Gorobeiko M. Methodological approaches to a choice of therapeutic treatment of diabetic foot syndrome on the basis of stratification criteria of the lower extremities ischemia in patients with diabetes mellitus 2 type

Object of the study Diabetic foot syndrome, diabetic peripheral neuropathy and angiopathy, wound healing in critical ischemia and non critical ischemia. Aim of study: Increase the efficiency of treatment in patients with type 2 diabetes with diabetic foot syndrome (SDF) by implementation of new methods and optimal terminology, types of therapeutic treatments based on stratified criteria of ischemia with individual dynamic evaluation of level TcPO2 and level of diabetic polyneuropathy. Theoretical and practical results: We were the first in the world who found the optimal dose and objectively evaluated the use of AL acid and bemiparin as a combination, and individually in neuro-ischemic forms of diabetic foot syndrome. We compared the effectiveness of ultrasound debridement of wounds, regular wound dressing using wound bandages containing ORC-C in comparison to standard debridement and found that ultrasound debridement was much effective , the effect while using special dressings containing ORC-C did not differ from standard procedures. We analyzed the results of treatment and long-time follow up (10-12 years) of patients using the specified criteria ( high or low amputation, mortality) and found the objective margin of critical ischemia, which differs from the generally accepted value in non diabetic patients(14 mmHg v/s 20 mmHg). We formulated a set algorithm which decreases the number of disabled patients and amputations using differentiated combinative treatment of diabetic foot syndrome and optimized the terms used.