Diabetes and amputations…

It loses no his leg is something that we have connected him more with the Possession (where a lot of soldiers suffered frostbites, gangrene and finally lost utmost their in order to do not lose their life) despite with our current peaceful and “evolved” season. Nevertheless, the amputations of utmost are also current phenomenon. A portion of diabetic patients develops ulcerations of legs that render the amputation inevitable. However the message is optimistic: “Up to the 80% of amputations could be anticipated” say the professor of Medical Faculty and director of [A]´ [Propaideytikis] of Pathological Clinic and Diabetic Centre of Popular Hospital Mr N. [Katsilampros]. With the occasion of circulation of Atlas of Diabetic Leg (Atlas of the Diabetic Foot, publications Wiley, 2002) from Greek professor and his collaborators, “the Step” asked from Mr [Katsilampro] more information and practical advices so as to are anticipated as much as possible more amputations.

Most of we know us the diabetes. Years this illness offends already the 6%-8% population, while the frequency of diabetes of type 2 presents in world scale a increase
such degree in order that many speak for epidemic. With the increase of frequency of diabetes is expected increase of also complications of illness, as eg the coronary illness, the renal insufficiency and the loss of sight. From the knownest complications of diabetes, despite the fact that their frequency between the diabetic patients is increased, they are problems that are related with under utmost and which lead often to amputations.
In the foreigner bibliography it is reported that the medium repercussion of amputations in the individuals with diabetes is four cases in the 1.000 individuals the by year's. This means that between the individuals with diabetes in Greece it will be supposed become 2.400 amputations the by year's, even if, as it points out Mr [Katsilampros], “the existing elements thereupon they are not sufficient and exist the sense that in the country our figures are smaller”.
* The pathological activities
The mainer cause which can lead the diabetic individual to amputation (percentage 85%) it is the appearance of ulceration in the legs, which can be the final result of line of pathological activities, with common denominators the diabetic neuropathy and/or [artiriopatheia]. As explains Mr [Katsilampros]: “The damage neuron in the diabetes (neuropathy) causes loss [aisthitikotitas]. Because this damage the harmful stimuli (wounds, burns, surface you will corrode) do not become perceptible because the patients do not ache. Thus the small damage is not faced in time and the damage grows because the lack of suitable care and the continuing activity. Eg, a small erosion by new shoes in a individual without diabetes causes intense pain and is avoided the use of these footwears. In a individual with diabetes however the surface damage because the lack of pain grows in extent and in-depth and it can [epimolynthei] because the continuing activity. Enough often the damage becomes perceptible from the existence [pyoy] in the socks or in the interior of footwears. In the Surgery of Diabetic Leg of our hospital arrived patients with burns from stoves or with extensive damage from the existence of foreigner bodies in the interior of shoes (small Stones, keys, coins, various sharp objects) that became perceptible with big delay, when the damage was threatening for the leg or even the life because the infections”.
* The figure of footwears
Characteristic consequence of loss [aisthitikotitas] is also the purchase of footwears a until three figures smaller than regular. This happens because the loss [aisthitikotitas] the individuals with diabetes feel that they wear shoes only when these are very narrow and practise in the leg big pressure accomplishing they irritate the remaining functionalism neuron.
The damage neuron causes also atrophy of initiating leg, which with her line leads to deformities to the legs. Characteristic deformities are [gampsodaktylia], the projection of heads [metatarsion] and the shift of subcutaneous grease (“cushions”) under the heads [metatarsion] to the bases of fingers. The all deformities cause [bathmidon] ulcerations in various points of leg. Similarly ulcerations are caused also from a [xirodermia], other consequence of diabetic neuropathy. This causes initially the appearance [ragadon] in the soles, particular in the heels, that if they are not faced can they develop in ulcers. Heavier complication of neuropathy are the appearance nerve-[osteo]-[arthropatheias] ([arthropatheias] Charcot), which causes, if is not diagnosed and is faced in time, complete deformity of leg and weakness [badisis].
* Regional [artiriopatheia]
Second, afterwards the neuropathy, more serious cause for the challenge of damage in the legs is [periferiki] [artiriopatheia], which makes the skin of legs thin and frail in wounds. According to Mr [Katsilampro], “the benefit of blood can be marginal and, when the needs for bigger [aimatosi] and oxygenation are increased (eg, from a infection), then the defensive and [epoylotikoi] mechanisms of organism [aneparkoyn], with result the appearance of threatening infections. When in deed coexists also damage neuron from the diabetes, harmful result of wounds is multiple. In the clinical examination is not infrequent the ascertainment of gangrene in the fingers of legs in individuals with diabetes which had not become perceptible from suffering”.
* The organised centres
The care of individuals with diabetes that has problems in the legs should be provided from organised centres that allocate personnel with experience while often attends the need of collaboration of doctors of various specialities ([diabitologos], [aggeiocheiroyrgos], orthopaedic, experts with knowledge and experience in the manufacture of experts of [orthotikon] footwears and bottom). In this organised centres becomes systematic work and really is saved the legs of individuals with diabetes. As long as for the cost of operation of such centres, Mr N. [Tentoloyris], collaborator of Mr [Katsilamproy], appreciates that she is to the interest of state to cover their expenses than to she has to face the socio-economic consequences of amputations. As characteristically it said to us: “A study in the Britain showed that only the cost of chirurgical intervention for a amputation, without are included the expenses for re-establishment or the loss working hour, corresponds in the cost of purchase of roughly 100 pairs of special footwears for the prevention of appearance of ulcers in the legs…”.
Practical advices
Are not in danger the all individuals with diabetes they present damage in the legs. Increased danger of appearance of ulcers they run through the individuals in which coexists damage neuron and/or the arteries. And in these individuals however they can be anticipated the serious damage, reaches are observed certain simple rules. If you belong in the category of patients with increased danger of appearance of damage in the legs, it would be supposed:
* You look at your legs and the [mesodaktylies] aspects daily. The review of soles can become with the use of mirror or from a other individual.
* You do not walk never without shoes or slippers in or outside from the house.
* You do not even wear shoes without socks, for at an early date time intervals.
* When you buy new shoes you are careful these they have the correct figure.
* You do not always wear the new shoes more than one hour the day and, afterwards the abstraction of shoes, you look at your legs for the existence of wounds.
* You change your shoes once a day (better the midday).
* You look at and you feel the interior of shoes for existence of foreigner bodies or spoiled seams before you wear him.
* You wash your legs at least once a day and you carefully sweep the intervals between the fingers.
* You do not put your legs [konta] or on thermal bodies.
* Before the bathroom you check the temperature of water with the elbow. This should be smaller than 37 degrees of Celsius.
* You do not use [xyrafakia], custards or [epithemata] for the abstraction of [yperkeratoseon]. These should be removed from specialised personnel.
* You cut your nails with such way in order that the surface to the top of fingers is straight line (you avoid, that is to say, the [stroggylema] of nails in the sides).
* When it exists [xirodermia] you apply in the sole and in the dorsal surface, no however and between the fingers, special [enydatikes] custards afterwards the bathroom.
* You ask immediately medical help when you realise certain, be it small, damage in your legs.
The surgery of Diabetic Leg
In the Diabetic Centre of Popular Hospital functions from years special Surgery of Diabetic Leg with the responsibility [diabitologon] (professor N. [Katsilampros], [lektor] Medical Faculty, N. [Tentoloyris], P. [Tsapogas], E. [Diakoymopoyloy] and [lektor] Mr [Makrylakis]). The surgery [synepikoyreitai] by the Orthopaedic Clinic of hospital (E. [Ntoynis], director Orthopaedic Clinical), [loimoxiologoys] (G. [Petrikos], assistant professor, G. [Daikos], helping professor, and A. [Toskas], commissary [A]' YOU), the chirurgical clinics of hospital (directors: professor. [Mpastoynis] and professor A. [Kostakis]), the assistant of professor X. [Liapi] and the nurse with specialisation in the diabetic leg of G of. Mark.