Arterial reconstruction and bypass repair for diabetic ischemic-gangrenous foot ulcers; long lasting implicative way for level salvage

Abstract

Limb salvage is the gold aim of attempting any curative procedure for diabetic foot preservation. Arterial reconstruction may be better practical remedy among all other practical preserving protocols for diabetic feet. This retrospective cohort clinical study reflects 5 years experiences in revascularization of ischemic diabetic feet. Patients with Ischemic and non-healed wounds who had received vascular reconstructions are recruited and investigated through their file information. Doppler and angiography reports with recorded Blood Dropping Time index (BDT: time of edge bleeding during cutting until a drop formation) for patients during debridement had been considered. Feasible reconstruction was performed in deferent ways and grafts accompanied by toe pressure in some cases. BDT have compared before and after vascular reconstruction in patients that had been measured and recorded. From different 158 cases, 41 patients (28 male, 13 female) of ischemic, gangrenous diabetic foot wounds were found who had been revascularized by grafting or endartrectomies. They had been admitted 4-22 days (mean= 8.5 days) with >10 years diabetic history. Mean complete improvement time was 34.53 days after surgery. Mean BDT was about 71 seconds before repair and average 8.46 seconds after vascular repair (P=00.002). Detected Toe pressure in 11 cases was <30 mmHg and Toe–Brachial indexes were <0.6. Patency of Dacron was 13 months versus 22-61 months for autogenous vein bypasses for femoro-popliteal and 9-16 months for popliteo-tibial. Revascularization in arterial occlusions or severe stenosis of diabetic feet with threatening ischemia might be feasible and efficient and still may account the best way for long standing management especially by autogenous vein utility in which seems to be effective and more economical in comparisons.