MULTIDISCIPLINARY MANAGEMENT OF PATIENTS WITH DIABETIC FOOT SYNDROME

Abstract

A total of 2,431 patients with diabetic foot syndrome (DFS) who underwent inpatient treatment in the purulent surgery units of 6 large hospitals in Chelyabinsk were examined. Most patients with DFS suffered from type 2 diabetes (87,8%). Most (69,4%) of patients with purulent necrotic complications of DFS were over 60 years old (55,1% among men and 76,4% among women). The complications were subdivided into predominantly ischemic (gangrene, critical ischemia), predominantly neuropathic (pressure ulcers, osteomyelitis) and predominantly suppurative (purulent wounds, abscesses, phlegmon) according to the nature and the underlying cause for the development of purulent necrotic processes observed in various forms of DFS. The diabetic patients with neuropathy of the feet had pressure ulcers and chronic osteomyelitis lesions of the foot (44,6%) more often than those with ischemia (5,7%, p <0,01) and the mixed form of complications (18,8%, p <0,05). Given the pathogenetic heterogeneity of the DFS, it is recommended to provide multidisciplinary management of patients, an individual program of outpatient management of each patient including for the purposes of preventing the development of purulent-necrotic complications: the patient management protocol, the use of adequate combination drug therapy in accordance with the syndromic model, including thioctic acid derivatives, vitamins C, E, group B, drugs acting on the endothelial surface of microvessels and blood rheology i.e. angiotropic therapy (sulodexide, alprostadil, heparin, aspirin).

Keywords

• diabetes mellitus
• diabetic neuropathy
• diabetic foot syndrome
• alpha-lipoic (thioctic) acid