Surgical Management of Diabetic Neuropathy Foot Complications

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Surgical Management of Diabetic Neuropathy Foot Complications

Dragoş Eugen Georgescu, Petronel Mustăţea, Octavian Mihalache, Florin Bobircă, Alexandra Agache, Teodor Florin Georgescu, Ovidiu Chiriac, Vlad Marin, Horia Doran, Traian Pătraşcu
Original article, no. 5, 2018
Article DOI: 10.21614/chirurgia.113.5.634
Background: Diabetic foot complications result from the association between peripheral vascular disease, neuropathy and a precarious healing process. Peripheral neuropathy observed in diabetics affects all components of the nervous system, contributing to the occurrence of leg ulcers, musculoskeletal changes, resulting in severe deformities.
The clinical manifestation of these complications ranges from simple lesions to complex entities threatening the loss of pelvic limb or even life (1,2).

Methods: In our surgery department, a significant number of patients with diabetic foot lesions are hospitalized and treated annually, 40% having clinical manifestations of diabetic neuropathy associated. In 2017, a total of 448 patients were hospitalized for complications of diabetes. We performed a retrospective analysis of 150 consecutive patients who underwent surgery for neuropathic diabetic foot lesions.

Results: The analyzed patients had a favorable postoperative progression, benefiting from distal perfusion. Ray resection was the preferred surgical intervention. Major amputation was performed in 10% of cases with extensive gangrene and sepsis, amputation of the calf being preferred in all situations.

Conclusions: The management of these patients is delicate, often multidisciplinary approach being necessary. A well-managed therapeutic attitude can make the difference between preserving or losing the pelvic limb.

Keywords: neuropathy, diabetes, ulceration, Charcot