[Treatment of diabetic neuropathic defect at the surgery department and at the center for diabetic foot care].
The aim of the study was to evaluate the treatment of neuropathic diabetic ulcer at the surgery department and the treatment at the diabetic foot centre at dismissal time and 3 months after the dismissal.


METHODS
For assessment of treatment success parameters of glucose control were used (average of daily blood glucose values, glycosylated haemoglobin--HbA1C and glycosylated protein), healing of ulcers (Wagner classification), hospitalisation time and number of amputations. 22 diabetic patients at the centre and 17 patients at the surgical department were observed in this investigation. There was no difference between the groups as for the age, glucose control (HbA1C), and severity of diabetic ulcers (Wagner 3-4). Local and antibiotic therapies were the same ones. Results as median and difference 75th and 25th percentile were evaluated by Wilcoxon test for paired data within the groups and by Man-Whitney test between both of the groups.


RESULTS
In the both group the diabetic control and ulcer healing were significantly improved during hospitalisation period, 3 months after discharge deteriorate diabetic control and ulcer healing stagnated, however, only in the group treated at the surgical department. The hospitalisation time was significantly longer in the surgical group in comparison with the centre group [median 52 days (35)] vs. [median 31 days (38)], p < 0.01. Amount of transmetatarsal and higher amputations was lower at the foot centre in comparison with the surgical group (1 vs. 7). Statistical evaluation was not used for low amount of amputations.


CONCLUSIONS
Team approach at the centre of diabetic foot is effective in the treatment of diabetic foot ulcers, significantly shortened the hospital stay, probably decrease amount of amputations. Three months after discharge the diabetic control and ulcer healing were significantly better in patients treated at the diabetic foot centre.
Rusavý
Z
Z
I. interní klinika Lékarské fakulty UK a FN, Plzen.
Cechurová
D
D
Holubec
L
L
Lacigová
S
S
Jankovec
Z
Z
Treska
V
V
D000368:Aged; D003920:Diabetes Mellitus / Q000097:blood*; D017719:Diabetic Foot / Q000209:etiology / Q000601:surgery*; D003929:Diabetic Neuropathies / Q000150:complications*; D006757:Hospital Units; D006760:Hospitalization; D006801:Humans; D008875:Middle Aged
Lécba diabetického defektu neuropatické etiologie na chirurgické klinice a v centru diabetické nohy.