Treatment outcomes in patients with neuroischemic diabetic foot

Trandofilov A.M., Sapronova N.G., Khripun I.A., Kalinina A.A., Antonenko G.V.

Rationale: Diabetic foot syndrome remains one of the leading causes of non-traumatic amputations worldwide, with the neuroischemic form characterized by the most severe course and unfavorable prognosis. Despite the development of revascularization techniques, the incidence of major amputations reaches 40–60%, and postoperative mortality remains high. There is an urgent need to optimize the management of these patients to overcome the consequences of ischemia and post-reperfusion complications, making the search for effective integrated approaches critical for modern surgery.

Objective: To evaluate the long-term treatment outcomes of patients with HNO SDS and peripheral circulatory impairment treated with local negative pressure therapy. Materials and Methods: Treatment of patients with HNO SDS associated with critical lower limb ischemia (CLLI) has been a key focus of the Department of Cardiovascular Surgery at the Vascular Center of Rostov State Medical University (RostSMU) for over 30 years. Over the past years, the clinic has treated over a thousand patients with this condition. A multidisciplinary approach involving various specialists (endocrinologists, cardiologists, cardiovascular and endovascular surgeons, orthopedists, microbiologists, and pharmacologists) enables us to achieve the short- and long-term treatment outcomes presented in this study. A comparative analysis of data from 65 patients was conducted, divided into two groups: a study group (n = 33), which utilized a developed protocol with vacuum therapy after revascularization, and a control group (n = 32), which received standard treatment.

Methods: The methodology included assessment of transcutaneous oximetry, hospital stay, wound healing, and limb survival rates (Kaplan-Meier scale). Results: This study presents for the first time a rigorous three-stage treatment algorithm, in which local negative pressure well-pressure therapy (NPWT) is considered not as an additional method, but as a mandatory element integrated into a unified approach immediately after the restoration of main blood flow and necrosectomy. Early use of vacuum therapy in the post-revascularization period has been shown to significantly improve microcirculation (confirmed by T_cpO₂T_cpO₂ data) and block the cascade of purulent-necrotic complications more effectively than standard methods. In the study group, high amputations were avoided (0 cases), while in the control group, 5 high amputations at the femur level were performed (19.23%). The total number of amputations (including minor) in the control group was 38.46% versus 7.14% in the study group (p = 0.0043). The average duration of inpatient treatment in the study group was reduced to 11.73±0.23 days compared to 16.39±0.51 days in the control group (p = 0.000001). Complete healing of defects in the study group was faster: on average, 33.94 days versus 44.85 days in the control group (p = 0.01332). On the 5th day after the second stage of treatment, the T_cpO₂ level in the study group was significantly higher (35.32 mmHg) than in the control group (31.01 mmHg).

Conclusion: The authors conclude that integrating local negative pressure therapy into a rigorous algorithm after revascularization significantly improves the prognosis: 100% preservation of limb weight-bearing function was achieved in the study group (versus 84.37% in the control group). This method not only accelerates wound cleansing and granulation but also prevents a cascade of complications leading to repeated disabling surgeries.

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