Improving the performance of small amputations in complicated forms of diabetic foot

The aim of the study was comparative assessment of the effectiveness of typical and atypical amputations at the level of footstep in patients with the most complicated course of the diabetic foot syndrome (DFS). The patients suffering from diabetes mellitus type 2 and purulo-necrotic complications of the DFS, treated in the surgical department of the № 1 Pirogov National Surgical and Medical Center of the Sankt Petersburg Clinical Complex were investigated. The study group included 68 patients who underwent atypical surgical interventions taking into account blood flow angiosomes of footstep tissues. Operative interventions at the level of footstep were carried out to 47 patients of the control group. Obligatory angiography was performed in all patients. Operative intervention was carried out under emergency conditions before conduction of angiography only to those patients who were admitted with acute purulent processes in the area of lower extremities. In all other cases individual peculiarities of blood circulation disorder in lower extremities determined the choice of tactics of operative treatment. In 76% and 46% correspondingly, for each group after angiography balloon angioplasty was carried out for reconstruction of the main blood flow. The average duration of the in-patient treatment in study group was 14,4±2,3. In the control group - 18,2±3,1. Conduction of post-operative angiography and when necessary angioplasty in the footstep tissues is prescribed before operative intervention to patients with purulo-necrotic complications of DFS. Application of the principle of angiosome blood flow based on the data of duplex sonography of arteries and angiography enables to choose the most rational tactics of the operative treatment. 3. Application of atypical technique of amputations in the area of footstep after postoperative complications enables to reduce the length of inpatient treatment and to improve postoperative mobility and ability for independent movement of patients.