Features of diagnostics and management of complicated forms of diabetic foot syndrome in the Kyrgyz Republic
Authors: Kaziev U. K. , Musaev U. S. , Miklukhin D. S. 
Published: August 2024

Despite of the development of modern diagnostic and treatment technologies, lower limb amputation is performed every 30 seconds in patients with diabetic foot syndrome in the world. Elimination of infection and revascularization of the affected limb are still actual goals inpreserving the foot in diabetic foot syndrome. Studying specific features of the wound process, disease course as well as analyzing the effectiveness of modern diagnostic tools and surgical treatment contribute to the development and implementation of new measures to improve the quality of medical care in patients with complicated forms of diabetic foot syndrome.

Objective. To study specific features of the course of complicated forms of diabetic foot syndrome, to evaluate the effectiveness of diagnostic methods and surgical techniques in such patients.

Material and methods. The researchers have made a comparative analysis of the disease course, quality of its diagnostics and surgical treatment in 420 patients with complicated forms of diabetic foot syndrome, aged 16–85, who were treated at a second-level surgical hospital of the Kyrgyz Republic in January 2015 – December 2022. Study design is descriptive and retrospective. Operated patients with diabetic foot syndrome complicated by purulent-necrotic lesions were enrolled in the study.

Research results. Of all 420 patients, 57.6% were men and 42.4 % were women, in ratio 1.4 : 1.0. By the age parameter, elderly (n = 167, 42.4 %) and middle-aged (n = 155, 36.9 %) patients were more common; old (n = 45, 10.7 %) and young (n = 42, 10.0 %) were less common. The average length of hospital stay was 12.4 ± 1.6 days.

Patients with neuroischemic (n = 211, 50.2 %) and neuropathic (n = 157, 37.4%) forms predominated; less often were patients with ischemic forms (n = 52, 12.4 %). By the Wagner classification, patients with bone lesions (stage 3, 32.1 %) and skin lesions or ulcerations (stage 1, 28.1 %) were met most often too. Involvement of soft tissues till tendon or bone was relatively rare (stage 2, 10.2 %), while finger (stage 4) and feet (stage 5) gangrene was registered in 21.2 % and 8.3 % of cases, respectively.

Of surgical interventions, disarticulation of finger(s) (n = 127, 30.25 %) and surgical debridement of wounds and necrectomy (n = 123, 29.3 %) were made most often; less frequently: incision of purulent foci, necrectomy (n = 87, 20.7 %) and foot amputation (n = 23, 5.5 %). Among high amputations, transfemoral ones were 14 folds more common (13.3 %) than transtibial ones (1.0 %).

Good outcomes were registered in 173 (41.2 %) patients discharged with complete wound healing or with 70% wound healing, with eradicated pain and eliminated general/local inflammation processes as well as with normalized laboratory parameters. Satisfactory outcomes were in 163 (38.8 %) patients, in whom at discharge, there was incomplete wound healing (less than 70 %) despite normalized clinical and laboratory parameters and decreased pain. In 84 (20.0 %) patients, outcomes were evaluated as unsatisfactory; they had no local signs of wound cleansing or healing, but had progressing tissue ischemia, pain, clinical and laboratory indicators of inflammation. Postoperative mortality was 3.3 %.

Conclusion. High proportion of unsatisfactory outcomes (20.0 %) and high amputations (14.3 %) with predominance of transfemoral (13.3 %) over transtibial (1.0 %) types, mainly in patients with ischemic and neuroischemic forms, may be explained by the insufficient amount of medical equipment necessary for extremities revascularization. Such a situation requires better management of medical care in Kyrgyzstan for patients with diabetic foot syndrome so as to improve their quality of life.