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Video: Diabetic Foot: A Serious Problem And Its Solution
Diabetic foot: a serious problem and its solution
Diabetes mellitus is a dangerous disease with its complications. One of the sad consequences is diabetic foot syndrome. Why does a diabetic have ulcers and wounds on the leg, how to deal with them, is it possible to save the leg if the process has gone too far? Experts from the Moscow City Clinical Hospital # 17 - endocrinologist Yana Burnasheva and head of the department of purulent surgery Andrey Anikin - are talking.
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“Monitor your blood sugar readings. Control diabetes with insulin and antidiabetic medications. Remember, the disease is dangerous because of its complications”- doctors never tire of warning patients about this. One of the sad consequences is diabetic foot syndrome. Why does a diabetic have ulcers and wounds on the leg, how to deal with them, is it possible to save the leg if the process has gone too far? Experts from the Moscow City Clinical Hospital # 17, which have accumulated unique experience in solving problems of diabetic foot, tell the story - endocrinologist Yana Burnasheva and head of the department of purulent surgery Andrey Anikin.
Yana Burnasheva: Advice from an endocrinologist
Elevated cholesterol and high blood sugar levels cause the diabetic to develop atherosclerosis of the large vessels (arteries) and damage the nerves. As a result, sensitivity decreases: the leg does not respond to temperature, does not feel touch and pain. In such a situation, it is very easy to damage the foot and lower leg during skin cuts (for example, when processing nails) and upon impact. The diabetic will not notice the wound and bruise, since he will not feel it, and in the future this can lead to the development of chronic ulcers.
Prevention of the development of diabetic foot syndrome
This is a combination of many measures: controlling and normalizing blood sugar levels, proper foot care, stopping smoking, fighting excess weight, correcting blood pressure, timely prescribing treatment for the development of diabetic polyneuropathy (this is the name of damage to nerve endings and fibers).
If the patient constantly steps on the wound, it will not heal for a long time. Therefore, it is important to wear special orthopedic shoes (in pharmacies and orthopedic salons a special “half-shoe” is sold to relieve the foot) to reduce the pressure on the wound. Thanks to these shoes, the center of gravity of the body is transferred from the foot to the lower leg.
It is imperative to get rid of the fungus that has appeared on the feet (and it is not uncommon for a diabetic!) With the help of antimycotic agents. When caring for toenails and feet, a diabetic should not use sharp, cutting, stabbing objects - you can only file the nails, and not very shortly, and remove calluses with a special pumice stone purchased at the pharmacy.
You should not wear tight shoes, you should buy comfortable to wear, which will not cause blisters and chafing. After all, these troubles are a trigger for the problems of diabetic foot. When taking a bath, it is best to check the water temperature with your hand so as not to cause burns. It is dangerous to warm your feet with heating pads and electric heaters. If your feet are cold, it is better to wear warm socks without tight elastic bands.
Doctors recommend a diabetic to examine the sole of the foot with a mirror daily. If the patient noticed redness, swelling, pus, he should immediately consult a doctor. Chilliness of the feet, tingling sensation, crawling creeps, rapid fatigue of the legs when walking, cramps of the calf muscles should alert.
First aid for wounds, cuts, abrasions - treating them with an antiseptic (solutions of dioxidine or miramistin) and applying a sterile dressing. The mistake is to treat the wounds with iodine and brilliant green. These products can cause burns. In addition, they paint over the surface of the wound, and the surgeon will not be able to assess the extent of the wound. Also, no medicine in the form of ointments is suitable.
Diagnostics of the diabetic foot syndrome
To diagnose diabetic foot syndrome, methods such as ultrasound examination of the vessels of the lower extremities, electromyography, determination of the sensitivity of culture to antibiotics, and the identification of pathogens from wound infections are used. The patient must undergo an annual examination by specialists - a podiatrist (specialist in footsteps) and a surgeon in the office of the "Diabetic Foot", which are in every district of Moscow at city polyclinics.
Andrey Anikin: How the surgeon will help
It is worth contacting a surgeon in a polyclinic immediately when trophic ulcers appear. This is how doctors call long-term non-healing defects in the tissues of the foot (most often on the plantar surface), formed when the blood supply is disturbed. A diabetic should hurry up to a surgeon if the toes are darkened or reddened , swelling of the foot appears, and the body temperature rises. All these symptoms indicate that a purulent-necrotic process has begun in the foot.
What is the difference between wounds in an ordinary person and a diabetic?
In a diabetic, tissue healing is more difficult, wounds are less cleaned and require longer treatment, and the body's recovery capabilities are reduced. Any trophic ulcer is an entrance gate for infection and can lead to the development of phlegmon of the foot, to osteomyelitis (inflammation of the bone), and sometimes even gangrene. And then the question arises about foot amputation.
There are two forms of diabetic foot.
Neuropathic - when the blood flow in the foot is normal, and in such a situation it is easier to save it. Then surgical treatment of wounds is performed. If there is osteomyelitis of the finger - inflammation of the bone, operations on the foot, resection of the joints are performed. But with the neuroischemic form, when the blood flow suffers due to diabetic angiopathy (damage to the blood vessels of the lower extremities), as a rule, gangrene of the foot develops.
We have to resort to the help of vascular surgeons, they help restore blood flow - they do plastic surgery and stenting of the arteries of the lower extremities. Without restoring blood flow, the foot cannot be saved. Only then sparing local operations are performed aimed at preserving the support function of the foot: surgical treatments - opening and drainage of abscesses, resection of the metatarsophalangeal joints, exarticulation of the fingers, transmetatarsal amputations of the foot (when all the toes are removed, but the foot remains supporting).
The doctors of our hospital have been performing successful skin-plastic surgery for diabetics for several years. They are possible if good blood flow in the foot is restored, inflammations in it are stopped, and the wound or ulcer is covered with bright tissue.
How is skin plastic surgery performed?
It depends on the location of the problem. If the defect is on the dorsum or lateral surface of the foot, it can be closed by grafting a thin 0.4 mm skin layer from the lateral side of the thigh of the same leg. This is a fairly effective way. But if the wound or ulcer is located on the sole of the foot, they must be closed with full-thickness skin grafts. Then the flaps are cut out from the tissues surrounding the sore spot and moved to the wound or ulcer. A full-fledged skin is created.
Plantar ulcers are difficult to treat, because they must be covered with the same tissues, since the skin of the foot is unique in its structure. In our department, we began to use insular medial plantar pedicle flaps on a vascular pedicle to close heel defects. Such an operation is not performed in every Moscow hospital, but we have accumulated a wealth of experience, and almost all methods of skin and plastic surgery are used in the department.
But even amputation of a leg is not a sentence for a patient
In our hospital, whenever possible, they try to perform amputation at the level of the lower leg while preserving the function of the knee joint. The operation is done in 2 stages. First, guillotine amputation. After stabilization of the condition, a stump is formed under the prosthesis. The department cooperates with the orthopedic center, which is engaged in the manufacture of prostheses for patients after amputation. A specialist comes to the patient at the hospital, examines him and preliminarily decides on further prosthetics. Therefore, very soon after discharge, the patient will be able to move around.
But, of course, this is the most difficult option. Therefore, it is so important not to run the problems of the diabetic foot - sometimes seemingly harmless wounds, ulcers, dark spots on the foot should cause a diabetic to be alert. It is necessary to see a doctor as soon as possible.
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