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The complex surgical treatment of necrotic suppurative lesions in the diabetic foot

Author: Eduard Bernaz
Degree:doctor of medicine
Speciality: 14.00.27 - Surgery
Scientific adviser: Nicolae Gladun
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Scientific consultant: Valeriu Mitiş
doctor, associate professor (docent)
Scientific council:


The thesis was presented on the 29 November, 2006
Approved by NCAA on the 18 January, 2007


Adobe PDF document0.57 Mb / in romanian


CZU 617.586–002.4–02:616.379–008.64-06

Adobe PDF document 3.00 Mb / in romanian
130 pages


diabetic foot infection, surgical treatment, diabetic angiopathy


The results of complex surgical treatment of 388 patients with necrotic suppurative complications of diabetic foot (DF) during the period 2000-2005 are presented in this PhD thesis.

291 (75%) of patients formed the control group and 97 (25%) – the study group. The patients with DF from both groups were divided in two subgroups in accordance with the type of lesion: 1 neuropathic form, 2 – neuroischemic form. The male predominated – 62.9%. The age of patients varied from 20 to 88 years, with average of 59.8 years, the average age in the control group was 60.8 years.

We proposed a diagnostic algorithm, which includes clinical, laboratory and imaging data, including multiplanar foot radiography, CT, plantar TcPO2, color duplex scan, angiography.

In the control group surgical treatment was performed without appreciation of clinical anatomical type of DF and was limited to incision, excision, necrectomy and infectious focus drainage with subsequent local treatment until the definitive wound cicatrisation. The results of this tactics were: organ-preserving surgical interventions – 15.8%, primary wound healing – 24.4%, major amputations – 18.2%.

In the study group we applied staged surgical treatment differentiated depending on the clinical anatomical type of DF. In patients with neuropathic form (54 patients) we used following surgical tactics: 1st stage – surgical debridement of the necrotic suppurativ focus, 2nd stage – plasty of wound with local tissues or combined plasty (local tissues and split-skin grafting). In the neuroischemic form (43 patients): 1st stage – open or balloon angioplasty for amelioration of blood flow. In case of impossibility of surgical correction of ischemia medical treatment was administered. At the 2nd stage the surgical debridement of necrotic suppurative focus was performed; 3rd stage - plasty of wound with local tissues or combined plasty (local tissues and split-skin grafting). Using this method we obtained following results: organ-preserving surgical interventions – 99% (p<0,001), primary wound healing – 88.7%(p<0,001), major amputations – 1%(p<0,001).

Thus, modification of surgical tactics in treatment of DF during the period 2003-2005 allowed us to perform more organ-preserving operations, to decrease the number of major amputations and to obtain primary wound healing in 88.7% decrease number of incapacitating interventions, to preserve function of foot and to obtain social and economic rehabilitation of the patients.