ACADEMIC RESEARCH IN MODERN SCIENCE
International scientific-online conference
81
OPTIMISATION OF SURGICAL TREATMENT OF PURULENT-
NECROTIC COMPLICATIONS OF DIABETIC FOOT SYNDROME
Davlatov Salim Sulaymonovich
Bukhara State Medical Institute named after Abu Ali ibn Sino
https://doi.org/10.5281/zenodo.13302178
Relevance.
According to WHO, "...much has been achieved worldwide in
the treatment of diabetic foot syndrome (DFS), multidisciplinary approaches to
treatment have been developed ..." [9]. [5, 9]. However, despite all the
achievements, the number of leg amputations for purulent-necrotic
complications of Diabetic Foot Syndrome is increasing, with "every hour in the
world 55 diabetic patients lose a lower limb, which in turn is accompanied by a
high mortality rate, treatment and rehabilitation costs ..." [4, 7]. In the world
practice, scientific studies are conducted to develop new approaches to
determining the optimal level of lower limb truncation in severe purulent-
necrotic complications of DFS, which could not only save the lives of patients,
but also create favourable conditions for healing of the amputation stump and
early rehabilitation of this category of patients [1, 2, 6, 8]. At the same time, it is
of particular importance to assess the viability of the lower limb tissues at the
level of which amputation is planned to be performed in order to prevent
purulent-necrotic complications from the amputation stump, which in most
cases leads to reamputation at best, and at worst, to the development of
systemic inflammatory response syndrome, as well as multi-organ dysfunction
with lethal outcome [3, 5, 10].
Purpose of the study.
Improving the results of complex surgical
treatment of patients with purulent-necrotic complications of diabetic foot
syndrome by optimising the methods of determining the proper level of
amputation of the affected lower limb.
Material and methods of research.
The results of complex examination
and surgical treatment of 312 patients with purulent-necrotic complications of
DFS who were hospitalised in the department of purulent surgery of Bukhara
Regional Multidisciplinary Medical Centre in the period from 2017 to 2023 were
analysed. All patients had different signs of severity of systemic inflammatory
response syndrome. In accordance with the objectives of the study and
depending on the complex treatment and methods of determining the level of
amputation, the patients were conditionally divided into two groups. The first
(2017-2020) group consisted of 159 (50.96%) patients, for whom the complex
of surgical treatment consisted of amputations at different levels of the lower
extremities for vital indications, using traditional methods before surgical
ACADEMIC RESEARCH IN MODERN SCIENCE
International scientific-online conference
82
preparation. The second, main group (2021-2023) consisted of 153 (49.04%)
patients who underwent amputations of lower limbs at different levels for vital
indications.
Results and their discussion.
Depending on the method of determining
the optimal level of lower limb amputation and control of endogenous
intoxication manifested as systemic inflammatory response syndrome, all 312
treated patients were conditionally divided into 2 comparable groups. At the
same time, the main vital signs as well as the local status of the volume of
performed surgical interventions were representative. That is, when forming the
groups we observed the principle of representativeness: the parameters and
volume of the lower limbs lesions and concomitant diseases were close to each
other. The analysis of the degree of lower limb lesions showed that the
pathological processes on the affected lower limbs in the compared groups of
patients were comparable. Thus if in patients of the comparison group purulent-
necrotic phlegmon was 28,2% of cases, in the main group it was observed in
28,10% of cases accordingly. Gangrene of the toes in patients of the comparison
group was 40.25% of the total number of patients, while in the main group these
figures were 40.52% of cases, gangrene of the distal part of the foot was
observed in 21.38% and 21.57 cases, respectively. Creeping putrefactive
phlegmons of the foot, carpal space and tibia accounted for 10.06% and 9.80%
of cases, respectively. The analyses of comorbidities in the comparison groups
were also similar, i.e. representative. It is necessary to emphasise the fact that in
the comparison group of 159 patients the number of performed amputations at
different levels of the lower limbs was 197 (123,9%), i.e. after primary
amputation against the background of pathological process progression and
wound infection we resorted to reamputation, which increased the number of
operative interventions. The number of performed amputations in 153 patients
of the main group was 169 (110.5%) respectively. The state of the haemostasis
system in the compared groups on the background of the conducted complex of
measures, in the comparative analysis we did not reveal any special reliable
differences, i.e. they were comparable.
The analysis of the results of surgical
treatment (limb amputation) of the control group of patients showed that
against the background of a complex of therapeutic measures in 38 (23.9%)
patients of the study group there was a progression of both the pathological
process at the level of amputation (purulent-necrotic complications) and signs
of systemic inflammatory response syndrome (SIRS). The analysis of the results
of surgical treatment (limb amputation) in the main group of patients showed
ACADEMIC RESEARCH IN MODERN SCIENCE
International scientific-online conference
83
that against the background of complex measures 16 (10.5%) patients of the
study group showed progression of both pathological process at the level of
amputation (purulent-necrotic complication) and signs of SIRS. A comparative
analysis of purulent-necrotic complications that were the reason for performing
lower limb reamputations at a higher level showed that while purulent-necrotic
complications from the amputation stump of the fingers in the comparison
group accounted for 8.8%, in the main group these complications were observed
in 3.9% of patients. Progression of wound infection at the level of the foot in the
comparison group was 6.3%, while in the main group of patients 3.3% of cases.
Progression of the wound infection on the side of the amputation stump of the
tibia in the comparison group was observed in 3,9% of patients, while these
indicators in the main group of patients made up 3,3% of cases. Progression of
wound infection on the side of the thigh amputation stump in the comparison
group was 1.9%, in the main group such complications were not observed. The
comparative analysis of the causes of fatal outcomes in the comparison groups
showed that if in patients of the control group the fatal outcome was 11.95% of
cases, in the patients of the main group this index significantly decreased to
3.92% of cases.
Conclusions.
Application of the developed algorithm allows to radically change
the stratification of amputations at one or another level, based on the
implementation of the principles of routine methods of determining the
expected level of truncation of the limb towards optimisation, allowing to
minimise the number of unjustified high amputations from 23.9% to 10.5% and
lethal outcomes from 11.95% to 3.92% of cases, respectively.
References:
1.
Davlatov S. S., Khamdamov B. Z., & Teshaev Sh. J. (2021) Neuropathic form
of diabetic foot syndrome: etiology, pathogenesis, classifications and treatment
(literature review). Journal of Natural Remedies. Vol. 22, No. 1(2), – P. 147-156.
2.
Khamdamov B. Z., Davlatov S.S., Teshaev Sh.J. (2021) Neuropathic form of
diabetic foot syndrome: etiology, pathogenesis, classifications and treatment
(literature review). Journal of Natural Remedies. Vol. 22, No. 1(2). - P. 147-156.
3.
Khamdamov B. Z., Nuraliev N. A. Pathogenetic approach in complex
treatment of diabetic foot syndrome with critical lower limb ischemia
//American Journal of Medicine and Medical Sciences. – 2020. – Т. 10. – №. 1. –
С. 17-24.
4.
Nuraliev N. A., Khamdamov B. Z. Comparative assessment of the immune
status of patients with diabetic foot syndrome in critical lower limb ischemia
//Toshkent tibbiyot akademiyasi axborotnomasi. – 2020. – №. 1. – С. 132-137.
ACADEMIC RESEARCH IN MODERN SCIENCE
International scientific-online conference
84
5.
Okhunov A. O., Abdurakhmanov F. M. Ways to achieve positive results of
dermaplasty in patients with diabetic foot syndrome //British Medical Journal. –
2023. – Т. 3. – №. 1.
6.
Oltiev U. B., Hamdamov B. Z. Characteristics of changes in cytokine levels
in patients with diabetic foot syndrome on the background of various types of
anesthesia //European research: innovation in science, education and
technology. – 2022. – С. 79-84.
7.
Sattarov I. S. et al. A New Way to Treat Diabetic Foot Syndrome //Journal
of education and scientific medicine. – 2023. – Т. 1. – №. 4. – С. 43-50.
8.
Sulaymonovich D. S., Zarifivich K. B. The state of regional blood flow in
diabetic foot syndrome // Problems of biology and medicine. – 2022. – №. 4. – С.
137.
9.
Zarifovich K. B., Tashpulatovich D. A. Development of diagnostic criteria
for wound process phases in experimental animals with diabetes mellitus and
systemic inflammatory reaction syndrome //Art of Medicine. International
Medical Scientific Journal. – 2022. – Т. 2. – №. 3.
10.
Zarifovich K. B., Uktamovich R. D., Sharifovich R. A. Improving methods for
complex surgical treatment of diabetic foot syndrome //Journal of applied
medical sciences. – 2023. – Т. 6. – №. 4. – С. 4-19.
