Surgical intervention for diabetic foot

Surgical intervention for diabetic foot

Diabetic foot is a situation when the foot is rotting in diabetes mellitus. Diabetes mellitus disrupts the work of the pancreas, the gland ceases to produce insulin normally, which causes an increased level of sugar in the blood. And sugar has a toxic effect, which is why gangrene of the foot occurs in diabetes mellitus.

The legs are as far away from the heart as possible, that is, they are the worst supplied with blood — therefore, they are the ones who suffer most often. If the elevated sugar level lasts for a long time, it leads to the destruction of all body tissues, including nerve endings. As a result, sensitivity decreases, and the wound on the leg may go unnoticed. At the same time, due to the destroyed vessels, the legs do not receive normal nutrition, so the wound simply will not be able to heal.

Gangrene of the lower extremities in diabetes mellitus does not occur because of diabetes itself. The root cause is always trauma: fungus, ingrown toenail, severe calluses or corns, cuts on the feet and cracked heels. Due to the low sensitivity of the legs, the patient does not notice the injury in time, which is why the wound becomes infected, inflamed and does not heal for a long time. In the extreme stage, such inflammation can turn into diabetic gangrene.

Pathogenesis of diabetic foot gangrene

Gangrene is called complete tissue death, which leads to severe blood diseases and, in the complete absence of medical care, even lead to death.

Surgical intervention for diabetic foot

Usually diabetics develop infectious gangrene. If the wound on the leg does not heal for a long time, pathogenic bacteria gradually accumulate in it, the products of which cause complete tissue death.

Sometimes patients complain that their legs fester with diabetes, even in the absence of injuries. This is a sign of ischemic gangrene, the cause of which is narrowing or complete blockage of veins and arteries. The tissues of the legs die due to the fact that they do not receive blood, and with it oxygen and the necessary nutrients.

Signs of gangrene of the leg in diabetes are not easy to recognize. In the initial stages, it manifests itself only with a slight tingling in the legs and increased fatigue. The shape of the feet may change slightly, but this, too, can often be noticed only by a doctor. Therefore, if your legs often get tired even from normal walking, you should go to the hospital.

If the disease has gone further, then the following symptoms of gangrene of the foot occur in diabetes mellitus:

  • Swelling, redness and blackening of tissues.
  • Severe pain in the legs.
  • urulent discharge from darkened ulcers.
  • Blue veins on the legs.
  • General weakness, chills, fever due to intoxication of the body.
  • Pathogenesis of diabetic foot gangrene

When foot surgery is required

At the very initial stages, when you have just discovered ulcers on the foot, therapeutic treatment is possible — treatment of wounds with antimicrobial agents, bandages, the use of healing ointments. It helps to relieve the load from the feet — wearing special shoes or orthopedic structures.

If medications do not help, you have to resort to surgery. Treatment of gangrene of the lower extremities is surgically necessary in case of a violation of blood supply – drugs in this case will only help to relieve symptoms, but cannot eliminate the cause of the disease, so vascular surgery will be needed.

Types of surgical operations

Vascular operations help to save the leg and stop necrosis — they normalize blood circulation, which contributes to wound healing and restoration of nutrition. The three most popular operations are:

  • bypass surgery;
  • balloon angioplasty;
  • sympathectomy.

Bypass surgery is the creation of a workaround for blood flow. A graft is implanted in the leg, through which blood will flow bypassing the blocked area. The graft attaches to the intact parts of the vessel and replaces the damaged area.

Balloon angioplasty is the expansion of the patient’s own narrowed vessels. To do this, a special balloon is inserted into the vessel, which mechanically inflates it and restores blood flow. Sometimes, after angioplasty, a stent-expander is installed in the vessel, which prevents it from narrowing back.

Sympathectomy is the removal of several lumbar nerves that cause vasoconstriction. This is a complex and rather unpredictable operation, so it is rarely performed.

Treatment of wounds on the legs can also be surgical — necrosis is removed with a scalpel and corns are excised. It is necessary to remove dead tissues because infection multiplies much more actively in them, which eventually leads to severe infection.

Amputation of the leg in diabetes mellitus

With severe tissue necrosis in the late stages of gangrene, vascular operations are no longer effective, since it is no longer possible to revive a dead foot. In this case, it is necessary to resort to amputation — the complete removal of the affected parts of the legs.

Sometimes only the removal of the toes is carried out — they often die in the first place, and if the operation is performed on time, the leg will be saved. Healing after amputation of the fingers is necessarily monitored by a doctor to prevent necrosis of the rest of the foot.

Sometimes amputation of a toe in diabetes mellitus is ineffective, because initially the infection occurred on the foot, or has already moved on. In this case, it is necessary to amputate the entire dead part.

Surgical intervention for diabetic foot

Vascular operations are also performed after amputation to prevent further development of gangrene.

Amputation of the leg in diabetes mellitus

Indications for surgery

Surgical operation is indicated in the following cases:

  1. purulent manifestations on the foot;
  2. darkening and softening of fingers, feet and feet;
  3. severe pain not only during walking, but also at rest;
  4. gangrene of the toe in diabetes mellitus;
  5. lack of effect from taking medications.

The operation can be indicated without therapeutic treatment if the gangrene has already gone too far, or if the patient is contraindicated in taking anti-inflammatory and vasodilating drugs.

Contraindications to surgery

Surgical intervention in diabetes should be carried out with extreme caution. Diabetic wounds heal with difficulty, so any incisions in the leg area can become a source of new inflammation and necrosis. But in most cases, foot surgery is vital, so there can be no complete contraindications to it, especially if we are talking about amputation to save the patient’s life.

Operations may be contraindicated in case of poor blood clotting, HIV, vascular fragility. In this case, they try to cure the disease therapeutically, and if treatment is ineffective and the patient’s life is threatened, amputation is performed.

It is better to avoid operations — to do this, you need to carefully monitor the cleanliness of the legs and consult a doctor at the first injuries or discomfort in the feet.

Douglas Badenoch
I am an information scientist with an interest in making knowledge from systematic research more accessible to people who need it. This means you. I've been attempting this in the area of Evidence-Based Health Care since 1995. So far the results have been mixed. For some reason we expected busy clinicians to search databases and appraise papers instead of seeing patients. We also expected publishers to make the research freely available to the people who paid for it.. Ha! Hence The National Elf service.

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