Author/Editor		Triller, Ciril; Smrke, Dragica; Parač, Zlatko
Title		Diabetično stopalo - kirurško zdravljenje
Translated title		Diabetic foot - surgical treatment
Type		članek
Source		Med Razgl
Vol. and No.		Letnik 42, št. Suppl 2
Publication year		2003
Volume		str. 69-76
Language		slo
Abstract		Diabetes mellitus and its complications, such as angiopathy and neuropathy, cause the complex diabetic foot syndrome. Ischemic and neuropathic ulcers on diabetic feet are frequently infected, which additionally impedes wound healing and frequently leads to gangrene. The health care of diabetic patients with foot problems must be comprehensive and is nearly always interdisciplinary. Prior to surgical treatment, revascularization by percutaneous transluminal angioplasty should be attempted and infections should be treated by appropriate antibiotics. The goal of surgical treatment is debridement of necrotic tissue and infectious foci, and operative revascularization when needed and feasible. Because gangrene is often rather advanced in diabetic patients, amputation of toes and parts of the foot is often necessary. After amputation, healing of the wound is facilitated by appropriate dressings, and in selected cases by low-energy laser treatment or continuous negative pressure suction of wound excretions. When gangrene extends to the calf, below-knee amputation is often unavoidable. Most patients with below-knee amputation are successfully rehabilitated and ambulatory with a below-knee prosthesis. In case of severe ischemia accompanied by extensive gangrene, above-knee amputation or exceptionally hip exarticulation must be performed. A decrease in the rate of major amputations can be achieved only by educating patients and health care providers, which will lead to an early detection and treatment of foot lesions in diabetic patients.
Summary		Zaradi sladkorne bolezni in njenih zapletov nastajajo na nogah sladkornih bolnikov okvare žilja in živčevja, ki povzročajo "sindrom diabetične noge". Ishemične in nevropatične razjede na stopalih sladkornih bolnikov se pogosto okužijo, kar dodatno otežuje celjenje ran in pogosto vodi v gangreno. Pri obravnavanju sladkornega bolnika z okvarami na nogah je potreben celostni diagnostični pristop, ki vključuje sodelovanje več specialistiov. Pred kirurškimi posegi poskušamo s perkutano transluminalno angioplastiko izboljšati prekrvitev uda in z ustrezno izbiro antibiotikov zdraviti okužbo. Cilj kirurških posegov je odstranitev mrtvin in žarišč okužbe ter operacijsko izboljšanje sladkornih bolnikov je pogosto treba izvajati amputacije prstov ali dela stopala, po čemer poskušamo doseči celjenje ran z ustrezno izbiro oblog, v nekaterih primerih pa tudi z laserskim nizkoenergetskim obsevanjem ali uporabo konstantnega podtlaka za sesanje izločkov rane. Kadar mrtvine segajo na golen, je največkrat potrebna podkolenska amputacija, po kateri se večina bolnikov dobro rehabilitira s podkolensko protezo. Ob zelo slabi prekrvitvi spodnjih okončin in obsežni gangreni je potrebna nadkolenska amputacija, izjemoma pa eksartikulacija v kolku. Zmanjšanje števila visokih amputacij lahko pričakujemo le ob osveščanju bolnikov in zdravstvenih delavcev ter zelo zgodnjem odkrivanju in zdravljenju sprememb na nogah bolnikov s sladkorno boleznijo.
Descriptors		DIABETIC FOOT DIABETES MELLITUS ANGIOPLASTY AMPUTATION