UA22566U - Method for surgical treatment of trophic ulcers at the syndrome of diabetic foot - Google Patents

Abstract

A method for surgical treatment of trophic ulcers at the syndrome of diabetic foot includes excision of ulcer, d-bridement of osseous lesion focus, plastic ulcer closing. The cuts are made on the back or lateral surface of the foot to the lesion area for active drainage through the surface opposite to the ulcer.

Description

Description of the invention

The proposed method refers to the field of medicine, in particular to surgery, and can be used for 2 treatment of deep trophic ulcers in diabetic foot syndrome, primarily caused by osteoarthropathic changes and osteomyelitis of bones or secondary purulent lesions of the corresponding bone structures (penetration of ulcers into bones).

There are known methods of surgical treatment of trophic ulcers (1Й. They include conservative treatment with the use of drugs that promote healing of ulcers, physiotherapeutic procedures. For surgical treatment, excision of the ulcer is used, followed by its plastic closure with an autodermal flap or suturing.

The disadvantages of this type of ulcer treatment are the high probability of ulcer recurrence in the immediate postoperative period, the possibility of continued exudation from the bone lesion area through the ulcer, the rejection of plastic material by the exudate that is released, as a rule, for a long time from the trophic ulcer, 72 even after the excision and sanitation of the bone lesion defeat

The basis of the useful model is the task of improving the method, which ensures an increase in the effectiveness of treatment due to the acceleration of the healing processes of trophic ulcers. The task is solved by the fact that in the method of treating trophic ulcers in diabetic foot syndrome, which includes excision of the ulcer, remediation of the bone lesion, plastic closure of the ulcer, in accordance with a useful 20 model, incisions are additionally performed on the back or side of the foot to the lesion area for active drainage through the surface opposite to the ulcer.

The method is explained with pictures. Fig. 1 shows how operative access is carried out to rehabilitate the focus of destruction and to drain the area of the affected bone, which is performed on the back or side surface of the foot to the area of the lesion and excision of the ulcer. In Fig. 2, the X-ray image shows the limits of removal of the affected bones. In the next 22 stages, the ulcer is closed by one of the methods (free autodermoplasty, sutures are applied). In the next step, drainage is carried out through access outside the trophic ulcer until it heals (Fig. 3).

What is new in the proposed useful model is that access to the focus of destruction is carried out outside the ulcer.

The same access in the following acts as a new drainage channel for the outflow of exudate, unusual for an ulcer, which ensures healing of the ulcer. This method was tested in 6 patients with trophic ulcers on the background of EE, 30 with diabetic foot syndrome, complete healing was achieved in 4 in the short term, in the long term - in 1 patient. In one patient, healing occurred only after amputation of the finger with excision of the ulcer, but the wound on the back of the foot was used to drain the surgical wound. at

An example of a specific use of Ga

Patient V.I. Ponomarenko, 58 years old. He has been suffering from diabetes for 10 years, severe course, type T. At the 35th admission, he complained of the presence of a trophic ulcer in the projection of the III metatarsophalangeal joint on the plantar surface of the right foot, purulent exudation from the ulcer, periodic rises in body temperature up to 37.52C, redness and swelling of the right foot. A trophic ulcer has existed for 5 months, at the site of operative access, where the focus of osteomyelitis of the metatarsal bone was previously opened. In the anamnesis, removal of IM-M of the toes due to osteomyelitis. Trophic ulcer of rounded shape 1.0 cm in diameter, depth - to the metatarsal bone. З7З 70 X-ray confirmed the presence of a focus of osteomyelitis of the head of the metatarsal bone (Fig. 2). In the conditions of the operating room, an incision was made on the back surface of the foot in the projection of the focus of destruction with a length of 2.00 cm, osteonecrectomy was performed, the toe was not removed (Fig. 1). Polychlorinated vinyl tube drainage for washing the lesion area for 5 days was replaced by latex drainage. After 5 days the surface of the ulcer was filled with granulations, a free autodermoplasty was performed. After 23 days, the surface of the ulcer was completely closed, the drainage was stopped. The wound on the back of the foot healed after 4 days. In the next, it is recommended to unload the right foot (walking with a stick). Re-examination After 14 months - hyperkeratosis at the site of the ulcer, where there is no ulcer defect (Fig. 3).

The advantages of the proposed method are that the healing processes of trophic ulcers are accelerated and conditions are created for the engraftment of autoplastic material (skin flaps, sutures that adapt the edges of the wound) (He) 50 due to the creation of a new direction for the outflow of exudate in the immediate postoperative period.

F Sources of information taken into account: 1. Bregovsky V.B., Zaitsev A.A., Zalevskaya A.G., Karpov O.Y., Karpova I.A., Tsvetkova T.L. Lesions of the lower extremities in diabetes mellitus. - St. Petersburg: "Dylya Publishing House", 2004. - 272 p. p

Claims (1)

The formula of the invention The method of surgical treatment of trophic ulcers in diabetic foot syndrome, which includes excision of the ulcer, remediation of the focus of bone damage, plastic closure of the ulcer, which is characterized by the fact that 60 additionally make incisions on the back or side surface of the foot to the affected area for active drainage through the surface opposite to the ulcer. b5