia hniino-septychnoi khirurhii. Klinichna Khirurhiia. 2011;11:37-8. [In Ukrainian].

6. Tamm TI, Belov SG, Girka JeI, Solovej AN, Glushhenko JaA. Osobennosti diagnostiki i lechenija bol'nyh po povodu sindroma diabeticheskoj stopy, oslozhnennogo sepsisom. Klinichna Khirurhiia. 2011;(11):33-4. [In Russian].

7. Trybushnoi OV, Shapoval SD, Savon IL, Slobodchenko LYu. Mikrobnyi peizazh hniinykh oseredkiv u khvorykh z uskladnenym syndromom diabetychnoi stopy ta pry rozvytku sepsysu. Ukrainskyi Zhurnal Khirurhii. 2017;1(32):35-9. [In Ukrainian].

8. Shapoval SD, Savon IL, Smyrnov DA, Sofilkanich MM, Omelchenko MM, Belinskaya VO. Standarty protokoliv likuvannia uskladnenoho syndromu diabetychnoi stopy. Kharkivska khirurhichna shkola. 2013;3(60):119-23. [In Ukrainian].

9. Podpriatov SE. Efektyvnist povtornoho khirurhichnoho likuvannia khvorykh z diabetychnoiu stopoiu. Klinichna Khirurhiia. 2000;(5):24-5. [In Ukrainian].

10. Herych ID, Yaremkevych RV. Typovi nedoliky klasychnykh operatyvnykh vtruchan pry hniino-nekrotychnykh urazhenniakh syndromu diabetychnoi stopy (HNU SDS). Khirurhiia Ukrainy. 2005;1(13):62-4. [In Ukrainian].

11. Liakhovskyi VI, Krasnov OH, Liulka OM, Niemchenko II, Kravtsiv MI, Kyzymenko OO. Systemna zapalna vidpovid u khvorykh z syndromom diabetychnoi stopy. Klinichna Khirurgiia. 2015;(11.2):88. [In Ukrainian].

12. Ivashhenko VV, Ivashhenko AV. Nekotorye voprosy patogeneza, prognoza i profіlaktiki sepsisa u bol'nyh s sindromom diabeticheskoj stopy. Aktualni pytannia medychnoi nauky ta praktyky. Zbirnyk naukovykh prats Zaporizkoho derzhavnoho instytutu udoskonalennia likariv. Zaporizhzhia: Dyke pole. 2003;64(1):51-6. [In Russian].

13. Fedorenko VP, Zahorodnii OV, Mota YuS. Balna otsinka stupenia vazhkosti stanu khvorykh na tsukrovyi diabet, uskladnenyi nekrotychno-zapalnymy urazhenniamy stopy, za modyfikovanoiu systemoiu APACHE II. Shpytalna khirurhiia. 2014;2:5-8. [In Ukrainian].

14. Pysmenna NV. Struktura i chastota amputatsii nyzhnikh kintsivok u khirurhichnykh statsionarakh m. Kyieva. Litopys travmatolohii ta ortopedii. 2003;(1-2):131-4. [In Ukrainian].

15. Rusyn VI, Korsak VV, Rusyn VV, Nosenko OA, Korsak IuV. Kompleksne likuvannia neiroishemichnoi formy syndromu diabetychnoi stopy: mozhlyvosti vakuum-terapii. Shpytalna khirurhiia. 2014;(3):51-3. [In Ukrainian].
Published
2017-11-20
Section
General Problems of Surgery