Modern approaches in the surgical treatment of infectious complications of diabetic foot syndrome

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The study analyzed modern Russian and foreign scientific publications devoted to infectious complications in patients with diabetes mellitus and diabetic foot syndrome. The data of the International Diabetes Federation, the state register of patients with diabetes mellitus, demonstrate that the actual prevalence of diabetes mellitus is much higher than the registered data, which predisposes to large annual economic costs for the prevention, diagnosis, and treatment of diabetes mellitus, taking into account the treatment of complications and monitoring the morbidity of the global population. In the treatment of infectious complications in these patients, classical purulent surgeries are widely used, including opening abscesses and phlegmon and drainage of anatomical spaces of the foot. The classifications of infectious complications of diabetic foot syndrome has evolved. Modern surgical methods of treatment of infectious complications in these patients are highlighted. The classical approach to surgical opening and drainage of purulent foci is highly traumatic owing to impaired blood supply and innervation, prolonged postoperative period, and impaired supporting function of the limb, which is irreversible, at least during inpatient stay. The paper also described the use of minimally invasive approaches, including the use of endovide support, for the drainage of deep plantar phlegmon and the performance of staged rehabilitation, including additional treatment methods such as ultrasound cavitation, local application of negative pressure, and ozone therapy.

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About the authors

Sergey Yа. Ivanusa

Military Medical Academy of S.M. Kirov

ORCID iD: 0000-0003-3948-6928
SPIN-code: 8752-1600

doctor of medical sciences, professor

Russian Federation, Saint Petersburg

Boris V. Risman

Military Medical Academy of S.M. Kirov

ORCID iD: 0000-0002-6634-4450
SPIN-code: 8022-6313

doctor of medical sciences

Russian Federation, Saint Petersburg

Rauan E. Shaiakhmetov

Military Medical Academy of S.M. Kirov

Author for correspondence.
ORCID iD: 0000-0002-4459-4790
SPIN-code: 9334-1613


Russian Federation, Saint Petersburg


  1. Akashev RV, Piksin IN, Pigachev AV. Klassifikatsiya diabeticheskoi stopy "LANOTPAD". Meditsinskii al’manakh. 2013;(5(28)):165–168. (In Russ.).
  2. Karpushkina PI, Pigachev AV, Chapaev NA. Ozonoterapiya v lechenii gnoino-nekroticheskikh oslozhnenii nizhnikh konechnostei u bol’nykh sakharnym diabetom. Vestnik nauchnykh konferentsii. 2016;(1-5):98–100. (In Russ.).
  3. Artykova DM, Shagazatova BKh, Urunbaeva DA, et al. Syndrome of Diabetic Foot. Vestnik Soveta Molodykh Uchenykh i Spetsialistov Chelyabinskoi Oblasti. 2015;(2(9)): 70–76. (In Russ.).
  4. Dedov II, Antsiferov MB, Galstyan GR. Sindrom diabeticheskoi stopy. Klinika, diagnostika, lechenie, profilaktika. Moscow. Universum Publishing; 1998. P. 49–69. (In Russ.).
  5. Mezhdunarodnoe soglashenie po diabeticheskoi stope. Sostavleno Mezhdunarodnoi rabochei gruppoi po diabeticheskoi stope. Moscow: Bereg; 2000. 20 p. (In Russ.).
  6. Algorithms for specialized medical care for patients with diabetes mellitus, 7th edition, Dedov II, Shestakova MV, eds. Moscow; 2015. 112 р. (In Russ.).
  7. Apelqvist J, Bakker K, van Houtum WH, et al. Practical guidelines on the management and prevention of the diabetic foot: based upon the International Consensus on the Diabetic Foot (2007) Prepared by the International Working Group on the Diabetic Foot. Diabetes Metab Res Rev. 2008;24(1):181–187. doi: 10.1002/dmrr.848
  8. Dedov II, Shestakova MV, Vikulova OK, et al. Epidemiological characteristics of diabetes mellitus in the Russian Federation: clinical and statistical analysis according to the diabetes registry. Diabetes Mellitus. 2021;24(3):204–221. (In Russ.). doi: 10.14341/DM12759
  9. Mandolfino T, Canciglia A, Salibra M, et al. Functional outcomes of transmetatarsal amputation in the diabetic foot: timing of revascularization, wound healing and ambulatory status. Updates Surg. 2016;68(4):401–405. doi: 10.1007/s13304-015-0341-0
  10. Galstyan GR. Principles of care in diabetic foot patients in Russian Federation. Diabetes mellitus. 2009;12(1):4–7. (In Russ.). doi: 10.14341/2072-0351-5411
  11. Mitish VA, Paskhalova YuS, Eroshkin IA, et al. Pyo-necrotic changes of the foot, critical limb ischemia and diabetes mellitus. Surgical treatment. Russian Sklifosovsky Journal of Emergency Medical Care. 2012;(1):35–39. (In Russ.).
  12. Levin ME. The diabetic foot. O’Neal: Mosby; 2001. 790 р.
  13. Risman BV. Lechenie gnoino-nekroticheskikh oslozhnenii sindroma diabeticheskoi stopy [dissertation]. Saint Petersburg; 2011. 219 p. (In Russ.).
  14. Obolensky VN, Nikitin VG, Leval PSh, et al. Lechebno-diagnosticheskii algoritm pri sindrome diabeticheskoi stopy: standarty i novye tekhnologii. RMJ. 2012;(12):585–598. (In Russ.).
  15. Antsiferov MB, Komelagina EYu. Sindrom diabeticheskoi stopy. Diagnostika, lechenie i profilaktika. Moscow: Medical Information Agency; 2013. 304 p. (In Russ.).
  16. Boulton AJ, Armstrong DG, Albert SF, et al. American Diabetes Association; American Association of Clinical Endocrinologists. Comprehensive foot examination and risk assessment: a report of the task force of the foot care interest group of the American Diabetes Association, with endorsement by the American Association of Clinical Endocrinologists. Diabetes Care. 2008;31(8):1679–1685. doi: 10.2337/dc08-9021
  17. Gostishchev VK, Afanasiev AN, Khokhlov AN. Surgical treatment of diabetic osteoarthropathy complicated by purulent-necrotic lesions of the feet. Khirurgiya (Mosk). 1999;(8):40–44. (In Russ.).
  18. Lipsky BA, Senneville É, Abbas ZG, et al. Guidelines on the diagnosis and treatment of foot infection in persons with diabetes (IWGDF 2019 update). Diabetes Metab Res Rev. 2020;36(1):e3280. doi: 10.1002/dmrr.3280
  19. Briskin BS, Dibirov MD, Khalidov OKh, et al. Choosing method of surgery to cure suppurative and necrotic complications of pancreatonecrosis. Pacific Medical Journal. 2007;(4):38–40. (In Russ.).
  20. Wagner FW. A classification and treatment program for diabetic neuropathic and dysvascular foot problems. American Academy of Orthopedic Surgeons instructional: course lectures. St. Louis: Mosby Year Book; 1979. P. 143–165.
  21. Armstrong DG, Lavery LA. Diabetic foot ulcers: prevention, diagnosis and classification. Am Fam Physician. 1998;57(6): 1325–1332, 1337–1338.
  22. Lavery LA, Armstrong DG, Harkless LB. Classification of diabetic foot wounds. Foot Ankle Surg. 1996;35(6):528–531. doi: 10.1016/s1067-2516(96)80125-6
  23. PEDIS: Perfusion, Extent (size), Depth (tissue loss), Infection and Sensation. International Diabetes Foundation. Brussels; 2003.
  24. Lipin AN, Belivitin AB, Srabionov VO. Surgery of pyo-necrotic forms of a diabetic foot syndrome. Bulletin of the Russian Military Medical Academy. 2008;(4(24)):16–19. (In Russ.).
  25. Complex surgical treatment of purulent – necrotic forms of diabetic foot. In: Selected course of lectures on purulent surgery. Svetukhin AM, Fedorov VD, eds. Moscow: Miklosh; 2007. P. 153–171. (In Russ.).
  26. Bensman VM. Khirurgiya gnoino-nekroticheskikh oslozhnenii diabeticheskoi stopy. Moscow: Medpraktika-M; 2015. 495 p. (In Russ.).
  27. Svetukhin AM, Zemlyanoy AB, Koltunov VA. The follow-up results of patients with necrotic suppurative forms of diabetic foot syndrome. Pirogov Russian Journal of Surgery. 2008;(7):8–11. (In Russ.).
  28. Zemlyanoy AB, Yusupov IA, Kislyakov VA. Cytokine system in purulo-necrotic and recurrent purulo-necrotic complications of diabetic foot syndrome: possibility of immunomodulation. Difficult Patient. 2011;9(10):36–43. (In Russ.).
  29. Nabiev MKh, Abdulloev DA, Yusupova ShYu, et al. Rational surgical tactics in choosing the level of amputation in patients with complicated forms of diabetic foot syndrome. Journal of Postgraduate Medical Education. 2018;(2):58–63. (In Russ.).
  30. Lysova DP, Lysova MP. Malye amputatsii nizhnikh konechnostei pri sindrome diabeticheskoi stopy. Bulletin of Medical Internet Conferences. 2015;5(5):853. (In Russ.).
  31. Grekova NM, Shishmentsev NB, Lebedeva YuV. Operativnye vmeshatel’stva pri sindrome diabeticheskoi stopy: sovremennaya klassifikatsiya i novye tekhnologii. Grekov’s Bulletin of Surgery. 2016;175(5):106–109 (In Russ.).
  32. Fokin AA, Riffel AV, Rudenko AV, et al. "Bol’shie" amputatsii nizhnikh konechnostei posle neudachnykh rekonstruktivnykh operatsii na arteriyakh: blizhaishaya i otdalennaya sud’ba bol’nykh. Circulation Pathology аnd Cardiac Surgery. 2006;(3):72–76. (In Russ.).
  33. Vuorlaakso M, Kiiski J, Salonen T, et al. Major Amputation Profoundly Increases Mortality in Patients With Diabetic Foot Infection. Front Surg. 2021;8:655902. doi: 10.3389/fsurg.2021.655902
  34. Armstrong DG, Swerdlow MA, Armstrong AA, et al. Five year mortality and direct costs of care for people with diabetic foot complications are comparable to cancer. J Foot Ankle Res. 2020;13(1):16. doi: 10.1186/s13047-020-00383-2
  35. Zubarev PN, Ivanusa SYa, Risman BV. Lechenie gnoino-nekroticheskikh oslozhnenii sindroma diabeticheskoi stopy: a textbook for students. Saint Petersburg: Information Agency “Open Forum”; 2015. 36 p. (In Russ.).
  36. Voyno-Yasenetsky VF. (Arkhiepiskop Luka). Ocherki gnoinoi khirurgii. 4th ed. Moscow: Binom; 2008. 720 p. (In Russ.).
  37. Faris I. The managment of the diabetic foot. New York: Churchill Livingstone; 1982. 131 p.
  38. Ivashkevich GA, Golovatsky YaB. Preduprezhdenie i lechenie glubokikh flegmon diabeticheskoi stopy. Grekov’s Bulletin of Surgery. 1991;(4):31–36. (In Russ.).
  39. Emelyanov SI, Matveev LN, Fedenko VV. Laparoskopicheskaya khirurgiya: proshloe i nastoyashchee. Endoscopic Surgery. 1995;(1): 5–8. (In Russ.).
  40. Prudkov MI. Osnovy minimal’no invazivnoi khirurgii. Ekaterinburg: UGMA; 2007. 64 p. (In Russ.).
  41. Operativnaya khirurgiya i topograficheskaya anatomiya: uchebnik dlya meditsinskikh vuzov. Ostroverkhova GE, Bomash YuM, Lubotsky DN, eds. 5th ed., rev. Moscow: MIA; 2013. 736 p.
  42. Bogov AA, Masgutov RF, Khannanova IG, et al. Carpal canal syndrome. Practical Medicine. 2014;2:39. (In Russ.).
  43. Popov PA. Endovideokhirurgicheskie vmeshatel’stva v lechenii ostrykh gnoinykh zabolevanii myagkikh tkanei yagodichnoi oblasti. [dissertation]. Moscow; 2011. 24 p. (In Russ.)
  44. Pietravallo A, Pataro E, Cocozza C, et al. Endoskopicheskie vmeshatel’stva pri nedostatochnosti perforantnykh ven nizhnikh konechnostei. Phlebolymphology. 2003;(19):5–11. (In Russ.).
  45. Souza BG, de Souza Júnior GZ, Rodrigues RM, et al. Surgical Treatment of a Case of Ledderhose’s Disease: A Safe Plantar Approach to Subtotal Fasciectomy. Case Rep Orthop. 2015;2015:509732. doi: 10.1155/2015/509732
  46. Yanishevsky AV. Endovideoskopicheskii metod lecheniya gnoino-nekroticheskikh oslozhnenii sindroma diabeticheskoi stopy. In: Proceedings of the final conference of the military-scientific society of students of the faculty of the leading medical staff. Saint Petersburg: VMA; 2017. P. 429–431.
  47. Shumkov OA, Lyubarsky MS, Nimaev VV, et al. Rol’ nekrektomii v kompleksnom lechenii patsientov s sindromom diabeticheskoi stopy. Meditsina i obrazovanie v Sibiri. 2014;(4):1–8. (In Russ.).
  48. Abad C, Safdar N. From ulcer to infection: an update on clinical practice and adjunctive treatments of diabetic foot ulcers. Curr Infect Dis Rep. 2012;14(5):540–550. doi: 10.1007/s11908-012-0283-3
  49. Tokmakova AYu, Strakhova GYu, Galstyan GR. Sovremennaya kontseptsiya vedeniya bol’nykh s khronicheskimi ranami i sakharnym diabetom. Diabetes Mellitus. 2005;(1):42–48. (In Russ.).
  50. Dobrokvashin SV, Yakupov RR, Valeev AZ. Treatment of patients with purulent-necrotic complications of the diabetic foot syndrome. Practical Medicine. 2011;(6):97–99. (In Russ.).
  51. Mansurova AB. Ultrasonic cavitation in the complex treatment of acute paraproctitis against the background of diabetes mellitus. Herald of KRSU. 2015;15(7):105–107. (In Russ.).
  52. Teplyakov EYu. Primenenie nizkochastotnogo ul’trazvuka i ranevykh pokrytii v lechenii gnoinykh ran (eksperimental’no-klinicheskoe issledovanie) [dissertation]. Krasnoyarsk; 2005. 18 p. (In Russ.).
  53. Mitish VA, Galstyan GR, Doronina LP. The first experience of using the Versajet hydrosurgical system in patients with diabetes mellitus with long-term non-healing foot ulcers. Endocrine Surgery. 2008;2(1):23–24. (In Russ.). doi: 10.14341/2306-3513-2008-1-23-24
  54. Doronina LP, Mitish VA, Galstyan GR. The use of the Versajet hydrosurgical system in patients with diabetic foot syndrome. Diabetes Mellitus. 2010;(3):121–126. (In Russ.).
  55. McCardle JE. Versajet hydroscalpel: treatment of diabetic foot ulceration. Br J Nurs. 2006;15(15):S12–S17. doi: 10.12968/bjon.2006.15.Sup3.21695
  56. Chasnoit ACh, Zhilinsky EV, Serebryakov AE, et al. Action mechanisms of negative pressure wound treatment. Mezhdunarodnye obzory: klinicheskaya praktika i zdorov’e. 2015;4(16):25–35. (In Russ.).
  57. Morykwas M, Simpson J, Punger K, et al. Vacuum-assisted closure: state of basic research and physiologic foundation. Plast Reconstr Surg. 2006;117(7):121S–126S. doi: 10.1097/01.prs.0000225450.12593.12
  58. Othman D. Negative pressure wound therapy literature review of efficacy, cost effectiveness, and impact on patients’ quality of life in chronic wound management and its implementation in the United kingdom. Plast Surg Int. 2012:374398. doi: 10.1155/2012/374398
  59. Zaitseva EL, Doronina LP, Molchkov RV, et al. Features of angenesis against the background of negative pressure wound therapy in patients with neuropathic and neuroischemic forms of diabetic foot ulcers. Grekov’s Bulletin оf Surgery. 2014;173(5):64–72. (In Russ.). doi: 10.24884/0042-4625-2014-173-5-64-72
  60. Belyaev AN, Rodin AN, Gulin AN, et al. Vliyanie ozona na techenie diabeticheskogo ranevogo protsessa // Proceedings All-Russian scientific and practical conference with international participation “Aktual’nye voprosy diagnostiki, lecheniya i profilaktiki sindroma diabeticheskoi stopy“. Kazan; 2010. P. 71–73. (In Russ.).
  61. Belokurov YuN, Molodkin VV. Ozone therapy of purulent wounds. In: 2nd All-Russian Scientific and Practical Conference “Ozone in biology and medicine”: abstract. report. N. Novgorod; 2003. P. 29. (In Russ.).

Supplementary files

Supplementary Files
1. Fig. Surgical approaches during drainage of the phlegmon of the foot: a ― “club-shaped” incision; b ― projection lines of the T-shaped incision; c ― oblique plantar access (according to Konstantini)

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