Classification criteria and outcomes of treatment of necrotic-inflammatory foot lesions in patients with diabetes mellitus. Do we treat syndromes or patients?

Abstract

Aim. To analyze the classification criteria and outcomes of treatment of surgical complications in patients with diabetic foot syndrome. Material and Methods. The publications for the period 1987 - 2016 were analyzed. Thirty-six primary sources, showing the evolution of the classification criteria and outcomes of treatment of patients with diabetes mellitus, complicated by necrotic-inflammatory lesions of the foot, were selected. Results and Discussion. The occurrence of necrotic-inflammatory lesions of the foot in patients with diabetes mellitus indicates the late stage of the disease, and the threat of mutual burden phenomenon. It requires emergency hospitalization to a specialized surgical department, the doctor's multidisciplinary knowledge and capability to define and perform a consecutive diagnostic program and optimal complete treatment. To save the patient's life, there is no alternative to adequate surgical intervention, particularly large amputation of the lower limb. The indications for the large amputation of lower limb should be determined immediately, considering the condition of peripheral limb hemodynamics, nature and prevalence of pathological focus, comorbidity, and the patient's general condition. The causes of unsatisfactory outcomes of treatment of necrotic-inflammatory foot lesions in patients with diabetes mellitus may include: insufficient volume of the first surgical intervention; presence of lower limb ischemia; proteinuria; anemia; and lymphocytopenia as burdensome prognostic factors. Conclusions. The analysis of the literature shows the evolution of the classification criteria - from surgical complications of diabetic foot syndrome to gradual involvement of the signs of hypochromic anemia, caused by diabetic nephropathy, sepsis - SIRS or repeated surgical interventions and other complications of diabetes mellitus and comorbidities. Using assessment of severity of the patient's condition in diabetes mellitus, complicated by necrotic-inflammatory lesions of the foot, by a modified APACHE II system, allows us to estimate the severity of the patient's condition, to determine prognosis and appropriate treatment strategy.

Keywords

• diabetes mellitus, necrotizing-inflammatory lesions of the foot, classification criteria, results of treatment