Espinosa AA, Escotto SI, Rodríguez TJM, Rodríguez RN, Morales GLG, Marquina RM

Language: Spanish
References: 28
Page: 135-141
PDF size: 154.50 Kb.

ABSTRACT

Objective: To evaluate the usefulness of the LASER Doppler, as a study to predict the relationship regarding the closure of an ischemic injury or limb loss in patients with diabetes mellitus operated for pelvic limbs revascularization.
Materials and methods: The study conducted over a period of 8 months, a study of the Doppler velocimetry on 22 diabetic patients who presented critical ischemia and who were candidates for bypass surgery as a rescue of the limb, determining the parameters base of microcirculation areas adjacent to the site of the injury before and after the derivation surgery in order to determine the redistribution and improved flow characteristics in terms of microcirculation in the distal beds. The studies were conducted with the system PeriFlux System LASER Doppler 5000, with measurements capillary flow to his income and after two days of surgery, in order to determine what parameters were related to the wound and which were related to the failure of management of the wound, or even conditioned the subsequent amputation of the limb.
Results: Determining achievement with a statistically significant result that patients with preoperative capillary flow under 12 mv failed to close their wounds even with a successful surgery, so those same patients with postsurgical capillary flow over 40 mv presented in a 100% successful closure of the ischemic wound.
Conclusions: The study of LASER Doppler capillary flow has a predictive value in the closure of ischemic wounds in diabetic patients, comparing the value capillary flow in the preoperatory period to the postoperatory.

REFERENCES

1. Shultz G, Mozingo D, Romanelli M, et al. Wound Healing and TIME: new concepts and scientific applications. Wound Repair and Regeneration 2005; 13(4): S1-S11.

2. Akbari MC, LoGerfo WF. Diabetes y enfermedad vascular periférica. J Vasc Surg 1999; 30(2).

3. Karanfilian GR, Lynch GT, Zirul TV. El valor de LÁSER Doppler y determinación transcutánea de oxígeno como predictores de curación de úlceras isquémicas de miembro pélvico y amputaciones en pacientes diabéticos y no diabéticos. J Vasc Surg 1986.

4. Akbari MC, LoGerfo WF. Diabetes y enfermedad vascular periférica (guest review). J Vasc Surg 1999; 30(2).

5. Rutherford R. Vascular Surgery. 6a Ed. Elsevier; 2005.

6. Frykberg RG. An evidence-based approach to diabetic foot infections. Am J Surg 2003; 186/5A(28): 44S-54S.

7. Wieman TJ. Principles of management: the diabetic foot. Am J Surg 2005; 190: 295-9.

8. Blanes JI, Lluch I, Morillas C, Nogueira JM, Hernández A. Tratado del pie diabético. Cap. III. Ed Mosby; 2000.

9. Arana V, Méndez J. Fisiopatología de las complicaciones vasculares del pie diabético. Gac Med Mex 2003; 139(3).

10. Marinel J, Blanes JL, Escudero JR. Tratado de pie diabético. 2a Ed. Madrid: Editorial Gpo Esteve; 2003.

11. Norgren L, Hiatt WR, Dormandy JA, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg 2007; 45(1).

12. Roeckl W, Bennett M, Kranke P. Systematic review of hyperbaric oxygen in the management of chronic wounds. Br J Surg 2005; 92: 24-32.

13. Brem H, Sheehan P, Andrew L, et al. Protocol for treatment of diabetic foot ulcers. Am J Surg 2004; 187(Suppl.): 1S-10S.

14. Lipsky B, Berendt A, Deery G, et al. Diagnosis and Treatment of Diabetic Foot Infections IDSA GUIDELINES (Infectious Diseases Society of America). University of Wa-shington. School of Medicine. Veterans Affairs Medical Center, Pennsylvania. Harvard Medical School, University of Texas, Galveston, Texas. New Jersey School of Medicine. Clinical Infectious Diseases 2004; 39: 885-910.

15. Pedrosa HC, Leme LAP, Novaes C, et al. The diabetic foot in South America: Progress with the Brazilian. Save the Diabetic Foot project. Int Diabetes Monitor 2004; 16: 17-24.

16. Brand P, Yancey P. Pain: The Gift Nobody Wants. Harper- Collins. Zondervan; 1993.

17. Boulton AJM. The diabetic foot – from art to science. Diabetologia 2004; 47: 1343-53.

18. Wahlberg E, Jorneskog G. Patients with Diabetes and Critical limb Ischemia Have a High Peripheral Vascular Resistance. Ann Vasc Surg 1997; 11: 224-9.

19. Rosenblatt MS, Quist WC, Sidaway AN, et al. Result of vein graft reconstruction of the lower extremity in diabetic and nondiabetic patients. Surg Gynecol Obstet 1990; 171: 331-5.

20. Earnshaw JJ, et al. The evidence for Vascular Surgery. 2nd Ed. TFM; 2007, p. 91-100.

21. Hurley JJ, Auer AI, Hersey FB, et al. Distal arterial reconstruction: Patency and limb salvage in diabetes. J Vasc Surg 1987; 5: 7807-96.

22. Dormandy JA, Rutherford RB. Management of Peripheral Arterial Disease. TASC Working Group. J Vasc Surg 2000; 31: S1-S296.

23. Ganda OP, Arkin CF. Hyperfibrinogenemia: An important risk factor for vascular complications in diabetes. Diabetes Care 1992; 15: 1245-50.

24. Ubbink TD, Spincemaille G, et al. Predicción de amputación inminente en pacientes con isquemia no reconstruible en términos de investigaciones de microcirculación. J Vasc Surg; 30(1).

25. De Graff CJ, Ubbink TD. La utilidad del LÁSER Doppler en la medición de presiones de los dedos del pie. J Vasc Surg 2000; 23(6).

26. Castronuovo JJ Jr, Adera MT, Smiell MJ, Price MR, Moorristown NJ. Medición de perfusión transcutánea es valorable en el diagnóstico de la isquemia crítica. J Vasc Surg 1997; 26: 629-37.

27. Graziani L, Silvestro A, et al. Involucro vascular en pacientes diabéticos con úlceras isquémicas: una nueva clasificación morfológica en relación a la severidad de la enfermedad. Eur J Vasc Endovasc Surg 2007; 33: 453-60.

28. Sottiari V, White VJ. Revascularización extensa o amputación primaria: qué pacientes con isquemia crítica no deben ser revascularizados. Seminars in Vascular Surgery; 2007-02-09.