MODERN METHODS OF SURGICAL TREATMENT OF DIABETIC FOOT SYNDROME.

Abstract

This article discusses the problems of surgical tactics in diabetic foot syndrome and its complications, both in the early postoperative and remote periods. The above complications require surgeons to search for the most optimal method of surgical treatment.

Aim of the work: to evaluate the results of surgical treatment using different revascularization and non-revascularization methods in patients with diabetic foot syndrome.

Study design: non-randomized controlled clinical trial.

Materials and methods: The article presents the experience of treatment at the University Hospital of NCJSC 'SMU' in the period from 2021 to 2024, where 93 patients were operated on. All patients had narrowing or complete occlusion of arteries of the lower limbs on the background of decompensated diabetes mellitus, which required surgical intervention. The patients were divided into 2 groups based on the results of computed tomography or angiography. The first group consisted of 45 patients who underwent revascularization interventions, while in the second group 48 patients underwent nonrevascularization interventions. The most frequently performed revascularization interventions were balloon angioplasty (53.33%), femoral-pelvic bypass (31.1%), bifurcation aorto-femoral bypass (11.1%); profundoplasty of the deep femoral artery and stenting of the superficial artery were performed less frequently (2.2%). Lumbar sympathectomy (89.58%) and revascularisation osteotrepanation (10.42%) were performed in the group of non-revascularisation interventions.

Results: Most complications were observed in revascularisation interventions. 2 complications were in patients who underwent balloon angioplasty, and 3 complications in patients who underwent femoral-popliteal bypass. In other interventions, as well as in non-vascularisation treatment methods, there were no complications. However, wound healing, and the management of lower limb ischaemia were much better in patients who underwent revascularisation intervention.

Conclusions: This study found that revascularisation therapies such as angioplasty and bypass surgery demonstrate higher efficacy rates in the treatment of patients with diabetic foot syndrome compared to non-revascularisation techniques. Revascularisation improves blood flow, reduces the risk of amputations and accelerates wound healing, which is supported by data on low complication rates in the group of patients who received these interventions. However, despite the clear advantages of revascularisation, the choice of treatment method should be based on individual indications, taking into account the degree of vascular damage, the presence of comorbidities and the general clinical characteristics of the patient. In some cases, for example, in less severe circulatory disorders, non-revascularisation methods may be equally effective and less invasive.