RESUMO
Experience in the treatment of 77 patients with diabetic angiopathy of the lower limbs is discussed. Various pyonecrotic complications developed in 44% of cases. Laboratory and instrumental diagnostic methods included general clinical, biochemical, and coagulation tests, angiography, dopplerography, and rheovasography. Rheovasography was elaborated in 1952 at the Facultative Surgical Clinic head by N. Elansky and is still an informative method. The management of patients with diabetic angiopathy included correction of carbohydrate metabolism, angioprotectors, anticoagulants, and anti-aggregation agents. In patients with pyonecrotic complications intraarterial infusion of the medicinal agents is preferred, the method is used in the clinic since 1951. Operations were performed on 74% of patients, the character of the intervention was determined by the affection of the vascular bed. Reconstructive operations were conducted on 16% of patients. In the absence of conditions for reconstruction lumbar sympathectomy was undertaken. According to indications, the operation was combined with necrotomy or "minor" amputations. Adequate non-operative therapy, improvement of circulation in the limb by reconstructive operations of sympathectomy save the limb or limit the volume of the amputation. Amputation through the middle third of the leg was performed in 7, exarticulation at Chopart's joint in 2 and at Lisfranc's joint in one, and exarticulation of the toes in 10 patients. No fatal outcomes occurred. The thigh was amputated in 13 patients with moist gangrene for vital indications, mortality was 45%. Timely recognition of affection of the arteries in diabetes mellitus is recommended for determining the indications for operative interventions aimed at preventing pyonecrotic complications.
