AIMS: Data about long-term clinical outcomes of revascularization procedures, especially for autologous cell therapy (ACT), in diabetic patients with chronic limb-threatening ischaemia (CLTI) are lacking. The aim of our study was to compare the mortality and amputation rates in patients with diabetic foot ulcers (DFU) and CLTI treated by ACT with patients treated by repeated percutaneous transluminal angioplasty (re-PTA) and those treated conservatively. MATERIALS AND METHODS: One-hundred and thirty patients with DFU and CLTI (defined as transcutaneous oxygen pressure-TcPO2 <30 mmHg after unsuccessful standard revascularization) treated in our foot clinic over 9 years were enrolled in the study. Forty-five patients were treated by ACT, 43 patients underwent re-PTA, and 42 patients were treated conservatively and formed the control group. Overall survival, amputation-free survival (AFS) and major amputation rate were assessed over a 7-year follow-up period. RESULTS: Baseline demographic characteristics and comorbidities were similar between groups. However, patients in ACT and control groups had significantly worse baseline angiograms in accordance with Graziani and GLASS (infrapopliteal region) classifications than the re-PTA group (both p < 0.001), but there were no differences in baseline values of TcPO2 between groups. AFS in the ACT and re-PTA groups were significantly longer compared to control (both p < 0.001). The rate of major amputation was significantly lower in both active groups (both p < 0.001). The re-PTA group showed significantly longer overall survival compared to the control group (p < 0.001), but there was no significant difference between ACT and control groups (p = 0.063) and ACT and re-PTA groups (p = 0.081) in this parameter. CONCLUSIONS: Our study showed significantly longer AFS and lower major amputation rates in patients treated by ACT and re-PTA in contrast to patients treated conservatively. Overall survival was significantly longer only in the re-PTA group. ACT was shown to be effective in long-term limb salvage in people with no-option CLTI.

• Klíčová slova
• cellular research, clinical trial, diabetes complications, effectiveness,
• MeSH
• amputace statistika a číselné údaje   MeSH
• angioplastika * MeSH
• autologní transplantace MeSH
• buněčná a tkáňová terapie * MeSH
• chronická kritická ischemie končetin * terapie   mortalita   MeSH
• diabetická noha * terapie   mortalita   komplikace   chirurgie   MeSH
• ischemie * terapie   mortalita   MeSH
• konzervativní terapie * MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• výsledek terapie MeSH
• záchrana končetiny statistika a číselné údaje   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH

The aim of study was to confirm the hypothesis that advanced medial arterial calcification (MAC)/ small artery disease (SAD), much like the progression of peripheral arterial disease (PAD) stages can adversely impact the outcomes in DFU patients, even after successful endovascular procedures. In retrospective study, we enrolled 54 patients with DFUs who underwent percutaneous transluminal angioplasty (PTA). MAC was quantified using a three-level scoring system based on radiographs. Patients were categorized based on their MAC score into three groups. Study groups were compared in terms of primary DFU outcomes (healing, amputations) and secondary DFU outcomes (mortality, changes in transcutaneous oxygen pressure (TcPO2)) three and six months after PTA. The MAC/SAD score increased significantly with age (p = 0.014). The MAC/SAD score was't associated with the risk of amputation or the healing of DFUs up to three months after revascularization. However, a significant association was observed after six months (p = 0.043). The MAC/SAD score correlated significantly with severity of PAD, as classified by the Global Limb Anatomic Staging System (p = 0.042) and the Graziani system (p = 0.019). We found a negative correlation between the MAC/SAD score and absolute levels of TcPO2 after PTA. MAC/SAD score was significantly associated with long-term unhealed DFUs and the risk of lower limb amputations.

• Klíčová slova
• diabetic foot, peripheral arterial disease, small artery disease, wound healing,
• MeSH
• amputace statistika a číselné údaje   MeSH
• angioplastika * metody   MeSH
• diabetická noha * chirurgie   diagnóza   patofyziologie   MeSH
• hojení ran * fyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• onemocnění periferních arterií * diagnóza   chirurgie   patofyziologie   komplikace   MeSH
• retrospektivní studie MeSH
• senioři MeSH
• stupeň závažnosti nemoci MeSH
• vaskulární kalcifikace * diagnóza   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Because of their aggressive nature and limited treatment options, soft tissue sarcomas present a significant challenge for patients. Isolated limb perfusion with tumor necrosis factor α and melphalan (TM-ILP) has emerged as a promising modality against soft tissue sarcomas aimed at downstaging tumors with significant local invasion, offering a localized approach to deliver high doses of chemotherapy directly to the affected limb while minimizing systemic toxicity. However, its feasibility in centers with limited experience and its true impact on limb salvage remain unclear. Our study aims to address these knowledge gaps by evaluating outcomes in a diverse patient population and assessing factors that influence treatment success and limb preservation. QUESTIONS/PURPOSES: (1) What was the cumulative incidence of amputations at 12 months after TM-ILP in patients with tumors that were initially considered nonsalvageable? (2) What proportion of patients treated with this approach developed early severe complications, defined as death of the patient, compartment syndrome of the treated extremity, or a treatment reaction leading to limb amputation within 30 days from the ILP procedure? (3) What was the all-cause survivorship and survivorship free from local recurrence in patients treated with TM-ILP? METHODS: A retrospective observational study was conducted on patients who underwent TM-ILP for a soft tissue sarcoma that was deemed not amenable for limb salvage between July 2016 and June 2023. During this time, among a total of 528 patients treated for soft tissue sarcoma, 36 patients not considered candidates for a limb salvage procedure by a multidisciplinary tumor board were recommended for TM-ILP. The determination of limb nonsalvageability was based on the feasibility of achieving negative surgical margins and adequate soft tissue coverage after resection. Two patients declined TM-ILP, and a total of 34 patients were included in the study. After the TM-ILP treatment, an MRI was performed, and the feasibility of a limb salvage procedure was reassessed by the same multidisciplinary team against the same initial criteria. There were 12 females and 22 males, and the mean ± SD age was 55 ± 17 years. The most common sarcomas were of the lower extremity (62% [21 of 34]). The most frequent diagnoses were undifferentiated pleomorphic sarcoma (18% [6]) and myxoid liposarcoma (18% [6]). Seventy-six percent (26 of 34) of patients completed ILP followed by surgery, which took place between 2 and 3 months from TM-ILP. For the remaining eight patients, in four patients ILP could not be completed (two attributed to leaks, one attributed to arterial blockage, and one attributed to insufficient venous return), and the additional four patients elected not to proceed with surgery because of systemic disease progression. Seventy-nine percent (27 of 34) of patients were alive and had a documented follow-up of at least 1 year after treatment. To estimate the cumulative incidence of amputation-free survival, we used the survival package in R, version 4.3.2, considering death of the patient as a competing event. For Question 2, the proportion of patients experiencing severe complications was calculated by dividing the number of patients with at least one severe complication by the total number of patients in the cohort, expressed as a percentage. All-cause survivorship and survivorship free from local recurrence analysis for Question 3 was performed using a Kaplan-Meier estimator analysis with SPSS Statistics 29.0.2.0 (IBM). RESULTS: The cumulative incidence of amputations at 12 months after TM-ILP treatment was 13% (95% confidence interval [CI] 75% to 100%) in patients initially deemed to have unresectable lesions. Zero percent (0 of 34) had major complications, death attributed to TM-ILP treatment (0 of 34), compartment syndrome (0 of 34), and amputation attributed to reaction to TM-ILP (0 of 34). All-cause survivorship was 77% (95% CI 63% to 90%) at 12 months and 58% (95% CI 42% to 75%) at 24 months. Local recurrence-free survival at 12 months was 93% (95% CI 83% to 100%) and 84% (95% CI 71% to 97%) at 24 months. CONCLUSION: In this small, retrospective series, TM-ILP allowed limb-sparing surgery in patients with locally advanced or recurrent extremity sarcomas considered borderline resectable. While early results are encouraging, further studies with larger cohorts and longer follow-up times are needed to clarify the role of TM-ILP in multidisciplinary sarcoma care. LEVEL OF EVIDENCE: Level IV, therapeutic study.

• MeSH
• amputace * statistika a číselné údaje   MeSH
• časové faktory MeSH
• chemoterapie nádorů pomocí regionální perfúze * škodlivé účinky   metody   MeSH
• dospělí MeSH
• končetiny chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• melfalan * aplikace a dávkování   škodlivé účinky   MeSH
• nádory měkkých tkání * farmakoterapie   patologie   mortalita   chirurgie   MeSH
• retrospektivní studie MeSH
• sarkom * farmakoterapie   chirurgie   patologie   mortalita   MeSH
• senioři MeSH
• TNF-alfa aplikace a dávkování   MeSH
• výsledek terapie MeSH
• záchrana končetiny * metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH
• Názvy látek
• melfalan * MeSH
• TNF-alfa MeSH

AIM: A diabetes-related foot ulcer (DFU) is a major risk factor for lower-extremity amputation (LEA). To help clinicians predict the risk of LEA in people with DFU, the Diabetic Foot Risk Assessment (DIAFORA) system was developed but has never been externally validated. METHODS: In this study, 317 people presenting with a new DFU were included. At baseline, participants were grouped into three groups based on their DIAFORA score: low-risk (<15), medium-risk (15-25), and high-risk (>25). Participants were followed until healing, LEA, death, or at least 3 months. Discriminative accuracy was evaluated using sensitivity, specificity, likelihood ratios (LRs) and the area under the curve (AUC). RESULTS: All 317 participants completed at least 3 months of follow-up for a median duration of 146 days, during which 12.6% underwent minor amputation and 2.5% major amputation. People in the low- and medium-risk categories had major amputation rates of 0.9% and 2.1%, respectively, and negative LR of major LEA of 0.10 and 0.38, respectively, while the people in the high-risk category had an amputation rate of 25.0% and a positive LR of 12.9. The DIAFORA risk groups had a sensitivity of 75.0% and a specificity of 65.7%, with a corresponding AUC of 0.78 (95% CI 0.68-0.87) for the prediction of major LEA. CONCLUSION: The DIAFORA score is a useful tool for risk stratification of people presenting with a newly occurred DFU, with the external validation presenting results similar to those presented in the original study. The DIAFORA score may guide clinicians towards more individualized DFU treatment regimens.

• Klíčová slova
• diabetic foot, diabetic foot ulcer, lower‐extremity amputations, scoring systems,
• MeSH
• amputace * statistika a číselné údaje   MeSH
• diabetická noha * chirurgie   epidemiologie   MeSH
• dolní končetina chirurgie   MeSH
• hodnocení rizik metody   MeSH
• kohortové studie MeSH
• lidé středního věku MeSH
• lidé MeSH
• prediktivní hodnota testů MeSH
• prospektivní studie MeSH
• rizikové faktory MeSH
• senioři MeSH
• senzitivita a specificita MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• validační studie MeSH
• Geografické názvy
• Dánsko epidemiologie   MeSH

AIM: To assess the impact of autologous cell therapy on critical limb ischaemia in people with diabetes and diabetic kidney disease. METHODS: A total of 59 people with diabetes (type 1 or type 2) and critical limb ischaemia, persisting after standard revascularization, were treated with cell therapy in our foot clinic over 7 years; this group comprised 17 people with and 42 without severe diabetic kidney disease. The control group had the same inclusion criteria, but was treated conservatively and comprised 21 people with and 23 without severe diabetic kidney disease. Severe diabetic kidney disease was defined as chronic kidney disease stages 4-5 (GFR <30 ml/min/1.73 m²). Death and amputation-free survival were assessed during the 18-month follow-up; changes in transcutaneous oxygen pressure were evaluated at 6 and 12 months after cell therapy. RESULTS: Transcutaneous oxygen pressure increased significantly in both groups receiving cell therapy compared to baseline (both P<0.01); no significant change in either of the control groups was observed. The cell therapy severe diabetic kidney disease group had a significantly longer amputation-free survival time compared to the severe diabetic kidney disease control group (hazard ratio 0.36, 95% CI 0.14-0.91; P=0.042); there was no difference in the non-severe diabetic kidney disease groups. The severe diabetic kidney disease control group had a tendency to have higher mortality (hazard ratio 2.82, 95% CI 0.81-9.80; P=0.062) than the non-severe diabetic kidney disease control group, but there was no difference between the severe diabetic kidney disease and non-severe diabetic kidney disease cell therapy groups. CONCLUSIONS: The present study shows that autologous cell therapy in people with severe diabetic kidney disease significantly improved critical limb ischaemia and lengthened amputation-free survival in comparison with conservative treatment; however, the treatment did not influence overall survival.

• MeSH
• amputace statistika a číselné údaje   MeSH
• autologní transplantace MeSH
• buněčná a tkáňová terapie metody   MeSH
• diabetická noha komplikace   epidemiologie   terapie   MeSH
• diabetické nefropatie komplikace   epidemiologie   patologie   terapie   MeSH
• ischemie komplikace   epidemiologie   terapie   MeSH
• kritický stav epidemiologie   terapie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• následné studie MeSH
• noha (od hlezna dolů) krevní zásobení   patologie   MeSH
• retrospektivní studie MeSH
• senioři MeSH
• studie případů a kontrol MeSH
• stupeň závažnosti nemoci MeSH
• výkony cévní chirurgie metody   MeSH
• výsledek terapie MeSH
• záchrana končetiny metody   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH

BACKGROUND: Patients with peripheral artery disease have an increased risk of cardiovascular morbidity and mortality. Antiplatelet agents are widely used to reduce these complications. METHODS: This was a multicentre, double-blind, randomised placebo-controlled trial for which patients were recruited at 602 hospitals, clinics, or community practices from 33 countries across six continents. Eligible patients had a history of peripheral artery disease of the lower extremities (previous peripheral bypass surgery or angioplasty, limb or foot amputation, intermittent claudication with objective evidence of peripheral artery disease), of the carotid arteries (previous carotid artery revascularisation or asymptomatic carotid artery stenosis of at least 50%), or coronary artery disease with an ankle-brachial index of less than 0·90. After a 30-day run-in period, patients were randomly assigned (1:1:1) to receive oral rivaroxaban (2·5 mg twice a day) plus aspirin (100 mg once a day), rivaroxaban twice a day (5 mg with aspirin placebo once a day), or to aspirin once a day (100 mg and rivaroxaban placebo twice a day). Randomisation was computer generated. Each treatment group was double dummy, and the patient, investigators, and central study staff were masked to treatment allocation. The primary outcome was cardiovascular death, myocardial infarction or stroke; the primary peripheral artery disease outcome was major adverse limb events including major amputation. This trial is registered with ClinicalTrials.gov, number NCT01776424, and is closed to new participants. FINDINGS: Between March 12, 2013, and May 10, 2016, we enrolled 7470 patients with peripheral artery disease from 558 centres. The combination of rivaroxaban plus aspirin compared with aspirin alone reduced the composite endpoint of cardiovascular death, myocardial infarction, or stroke (126 [5%] of 2492 vs 174 [7%] of 2504; hazard ratio [HR] 0·72, 95% CI 0·57-0·90, p=0·0047), and major adverse limb events including major amputation (32 [1%] vs 60 [2%]; HR 0·54 95% CI 0·35-0·82, p=0·0037). Rivaroxaban 5 mg twice a day compared with aspirin alone did not significantly reduce the composite endpoint (149 [6%] of 2474 vs 174 [7%] of 2504; HR 0·86, 95% CI 0·69-1·08, p=0·19), but reduced major adverse limb events including major amputation (40 [2%] vs 60 [2%]; HR 0·67, 95% CI 0·45-1·00, p=0·05). The median duration of treatment was 21 months. The use of the rivaroxaban plus aspirin combination increased major bleeding compared with the aspirin alone group (77 [3%] of 2492 vs 48 [2%] of 2504; HR 1·61, 95% CI 1·12-2·31, p=0·0089), which was mainly gastrointestinal. Similarly, major bleeding occurred in 79 (3%) of 2474 patients with rivaroxaban 5 mg, and in 48 (2%) of 2504 in the aspirin alone group (HR 1·68, 95% CI 1·17-2·40; p=0·0043). INTERPRETATION: Low-dose rivaroxaban taken twice a day plus aspirin once a day reduced major adverse cardiovascular and limb events when compared with aspirin alone. Although major bleeding was increased, fatal or critical organ bleeding was not. This combination therapy represents an important advance in the management of patients with peripheral artery disease. Rivaroxaban alone did not significantly reduce major adverse cardiovascular events compared with asprin alone, but reduced major adverse limb events and increased major bleeding. FUNDING: Bayer AG.

• MeSH
• amputace statistika a číselné údaje   MeSH
• Aspirin aplikace a dávkování   škodlivé účinky   terapeutické užití   MeSH
• cévní mozková příhoda epidemiologie   etiologie   prevence a kontrola   MeSH
• dolní končetina krevní zásobení   chirurgie   MeSH
• dvojitá slepá metoda MeSH
• incidence MeSH
• infarkt myokardu epidemiologie   etiologie   prevence a kontrola   MeSH
• inhibitory agregace trombocytů aplikace a dávkování   škodlivé účinky   terapeutické užití   MeSH
• inhibitory faktoru Xa aplikace a dávkování   škodlivé účinky   terapeutické užití   MeSH
• kardiovaskulární nemoci mortalita   prevence a kontrola   MeSH
• kombinovaná farmakoterapie MeSH
• krvácení chemicky indukované   MeSH
• lidé středního věku MeSH
• lidé MeSH
• morbidita MeSH
• nemoci arterie carotis komplikace   farmakoterapie   epidemiologie   MeSH
• onemocnění periferních arterií komplikace   farmakoterapie   epidemiologie   MeSH
• rivaroxaban aplikace a dávkování   škodlivé účinky   terapeutické užití   MeSH
• rozvrh dávkování léků MeSH
• senioři MeSH
• vztah mezi dávkou a účinkem léčiva MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH
• Názvy látek
• Aspirin MeSH
• inhibitory agregace trombocytů MeSH
• inhibitory faktoru Xa MeSH
• rivaroxaban MeSH

INTRODUCTION: One of the most serious complications of the diabetic foot (DF) is a major amputation, which is associated with poor patient prognosis. The occurrence of major amputations may be influenced by a variety of factors including deep infection caused by resistant pathogens.The aims of our study were to compare the incidence of major amputations in podiatric center, characteristics of amputated patients with the DF and other factors contributing to major amputations in last decade. METHODS: We included into our study all patients hospitalized for the DF in our center whose underwent major amputations from 9/2004 to 9/2006 (group 1) and from 9/2013 to 9/2015 (group 2). Risk factors such as severity of DF ulcers based on Texas classification, duration of previous anti-biotic therapy, the presence and severity of peripheral arterial disease (PAD) according to Graziani classification, the number of revascularizations, renal failure/hemodialysis, osteomyelitis, infectious agents found before amputations and their resistance were compared between the study groups. RESULTS: During the 1st study period (9/2004-9/2006) 373 patients were hospitalized for the DF, of whom 3.2 % underwent major amputation (12/373 - group 1), during the 2nd study period (9/2013-9/2015) 376 patients, of whom 5.1 % absolved major amputation (19/376 - group 2). As the numbers of major amputations as their indications were similar in both study groups. The study groups did not differ significantly in the age, BMI, duration and type of diabetes, duration of DF and severity of DF ulcers, the presence of renal failure/hemodialysis, osteomyelitis and PAD. Group 2 had milder forms of PAD by Graziani classification (4.4 ±1.4 vs 5.7 ± 0.9; p = 0.012) and a higher number of revascularizations before major amputations (2.5 ± 1.5 vs 1 ± 1; p = 0.003) compared to the group 1. These patients were significantly longer treated by antibiotics (5.4 ± 2.4 vs 2.5 ± 2 months; p = 0.002) and underwent more resections and minor amputations (3.1 ± 2.1 vs 0.9 ± 0.5; p = 0.0004) before major amputations in contrast to the group 1. There was a trend to higher incidence of Gram-negatives (65.1 % vs 61.5 %; NS) with a predominance of Enterobacteriacae species (60.7 % vs 56 %; NS) and a trend to the increase of Pseudomonas (25 % vs 18.8 %; NS) and Enterococci sp. (46.7 % vs 20 %; NS) in the group 2 compared to the group 1. The incidences as of MRSA, multidrug resistant Pseudomonas sp. of other resistant microbes were similar in both study groups. CONCLUSIONS: The incidence of major amputations in patients hospitalized for the DF remains unchanged during the last decade. The therapy of factors leading to amputations has evidently intensified. This is in accordance with the latest international recommendations for the therapy of DF. In the future, it is appropriate to focus on the improvement of detection and treatment of infection and ischemia in such risk group of patients.Key words: diabetic foot - major amputation.

• MeSH
• amputace statistika a číselné údaje   MeSH
• antibakteriální látky terapeutické užití   MeSH
• bakteriální infekce komplikace   farmakoterapie   MeSH
• diabetická noha klasifikace   epidemiologie   chirurgie   terapie   MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• stupeň závažnosti nemoci MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH
• Názvy látek
• antibakteriální látky MeSH

OBJECTIVE: Infection commonly complicates diabetic foot ulcers and is associated with a poor outcome. In a cohort of individuals with an infected diabetic foot ulcer, we aimed to determine independent predictors of lower-extremity amputation and the predictive value for amputation of the International Working Group on the Diabetic Foot (IWGDF) classification system and to develop a risk score for predicting amputation. RESEARCH DESIGN AND METHODS: We prospectively studied 575 patients with an infected diabetic foot ulcer presenting to 1 of 14 diabetic foot clinics in 10 European countries. RESULTS: Among these patients, 159 (28%) underwent an amputation. Independent risk factors for amputation were as follows: periwound edema, foul smell, (non)purulent exudate, deep ulcer, positive probe-to-bone test, pretibial edema, fever, and elevated C-reactive protein. Increasing IWGDF severity of infection also independently predicted amputation. We developed a risk score for any amputation and for amputations excluding the lesser toes (including the variables sex, pain on palpation, periwound edema, ulcer size, ulcer depth, and peripheral arterial disease) that predicted amputation better than the IWGDF system (area under the ROC curves 0.80, 0.78, and 0.67, respectively). CONCLUSIONS: For individuals with an infected diabetic foot ulcer, we identified independent predictors of amputation, validated the prognostic value of the IWGDF classification system, and developed a new risk score for amputation that can be readily used in daily clinical practice. Our risk score may have better prognostic accuracy than the IWGDF system, the only currently available system, but our findings need to be validated in other cohorts.

• MeSH
• amputace statistika a číselné údaje   MeSH
• C-reaktivní protein metabolismus   MeSH
• diabetická noha komplikace   chirurgie   MeSH
• edém etiologie   MeSH
• horečka etiologie   MeSH
• infekce komplikace   chirurgie   MeSH
• lidé MeSH
• odoranty MeSH
• onemocnění periferních arterií komplikace   MeSH
• prognóza MeSH
• prospektivní studie MeSH
• rizikové faktory MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• pozorovací studie MeSH
• práce podpořená grantem MeSH
• Názvy látek
• C-reaktivní protein MeSH

INTRODUCTION: Diabetic foot syndrome is defined by ulcer or destruction of leg tissues in patients with diabetes (diabetics) associated with infection, neuropathy and various degree of ischaemia (peripheral vascular disease). In Czech Republic in 2010 were registrated over 45 000 patients with diabetic foot syndrome. 8500 (diabetics) patients with diabetes undergone the surgery (any type of amputation). MATERIAL AND METHODS: In retrospective non randomized trial we evaluated the population of patients with lower limb amputation admitted to Clinic of Surgery FNO between 2010-1012. We introduce current (present) view to possibilities of lower limb amputations, historical problems and development of surgical methods. Special aspect is dedicated to sagital shank amputation. Detail description of operative (surgical) technique itself and crural region (area) anatomy. RESULTS: In 2010-2012 we achieved 146 lower limb amputations in shank, from that 27 sagital shank amputations( sagital operative method). We observed ( followed up) the number of reoperations, reasons that led to amputation, wounds healing by secondary intention, itęs sources and necessity of revision due to postoperative hemorrhage. CONCLUSION: Effects of amputations on patientęs quality of life. Social and socioeconomical impacts. Provably lower number of complications in sagital shank amputations compared to (in comparison with) conventional methods. Authors would like to point out and introduce interesting operation method to the general public.

• MeSH
• amputace metody   statistika a číselné údaje   MeSH
• chirurgické laloky statistika a číselné údaje   chirurgie   MeSH
• diabetická noha epidemiologie   chirurgie   MeSH
• kvalita života psychologie   MeSH
• lidé MeSH
• pooperační komplikace epidemiologie   etiologie   MeSH
• reoperace statistika a číselné údaje   MeSH
• retrospektivní studie MeSH
• tibie chirurgie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH

In the past few years, rates of the lower extremity amputations for ischemia have been decreasing in some countries and many world regions. Surely, growing numbers of revascularization procedures contribute to the situation. In the Czech Republic, the amputation and large amputation rates are similar to those in the developed countries (45, resp. 24/100 000) (according to hospital data), as well as the numbers of surgical revascularizations. However, in our country, foot amputations are on increase, while numbers of major amputations do not decrease, probably as a result of the human age prolongation and fast increase of diabetes mellitus rates. The following prerequisites are required to improve the situation: primary prevention of atherosclerosis, building a network of vascular centres which are able to provide all modern revascularization methods. In cooperation with general practitioners, angiologists, diabetologists and other medical specialists, it is necessary to prevent most patients from developing critical extremity ischemia. If it develops, it should be diagnosed immediately and the revascularization procedure should be considered.

• MeSH
• amputace statistika a číselné údaje   trendy   MeSH
• bérec chirurgie   MeSH
• lidé MeSH
• noha (od hlezna dolů) chirurgie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH