Risk factors of high amputations in purulent-destructive forms of diabetic foot and prospects for surgical treatment

Objective. To analyze the risk factors of high amputations in purulent-destructive forms of diabetic foot and evaluate the effectiveness of complex surgical treatment. Material and methods. In 2020—2024, we analyzed treatment outcomes in 101 patients with purulent-destructive forms of diabetic infected foot syndrome. Of these, 64 (63.4%) ones had neuropathic form, 37 (36.6%) — neuroischemic form of disease. The factors leading to high amputations in patients with diabetes mellitus were studied, and a comprehensive program for optimizing surgical treatment was developed. Results. Phlegmon of the feet, shins and purulent wounds after previous drainage predominated (n=41, 64%) among patients with neuropathic form. Neuroischemic form was predominantly characterized by multiple-level atherosclerotic lesions of arteries under purulent process or gangrene of fingers (62%). Drainage of foot and lower leg phlegmons dominated among patients with neuropathic forms (55%), in the group of neuroischemic form — minor amputations (toes, foot) and necrectomy (78%). Various revascularization procedures for critical limb ischemia were performed in 82% of cases. Along with the main surgical measures, various methods of local wound treatment were used. Correction of complications was carried out by various specialists taking into account individual course of disease. Conclusion. An integrated approach with early and wide drainage of lower limb phlegmons in patients with diabetes mellitus, vascular technologies for correction of ischemia and effective local treatment using vacuum therapy, physiotherapy, hyperbaric oxygenation decreased «large» anatomical losses associated with high amputations. Amputation of the lower leg and thigh was performed in 4 (4%) and 3 (3%) cases, respectively (6.9%).