In 138 patients with diabetic foot syndrome with polyneuropathy, of which 90 were men (65.2 %) and 48 were women (34.8 %) with a median age of 65.1 years, a total of 291 toe operations with tenotomy of the FHL- or FDL-tendon were performed. Patients were either acutely affected by apical toe lesions (92.1 %) or showed an increased risk of ulcer formation (7.9 %). The median time to closing of the wound was 13 days. It was longer with higher Wagner stages. Of the surgically treated toes 3.1 % were affected by nosocomial infections. At the 1‑year follow-up 92.4 % of the patients did not show pathological results of the operated toe. Recurrence of the DFS occurred mostly during the first 6 months postoperatively. In the first year postoperatively 68.1 % of the patients remained in remission. Of the toes with Wagner grade 0, 93.7 % were free of local recurrence during the entire monitoring period and 72.2 % of the operated toes with Wagner grade 3. Within the first 1.5-8.5 months 13 % of the patients were affected by transfer lesions.
Zusammenfassung
In Deutschland leben ca. 8 Mio. Menschen mit Diabetes mellitus. Eine Spätfolge dieser Erkrankung ist das diabetische Fußsyndrom (DFS), dessen Prävalenz stark ansteigt. Es umfasst alle Veränderungen am Fuß als Folge der diabetischen Polyneuropathie sowie mikro- und makroangiopathischer (periphere arterielle Verschlusskrankheit, PAVK) Veränderungen. Jährlich entstehen ca. 250.000 neue diabetische Fußulzera. Diese werden oft zu chronischen Wunden. Trotz intensiver Bemühungen um Prävention, frühzeitige Diagnostik und stadiengerechte Wundbehandlung werden in Deutschland jährlich ca. 13.000 Majoramputationen bei Diabetikern durchgeführt. Bei konsequenter Therapie des DFS in interdisziplinären Zentren mit Ausschöpfung aller Möglichkeiten der Wundbehandlung, der Druckentlastung sowie einer arteriellen Revaskularisation kann die Majoramputationsrate um bis zu 80 % gesenkt werden. Durch eine geeignete Präventionsstrategie wäre die große Gefahr der Rezidivulzera geringer.
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