CURRENT PRINCIPLES OF DIAGNOSIS AND TREATMENT OF BONE LESIONS IN PATIENTS WITH DIABETIC FOOT SYNDROME

Authors:

Abstract:

One of the most unresolved issues in patients with diabetic foot syndrome is the diagnosis and treatment of bone tissue lesion. The aim was to compare the results of treatment of bone tissue lesions in patients with diabetic foot syndrome and to highlight the factors of prevention of limb amputation. We have carried out treatment of 658 patients with diabetic foot syndrome. High amputation of lower limb in the control group were performed more often. Mortality was higher in the control group. At the same time, the supporting function of the foot in patients was preserved more often in the main group. Radical surgical treatment of osteomyelitis leads to a reduction in the duration of treatment of patients with diabetic foot syndrome and an increase in the number of surgical interventions. However, conservative therapy of osteomyelitis reduces the risk of impaired foot support function and high amputation of the lower limb.

Keywords:

diabetic foot syndrome osteomyelitis treatment osteoarthropathy

References:

1. Krasnov OH, Liakhovskyi VI, Liulka OM, Kravtsiv MI, Al-masri AM, Kyzymenko OO. Udoskonalennia orhanozberihaiuchoho likuvannia syndromu diabetychnoi stopy z urakhuvanniam osoblyvostei perebihu ranovoho protsesu. Klinichna khirurhiia. 2015; 11.2 (880): 72–74 [in Ukrainian].
2. Aragon-Sanchez J, Lipsky BA. Modern management of diabetic foot osteomyelitis. The when, how and why of conservative approaches. Expert Rev Anti Infect Ther. 2018; 16: 35–50. doi:10.1080/14787210.2018.1417037.
3. Armstrong DG, Boulton AJM, Bus SA. Diabetic Foot Ulcers and Their Recurrence. N Engl J Med. 2017; 376(24): 2367–75. doi:10.1056/NEJMra1615439.
4. Brownrigg JR, Hinchliffe RJ, Apelqvist J, Boyko EJ, Fitridge R, Mills JL, et al. Performance of prognostic markers in the prediction of wound healing or amputation among patients with foot ulcers in diabetes: a systematic review. Diabetes Metab Res Rev. 2016; 32 Suppl 1:128–35. doi: 10.1002/dmrr.2704.
5. Crawford F, Cezard G, Chappell FM, Murray GD, Price JF, Sheikh A, et al. A systematic review and individual patient data meta-analysis of prognostic factors for foot ulceration in people with diabetes: the international research collaboration for the prediction of diabetic foot ulcerations (PODUS). Health Technol Assess 2015 Jul; 19(57):1–210. doi: 10.3310/hta19570.
6. Elmarsafi T, Kumar A, Cooper PS, Steinberg JS, Evans KK, Attinger ChE, et al. Concordance Between Bone Pathology and Bone Culture for the Diagnosis of Osteomyelitis in the Presence of Charcot Neuro-Osteoarthropathy. J Foot Ankle Surg. 2018; 57(5):919–923. doi: 10.1053/j.jfas.2018.03.016.
7. Game FL, Apelqvist J, Attinger C, Hartemann A, Hinchliffe RJ, Löndahl M et al. Effectiveness of interventions to enhance healing of chronic ulcers of the foot in diabetes: a systematic review. Diabetes Metab Res Rev. 2016; 32 (Suppl 1):154–168. doi: 10.1002/dmrr.2707.
8. Jupiter DC, Thorud JC, Buckley CJ, Shibuya N. The impact of foot ulceration and amputation on mortality in diabetic patients. I: From ulceration to death, a systematic review. Int Wound J. 2016 Oct; 13(5):892–903. doi: 10.1111/iwj.12404.
9. Lipsky BA, Senneville É, Abbas ZG, Aragón-Sánchez J, Diggle M, Embil JM, et al. Guidelines on the diagnosis and treatment of foot infection in persons with diabetes (IWGDF 2019 update). Diabetes Metab Res Rev. 2020; 36(S1): e3280. doi: 10.1002/dmrr.3280.
10. Peters EJG, Lipsky BA, Senneville É, Abbas ZG, Aragón-Sánchez J, Diggle M, et al. Interventions in the management of infection in the foot in diabetes: a systematic review. Diabetes Metab Res Rev. 2020 Mar; 36 Suppl 1: e3282. doi: 10.1002/dmrr.3282.
11. Pickwell K, Siersma V, Kars M, Apelqvist J, Bakker K, Edmonds M et al. Predictors of lower-extremity amputation in patients with an infected diabetic foot ulcer. Diabetes Care. 2015; 38:852–857. doi: 10.2337/dc14– 1598.
12. Puzyrov GS, Lyakhovskyi VI, Shepitko VI, Sydorenko AV. Morphological justification of the stepwise dosed balloon angioplasty application compared to standard methods in patients with diabetic foot. World of medicine and biology. 2020; 3 (73): 87–91. doi:10.26724/2079-8334-2020-3-73-87-91.
13. Ramanujam CL, Han D, Zgonis T. Medical Imaging and Laboratory Analysis of Diagnostic Accuracy in 107 Consecutive Hospitalized Patients With Diabetic Foot Osteomyelitis and Partial Foot Amputations. Foot Ankle Spec 2018; 11:433–43. doi: 10.1177/1938640017750255.
14. Schaper NC, van Netten JJ, Apelqvist J, Bus SA, Hinchliffe RJ, Lipsky BA. IWGDF practical guidelines on the prevention and management of diabetic foot disease (2019), https://iwgdfguidelines.org/wp–content/uploads/ 2021/03/IWGDF–2019–final.pdf [Access January 2024]. doi: 10.1002/dmrr.3266.
15. Senneville É, Lipsky BA, Abbas ZG, Aragón-Sánchez J, Diggle M, Embil JM, et al. Diagnosis of infection in the foot in diabetes: a systematic review. Diabetes Metab Res Rev. 2020; 36(S1):e3281. doi: 10.1002/dmrr.3281.

Publication:

«World of Medicine and Biology» Vol. 20 No. 90 (2024) , с. 112-117
УДК 616.379–008.64–06

DOI:

https://doi.org/10.26724/2079-8334-2024-4-90-112-117