Necrotizing Infectious Complications in Diabetic Foot Syndrome and their Solutions

Czech version

Authors: R. Ston; J. Weiss
Authors‘ workplace: Chirurgická klinika 3. LF UK FNKV Praha, přednosta: prof. MUDr. R. Gürlich, CSc.
Published in: Rozhl. Chir., 2009, roč. 88, č. 7, s. 381-386.
Category: Monothematic special - Original

Overview

Background:
Diabetic foot syndrome affects an increasing percentage of the population as the incidence and prevalence of diabetes increases. In some cases of the disease, acute necrotizing infectious complications can be observed to the extent that they require acute and extensive surgery débridement, often across anatomical structures. Local treatment is always preceded by vascular examination, possibly limb revascularization.

Methods:
After open necrectomy, which frees the patient from infectious focus and necrotic tissue, and which, in some cases, is the last resort to preserve the limb’s length, there is, in the second period (after the acquisition of granulation tissue in the defect), a need to close the defect. It is possible to let small areas heal spontaneously through epithelialisation from the edges of the wound, however, major defects have to be close either operationally with secondary suture or with dermoepidermal skin-grafting. Secondary suture requires a local shift or additional resection of the bone to obtain sufficient material for wound closure. Skin graft respects the requirement to preserve the maximum of healthy tissue while not slowing down the closure of the wound in large defects.

Results:
Autotransplantation of secondary wound with dermoepidermal skin-graft after the debridement of necrotic tissue was performed in 16 patients. The average age was 58 years, the average surface of skin-grafting was 100 cm², the interval between transplantation and debridement was on average 21 days and from skin-grafting to the healing, of 62 days. 14 patients were completely healed; one patient suffers chronic osteomyelitis, and another one a smack chronic defect in the periphery of the graft. Transplants affecting the plant were localized outside the zone of the foot that bears the most of the body’s weight.

Conclusion:
Local treatment of infectious complications in necrotizing diabetic foot syndrome is important for managing the acute condition and preservation of limb function. It is appropriate to centralize the treatment to podiatric centers cooperating closely with the surgeon specializing on wound healing and diabetic foot.

Key words:
diabetic foot syndrome – necrotizing infection – surgical debridement –dermoepidermal skin – grafting

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