Possibilities of revascularization osteotrepanation in the complex treatment of purulent-necrotic forms of the diabetic foot syndrome
Objectives. To assess the efficacy of the revascularization osteotrepanation (ROT) in the complex treatment of patients with purulent-necrotic forms of the diabetic foot syndrome (DFS). Methods. We analyzed the treatment results of 24 patients with purulent-necrotic forms of DFS who underwent ROT according to the method of F.N.Zusmanovich (1996). The operation was carried out in case of contraindications for the method of the endovascular and direct revascularization. The critical ischemia was diagnosed according to the results of the ultrasound duplex angioscanning and angiography. To assess the impact of ROT on the lower limb blood supply the partial pressure of the oxygen and carbon dioxide was determined as well as the lactate content in the venous blood of the operated limb and the skin thermometry was also evaluated. Results. The рО 2 reading in the venous blood of the operated limb was found out to increase from 36,9 mm mercury (the interquartile mean (IQM) - 30,0 -43, 0 mm mercury up to 38, 7 mm mercury (IQM - 33,0-47,3) in patients after complex treatment with ROT application. The lactate decrease was registered from 2,17 mmol/L (IQM - 2,12-2,42 mmol/L) up to 1,69 mmol/L (IQM 1,41-1,91 mmol/L). The рСО 2 reading statistically reliably remained unchanged (р=0,895). The skin temperature in the middle third of the shin of the operated limb increased from 28,13°С (IQM 27,82 - 28,64°С) up to 30,33°С (IQM29,23 - 31,78°С). The resection operations on the foot permitting to save the supporting function of the limb were carried out in 81, 8% of patients in 5 months after the performed treatment. Conclusions. Application of ROT in patients with the critical ischemia on the background of the purulent-necrotic forms of DFS leads to the blood supply improvement of the affected limb tissue as well as microcirculation enhancement and minimization of the presented metabolic disturbances; this increases the probability of the resection operations on the foot with saving the supportive function of the limb.