ART OF MEDICINE 2017

 

PROGNOSTIC VALUE OF TRANSCUTANEOUS OXYGEN TENSION IN CHOOSING THE LEVEL OF AMHUTATION IN PATIENTS WITH DIABETIC FOOT SYNDROME COMPLICATED MEDIACALCIFICATION OF ARTERIES

 

R.V. Sabadosh, I.Ya. Myhaloyko, I.S. Myhaloyko, V.A. Reshetylo

             Ivano-Frankivsk National Medical University. Ivano-Frankivsk, Ukraine.

 

Abstract

Resume. The purpose of the study was to investigate the prognostic value of tcpO2 when limb amputations were performed at different levels in patients with DFS with mediacalcification of arteries.

39 patients with diabetic foot syndrome with severe subcompensated diabetes type II were examined and treated. All patients were diagnosed mixed form DFS. According to reconstructive angiography, these patients were not shown either reconstructive surgery on the arteries of the lower extremities or conditions for their implementation. The average age of patients was 65,7 ± 7,2 years. All patients were hospitalized in the surgical departments of Ivano-Frankivsk City Central Hospital.

The diagnosis is established according to recommendations of the International Agreement on diabetic foot. All patients had mediacalcification of arteries foot and lower leg of III-V degree. The degree of mediacalcification was evaluated by V.A. Horyelysheva classification. All patients had grade III-V foot lesions classification by Wagner. Patients definition tcpO2 conducted using the apparatus TCM-2. When amputation of fingers, half-foot amputation tcpO2 measurements carried out on foot in the rear-II between fingers intervals, the performance measurement of high amputations performed at their level (thigh, lower leg). This was evaluated as a result of these interventions depends on the values tcpO2. Measurements were carried out evenly over the area of the capillary bed without large arteries and veins, blemishes or hair.

Amputations were performed at different levels in 39 patients. Reamputations in the early postoperative period, due to the progression of suppurative necrotic process internally were performed in 11 cases. In general, performed 50 amputations and reamputation at different levels.

This has shown that when the amputation level tcpO2≤ 10 mm Hg. reamputation in the early postoperative period (due to progression of suppurative necrotic process at the level of amputation) at higher levels had performed in 4 of 4 cases (100%, 95% CI 39,8-100%) in cases where levels of amputations carried out within the meaning of tcpO2 10-25 mm Hg. reamputations forced performed in 5 of 25 cases (20% 6,8-40,7%), and the amputation of limbs segments at tcpO2 ≥ 25 mm Hg. have not been performed in any case: 0 of 21 (0.0%; 95% CI 0,0-16,1%).

According to the results, if mediacalcification arteries in patients with diabetic foot syndrome amputation of gangrenous limbs modified segments should be at a level where transcutaneous partial pressure of oxygen is greater than 10 mm Hg.

Amputation at tcpO2 ≥ 25 mm Hg. almost always is successful. For values tcpO2 10-25 mm Hg amputation of fingers is advisable to perform resection relevant to metatarsal bone.

Transcutaneous oximetry of diabetic foot syndrome with mediacalcification arteries may be an important, and in many cases the determining factor for optimal level of amputation.

 

Keywords. Diabetic foot syndrome, mediacalcification, level of amputation, transcutaneous oxygen tension.

 

Full text: PDF (Rus)

References
  1. Prevention of diabetic foot ulcer / Iraj, F. Khorvash, A. Ebneshahidi [et al.] // Int. J. Prev. Med. – 2013. – Vol. 4. – P. 373 – 376.
  2. Chammas N. K. Increased mortality in diabetic foot ulcer patients: the significance of ulcer type / N. K. Chammas, R. L. Hill, M. E. Edmonds // J. Res. – 2016. – Vol. 32. – P. 7 – 14.
  3. Yazdanpanah L. Literature review on the management of diabetic foot ulcer / L. Yazdanpanah, M. Nasiri, S. Adarvishi // World J. Diabetes. – 2015. – Vol. 6 (1). – P. 37 – 53.
  4. Gibbons W. Diabetic Vascular Disease: haracteristics of Vascular Disease Unique to the Diabetic Patient Gary / W. Gibbons, M. Palma Shaw. // Semin. Vasc. − 2012. – Vol. 25. – P. 89 − 92.
  5. Краснов О. Г. Рентгенологічні критерії прогнозування тяжкості перебігу синдрому діабетичної стопи / О. Г. Краснов, С. Д. Хіміч, В. І. Ляховський // Клінічна хірургія. − 2013. − № 11. – С. 16.
  6. Medial vascular calcification revisited: review and perspectives / P. Lanzer, D. Manfred, V. Sorribas [et al.] // Eur. Heart J. – 2014. – Vol. 35. – P. 1515 –
  7. Реконструкції артерій гомілки у хірургії дистальних оклюзійно-стенотичних уражень / І. І. Кобза, Р. А. Жук, Ю. Г. Орел [та ін.] // Науковий вісник Ужгородського університету, серія «Медицина». – 2012. – № 3 (45). – С. 31 − 33.
  8. Bradley L. Secondary prevention of arteriosclerosis in lower limb vascular amputees: a missed opportunity / L. Bradley, S. Kirker // Eur. J. Vasc. Endovasc. Surg . – 2006. – № 32. – Р. 491 − 493.
  9. Международное соглашение по диабетической стопе. Составлено Международной рабочей группой по диабетической стопе. −М. : Берег, 2011. − С. 96.
  10. Транскутанная оксиметрия в клинической практике: Методические рекомендации / В. А. Ступин, А. И. Аникин, С. Р. Алиев // Москва, 2010. – 57 с.
  11. Балацкий Е. Р. Ампутации и экзартикуляции нижних конечностей в условиях нарушенной трофики / Е. Р. Балацкий – Донецк: ЛАНДОН – ХХІ, 2015. − 199 с.
  12. Prevention and management of foot problems in diabetes: a Summary Guidance for Daily Practice 2015, based on the IWGDF Guidance Documents / C. Schaper, J. J. Van Netten, J. Apelqvist // Diabetes Metab Res Rev. – 2016. – Vol. 32. – P. 7 – 15.
  13. Test characteristics of the ankle-brachial index and ankle-brachial difference for medial arterial calcification on X-ray in type 1 diabetes / J. Ix, R. Miller, M. Criqui [et al.] // J. Vasc. Surg. – – Vol. 56. – P. 721 – 727.
  14. Ankle brachial index combined with framingham risk score to predict cardiovascular events and mortality: a meta-analysis / FG. Fowkes, GD. Murray, I. Butcher [et al.] // 2008. – Vol. 300. – P. 197 − 208.
  15. Hoyer C. Randomised diagnostic accuracy study of a fully automated portable device for diagnosing peripheral arterial disease by measuring the toe brachial index / C. Hoyer, J. Sandermann, L. Petersen // Eur. J. Vasc. Endovasc. Surg. – 2013. – Vol. 45. – P. 57 – 64.
  16. Ankle-brachial index, toe-brachial index, and cardiovascular mortality in persons with and without diabetes mellitus / S. Hyun, N. Forbang, M. Allison [et al.] // J. Vasc. Surg. – 2014. – Vol. 60. – P. 390 – 395.
  17. Transcutaneous oximetry but not arterial toe blood pressure or ankle-brachial index is related to macular thickness in patients with chronic diabetic foot ulcers / A. Sellman, M. Londahl, S. Andreasson [et al.] // J. Exp. Integr. Med. – 2013. Vol. 3 (2). – P. 81 – 85.
  18. Удосконалення хірургічної техніки ампутації пальців та лікування хворих із синдромом діабетичної стопи / М. О. Приступюк, Б. Г. Безродний // Эндокринная хирургия. – 2015. − № 8 (72). – С. 113 – 117.
  19. Удосконалення органозберігаючого лікування синдрому діабетичної стопи з урахуванням особливостей перебігу ранового процесу / О. Г. Краснов, О. М. Люлька, М. І. Кравців [та ін.] // Клінічна хірургія. – 2015. – № 11.2. – С. 72 – 74.