In addition to patients with paralysis due to carotid artery minimal invasive vascular surgery technique also yields successful results in situations such as diabetic foot, gangrene resulting from vascular congestion and Buerger’s disease. The method is applied with local anesthesia as in stroke surgery. We use minimal invasive vascular surgery techniques to treat patients in many different ways. In addition to diabetes, our patient group also suffers from many diseases such as kidney, blood pressure, heart and lung diseases at the same time. With this technique, we are able to keep them away from the risks of standard surgery.
There is a combined treatment and a team in the methods we apply. The treatment is carried out by specialists such as vascular surgeon, infectious diseases doctor, endocrine doctor, plastic surgeon and cardiologist as the doctor who conducts the operation. Because these are the patients in the risk group and they also experience many problems at the same time.
First of all, whatever the diameter of the vein, we can bypass any area that has a canal. But in diabetics, we usually have little chance of having a bypass, because in those patients, capillaries are almost completely dried out. If we can’t do this, we clean the lime within the veins with local anesthesia by opening small incisions. We also administer special drugs in the arteries. If we cannot recover them with these methods, we amputate in the same session if necessary. We’re trying to save the patient by only amputating the fingers and at worst, the heel. We benefit from hyperbaric oxygen therapy if there is an opening in those areas in the future. In the formation of tissue loss, we benefit from plastic surgeons. In an event that the plastic surgeon is not able to transfer the tissue we inject the growth hormone called epithelial growth hormone straight into the tissue.
How many of these patients’ legs can be saved?
All diabetic patients must be saved from the pain of getting their feet or legs cut. In many clinics and hospitals, there are patients who were said “This patient no longer has a chance. Take your patient and find a place to cut off their leg.” and we were able to save those patients. But we are not creating miracles when we are saying this. We just show a little interest in the patient, prepare the patient, and complete the missing things. Of course there are patients who go through amputation among these. The one’s we manage to save are not only our success but also the patient’s. So early diagnosis and treatment are extremely important in those patients. Every diabetic should check their foot every day. They should massage it with moisturizing cream every day whether or not there is a complaint. This provides both self-treatment and continuous control of the feet. If this happens, the amputation rates will drop or no amputation will be required. Patients caught early can be treated with the use of a simple drug treatment, simple wound care or hyperbaric oxygen therapy.
What should be the target in amputations?
In studies conducted between different diabetic groups abroad during the recent years it was published that diabetic foot had an amputation rate between 60 and 95. In Turkey, there is no clear information regarding the numbers. But from the statistics that we clearly know of show us that the chance for diabetics to develop diabetic foot in their life time is 15 percent. If we look at the statistics in my patient group, my amputation figure in the last 5-6 years is about 20.
On the other hand, the number of patients in which we just amputated the fingers and saved their leg from the heel is quite high. In amputations, the target should always be able to cut as low as possible and to save the leg. We always try to push the gangrene down in diabetic patients or in leg cuts. We try to save one finger, two fingers and at worst, the heel. In amputations, the knee joint is important for us for the patient to be able to use the part of their leg below the knee. But there are such patients that they lose the leg starting from the hip and whatever you do, it does not help. At that, the job is more about saving a life than saving a leg. Sometimes there are such patients that while other centers have decided amputate the leg starting from the hip but we have managed to save the leg in question from the heel.
What is diabetic foot?
In diabetics, especially after neuropathy, wounds and calluses are formed on their feet after they do not feel their feet and are not able to push on them properly. These calluses turn into infections very quickly. Diabetes patients do not necessarily need to have vascular occlusion. There are diabetic patients who lose their legs from the hip even though they have an open vein. When a very serious infection occurs in this region, especially when if it becomes too late, the infection mixes with the blood thus creating a serious result that we call sepsis. Therefore, diabetic foot manifests itself by the occurrence of serious infections that are connected to neuropathy in the feet and the gangrenes which are connected to this phenomenon.
That’s why diabetic foot problems are troubling cases. Patients can also miss the seriousness of this situation because of their lack of care and late realization. Because these patients don’t feel pain. Even if they notice, they don’t ponder on it, thinking it as a simple acronyx or a simple callus. Over time, this wound grows and turns into a serious infection. This time, when they apply to the hospital, if they did not apply to a qualified physician, antibiotic treatments based on oral use are suggested. Because it is a laborious job we can say that it is a job that is not attended to thoroughly. Diabetic foot is something that needs to be thoroughly attended. Therefore, sometimes the patient can bypass the hospital. And these patients in question usually do not have their diabetes under control and because of this the diabetes worsens the wound on their foot and the wound triggers the diabetes. And this makes the patient rot. As a result of this, he goes into sepsis and the life-critical danger begins. The patient, the patient’s relatives and the hospital as well, should be very sensitive about this issue. A simple diabetes wound can sometimes become very complicated and it can lead to the amputation of the leg. And this can lead to both social and economic losses.
This is one of the most important topics regarding diabetic foot vascular surgery.
It is a very important topic regarding diabetic foot vascular surgery. Even if the decision of cutting the leg has been made, the amputation procedure must be performed by a vascular surgeon. In such cases, the patient is usually referred to orthopedics. Indeed; both in the determination of the level and the amputation that is going to be made a vascular surgeon must be present and every vascular surgeon needs to know and accept this. This is important for two reasons. First, vascular surgeon sees the tissue wetting and intervenes accordingly. In orthopedics, traumatic amputation is performed via a tourniquet and blood is not seen. However, in patients whose situation is connected to vascular congestion, this procedure is in the form of intervention to vascular congestion and, if necessary, the removal of the dead part. It is made without a tourniquet and the bleeding on the cut site is observed. And according to this, the level as much as possible is tried to be drawn to the bottom. Diabetic foot policlinics, on the other hand, must be under the control of a vascular surgeon. We have diabetic foot policlinics in my control.