(DLS-027) Evaluation of the results of the introduction of a multidisciplinary approach in the patients with diabetic foot syndrome. Experience Almazov NMRC

Anna Dalmatova, Candidate of medical sciences; Elena Tsvetkova, None – Almazov NMRC; Sergey Mazurenko, None – Almazov NMRC; Vitaliy Solovev, None – Almazov NMRC

Introduction: To assess the feasibility and effectiveness of a multidisciplinary approach in the treatment of patients with diabetic foot syndrome in a single hospital.

Methods: A retrospective analysis of the outcomes of treatment of patients with neuroischemic diabetic foot syndrome was carried out using a multidisciplinary approach at the N.N. V. A. Almazov. The study included 48 patients with neuroischemic form of diabetic foot syndrome who received treatment from 2017 to 2019, which included complex treatment of complications of diabetes and correction of glycemia, assessment of cardiovascular risk, if indicated, revascularization of the myocardium, brachiocephalic arteries, and revascularization of the lower extremities followed by organ-preserving surgery on the foot. 98% of patients had type 2 diabetes mellitus, the average level of glycated hemoglobin was 7.9%. The multidisciplinary team included an endocrinologist, a vascular surgeon, a traumatologist, a cardiologist and a neurologist. The study assessed the healing time of ulcers and postoperative wounds, the percentage of high amputations (above the level of the ankle joint), the percentage of repeated revascularizations and operations on the foot and their causes, as well as mortality from any cause.

Results: In 10.41% of patients, the first stage was myocardial revascularization, in 8.33% - brachiocephalic arteries. After revascularization, complete regression of trophic changes and healing of postoperative wounds were noted in 70.8% (n=34) of patients within 6 months after discharge from the hospital. At the time of discharge, the achievement of the target glucose level was noted in 87.49% (n=42) of patients. Reconstructive surgery on the arteries of the leg was performed in 72.9% (n=35) of patients, endovascular revascularization of the femoropopliteal segment was performed in 70.8% (n=34), iliofemoral — in 35.4% (n=17). ) patients. Repeated revascularizations were performed in 14.5% of cases (n=7). In 68.5% (n=33) of patients, osteoplastic reconstructions were performed, 16.6% (n=8) of which required repeated amputations after discharge from the hospital due to the progression of trophic ulcers. During the three-year follow-up period, 10.41% (n=5) of patients died. Among the causes of death of patients, one can single out AMI (n=3), complications of a new coronovirus infection (n=1), cancer (n=1), in one case the cause of death remained unknown (n=1).