Identificación por imágenes del paciente con pie diabético del tipo de lesiones que requirieron o requerirán amputación / Identification by images of the patient with diabetic foot of the type of injuries that required or will require amputation

Resumen: Introducción: La diabetes es una enfermedad crónico degenerativa que se desarrolla posterior a una disfunción del páncreas. Se estima que actualmente hay 422 millones de personas en el mundo que cuentan con el diagnóstico de diabetes. Una de sus complicaciones más frecuentes es el pie diabético. Se estima que alrededor de 15% de los pacientes diabéticos tendrán úlceras en las extremidades inferiores. Material y métodos: Es un estudio observacional, descriptivo, prospectivo y transversal. Su objetivo es conocer cuáles son las lesiones iniciales que desencadenaron una amputación en un pie diabético complicado. A los pacientes se les mostraron fotografías clínicas con las imágenes típicas de las patologías para su reconocimiento. Resultados: Se incluyó un total de 50 pacientes entre Enero de 2017 y Julio de 2019. De éstos, 78% (38) pacientes fueron masculinos, 22% (11) femeninos. 22 pacientes (44%) reconocieron el inicio del pie diabético con una úlcera, 13 con flictenas (26%), 10 con hiperqueratosis (20%), cinco con dedos en martillo (10%). Conclusiones: 96% de los pacientes lograron identificar al menos una lesión como factor predisponente para la aparición de pie diabético complicado. La presentación de fotografías clínicas resultó ser una herramienta aceptada por los pacientes. Mediante la identificación de su lesión inicial podemos determinar qué lesión y en qué sitio dio origen a la complicación que los llevó a la amputación. Esta información puede contribuir a tomar medidas preventivas para limitar las amputaciones en los miembros pélvicos de los pacientes diabéticos.

Abstract: Introduction: Diabetes is a chronic-degenerative disease that develops after pancreatic dysfunction. An estimated 422 million people in the world are currently diagnosed with diabetes. One of its most common complications is diabetic foot. It is estimated that about 15% of diabetic patients will have lower extremities ulcers. Material and methods: It is an observational, descriptive, prospective and cross-sectional study. It aims to know what the initial injuries that triggered an amputation in a complicated diabetic foot. Patients were presented with clinical photographs with images typical of pathologies for recognition. Results: A total of 50 patients were included between January 2017 and July 2019. Of these 78% (38) patients were male, 22% (11) female. 22 patients (44%) recognized as the onset of diabetic foot an ulcer, 13 with blisters (26%), 10 with hyperkeratosis (20%), 5 with hammer toes (10%). Conclusions: 96% of patients were able to identify at least one injury as a predisposing factor for the onset of their complicated diabetic foot. The presentation of clinical photographs proved to be a patient-accepted tool. By identifying their initial injury we can determine which injury and where, where, it gave rise to the complication that led them to amputation. This information can help to perform preventive measures to limit amputations in the pelvic limbs of diabetic patients.

Bullosis diabeticorum ­ una lesión poco común / Bullosis diabeticorum ­ an uncommon lesion

IINTRODUCCIÓN: el bullosis diabeticorum forma parte del espectro de manifestaciones cutáneas de la diabetes mellitus, descrito por Kramer en 1930 y nombrado como bullosis diabeticorum por Cantwell y Martz. Es una enfermedad conocida, pero bastante rara (0.5 a 2% de la población diabética) siendo dos veces más común en hombres. Es una lesión espontánea y no está relacionada con trauma o causa fisiológica evidente, como infección, 3 que no causa dolor o se asocia a signos flogísticos. Se asocia principalmente a las extremidades, pudiendo ser una lesión única o múltiples lesiones. Puede ocurrir en la diabetes mellitus tipo 1 (DM1) y en el tipo 2. Las lesiones típicamente se curan espontáneamente de 2 a 6 semanas, pero pueden ocurrir en el mismo lugar nuevamente. El pronóstico es bueno, sin tratamiento específico necesario o seguimiento diagnóstico con biopsia. Se relata un caso de esta rara patología con documentación por resonancia magnética.

Bullosis diabeticorum is part of the spectrum of cutaneous manifestations of diabetes mellitus, described by Kramer in 1930 and named bullosis diabeticorum by Cantwell and Martz. It is a known disease, but quite rare (0.5 to 2% of the diabetic population) and is two times more common in men. Bullosis diabeticorum is a spontaneous lesion and not related to trauma or obvious physiological cause, such as infection that does not cause pain or is associated with inflammatory signs. Occurs at the limbs and may be single or multiple. It can occur in diabetes mellitus type 1 (DM1) and type 2, usually in the advanced stages. The lesions heal spontaneously typically in 2 to 6 weeks, but they may happen again on the same site. The prognosis is good with no need of special treatment or further diagnosis with biopsy. We report a case of this rare complication with magnetic resonance imaging.

Revascularisation in diabetic "small vessel disease" of lower limbs: is it worthwhile?

BACKGROUND: Diabetic patients with critical ischaemia of the lower limb despite a palpable popliteal pulse are presumed to have 'small vessel disease' that is unreconstructable and often subjected to major amputation. Results of revascularisation in such patients are presented. METHODS: A prospective observational study of revascularisation [n = 23, 14 men, mean age 62 years (range 47 to 80)] using saphenous vein to bypass occluded infrapopliteal arteries in diabetics with critical leg ischaemia over a 5-year period. OUTCOME MEASURES: Surgical mortality, graft patency, major amputation rate, time taken for healing, ambulation after discharge from hospital. RESULTS: There was one death within 30 days of surgery. 2/4 early thromboses were salvaged, 5 (5/22) limbs were amputated. Limb salvage was 17/23 (74%). Two limbs were amputated because of thrombosis and 3 were amputated for spreading sepsis despite a patent graft. 2 late graft failures were detected but the limbs remain healed and functional. 15/23 (65%) re-vascularisations remained patent at a mean follow up of 30 months (range 4 to 60). Mean wound healing time was 30 days (range 16 to 45). 14/17 (82%) of those with salvaged limbs were independent with regard to ambulation. CONCLUSION: Bypass of diabetic small vessel disease of the lower limbs is feasible and effective in preventing major amputation and maintaining independent mobility.