Dijabetičko stopalo

master's thesis

• Title (english): Diabetic foot
• Author: Martin Boroš
• Mentor: Zvonko Zadro (mentor)
• Committee member: Tomislav Meštrović (predsjednik povjerenstva)
• Committee member: Anko Antabak (član povjerenstva)
• Committee member: Zvonko Zadro (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Surgery); Zagreb
• Defense date and country: 2023-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Surgery

Abstract

U ovom radu opisuju se ključni elementi medicinske skrbi bolesnika s dijabetičkim stopalom i karakteristike tijeka bolesti koje se pojavljuju prije i poslije nastanka samih ulceracija stopala. Dijabetes ima visoku prevalenciju u općoj populaciji i progresijom bolesti dio bolesnika moţe razviti dijabetičke vrjedove stopala. Dijabetičko stopalo moţe zahvatiti bolesnike neovisno o etiologiji dijabetesa i predstavlja vaţnu javnozdravstvenu temu te sa sobom nosi visoke financijske izdatke liječenja. U patofiziologiji nastanka dijabetičkog stopala sudjeluje trijas koji se sastoji od opstruktivnih vaskularnih promjena, dijabetičke neuropatije i djelovanja infektivnih uzročnika. Sistemske promjene specifične za dijabetes imaju ulogu u brţem nastajanju i progresiji aterosklerotske bolesti. U primarnoj zdravstvenoj zaštiti treba omogućiti sveobuhvatnu skrb provodeći prevenciju, liječenje i rehabilitaciju. Problemi vezani uz dijabetičko stopalo u području obiteljske medicine često su kroničnog tijeka, ali akutizacija simptoma i prisutnost infekcije mogu traţiti hitno kirurško liječenje. U sklopu dijabetičkog stopala mogu nastati deformiteti kostiju i zglobova koji oteţavaju liječenje. Infekcije mogu pogoršati kliničku sliku dijabetičkog stopala i bolesnicima moţe biti ugroţen ţivot. Jedan od mogućih ishoda je amputacija prstiju, stopala ili većih dijelova donjeg ekstremiteta. Prevencijom komplikacija i pravilnim liječenjem moţe se utjecati na smanjenje smrtnosti i produţenje preţivljenja. U suvremeno doba dostupni su razni modaliteti kirurške skrbi i postoje razne tehnike koje poboljšavaju ishode i unaprjeĎuju rezultate. Radiološke pretrage imaju vaţnu ulogu u preoperativnom planiranju i praćenju tijeka bolesti. U ovom radu opisuju se osnovna kirurška načela zbrinjavanja rana, odnosno vrjedova na stopalima dijabetičkih bolesnika kao i sloţeniji principi specijalističkog kirurškog liječenja. U kirurškom liječenju vaţni su elementi plastično-rekonstruktivne, vaskularne i ortopedske kirurgije koji se isprepliću na sloţen način i predstavljaju temelj kvalitetnog liječenja.

Abstract (english)

This paper describes the key elements of medical care for patients with diabetic foot and the characteristic course of the disease that can be seen before and after the appearance of foot ulcers. Diabetes has a high prevalence in the general population and progression of the disease may cause for some patients to develop diabetic foot ulcers. Diabetic foot can affect patients regardless of the etiology of diabetes and represents an important public health topic carrying high financial expenses for medical treatment. Pathophysiology of the diabetic foot consists of a triad that includes obstructive vascular changes, diabetic neuropathy, and the action of infectious agents. Systemic changes specific to diabetes play a role in the faster development and progression of the atherosclerotic disease. In primary health care, comprehensive care should be provided by implementing prevention, treatment and rehabilitation. Physicians in the field of general practice often see the chronic manifestations of diabetic foot problems, but acute abrupt symptoms and the presence of infection may require urgent surgical treatment. As part of the diabetic foot problems bone and joint deformities which complicate treatment can occur. Infections can worsen the general condition of the diabetic foot patient and pose a life threatening risk. One of the possible outcomes is the amputation of the fingers, foot or larger parts of the lower limb. By preventing complications and assuring proper treatment it is possible to lower mortality and prolong survival. Various modalities of surgical care are available in modern times and there are various techniques that improve outcomes and results. Radiological diagnostics play an important role in preoperative planning and monitoring the course of the disease. This paper describes the basic surgical principles of treating wounds such as diabetic foot ulcers, as well as the more complex principles of specialist surgical treatment. In surgical treatment, the elements of plastic-reconstructive, vascular, and orthopedic surgery are important, which are intertwined in a complex way and represent the basis of quality treatment.

• Keywords: dijabetičko stopalo; dijabetički vrijed; dijabetička neuropatija; periferna arterijska bolest; infekcija; interdisciplinarno liječenje; prevencija; osteomijelitis; debridman; rekonstrukcija; amputacija
• Keywords (english): diabetic foot; diabetic ulcer; diabetic neuropathy; peripheral arterial disease; infection; interdisciplinary treatment; prevention; osteomyelitis; debridement; reconstruction; amputation
• Language: croatian
• URN:NBN: urn:nbn:hr:105:854922
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-10-23 10:56:58