RESUMO
Multifactorial pathogenesis of the "diabetic foot" syndrome suggests advisability to single out some clinical pathogenetic forms, depending on basic causes of the lesions: due to neuropathy, osteoarthropathy, neuro-ischemic factors. The authors has developed the algorithm which enables to diagnose various forms of the syndrome and differentiate the treatment. The most important treatment modalities include unloading and podiatric measures as well as surgery, systemic antibacterial and glucolytic therapy. Conservative or surgical antiischemic measures are indicated only in demonstration of the degree of the ischemic damage in the lower extremities by Doppler ultrasonography and measurement of local oxygenation of the skin. The combined differentiated treatment in 142 patients with diabetic lesions of the feet has resulted 97.2% favourable outcomes in neuropathy and 86.5% successful outcomes in neuroischemic damages. Local oxygenation of dorsal skin of the foot (< 20 mm Hg) indicates that amputation above the ankle is highly probable.
Assuntos
Pé Diabético/diagnóstico , Pé Diabético/terapia , Amputação Cirúrgica , Diagnóstico Diferencial , Humanos , Oximetria , Prognóstico , Ultrassonografia Doppler , Vasodilatadores/uso terapêuticoRESUMO
Examinations of 48 patients with the syndrome of "diabetic foot" (IV-V degree according to Wagner classification), have shown advantages of prolonged epidural anesthesia (EA) carried out during pre-, intra-, and postoperative (6-7 days) period. This method has relieved pain during postoperative period with minimal impact on carbohydrate metabolism and central hemodynamics. Moreover prolonged EA is a basic prophylactic method against the development of phantom painful syndrome in patients with amputated extremity. The prolonged postoperative EA is a reliable method for modification of surgical stress-response, being especially important in patient, afflicted with a severe form of diabetes mellitus who represent a high surgical and anesthesiological risk group.