Skip to main content

2022 | OriginalPaper | Buchkapitel

6. Therapiepfad der Bedingungen für ein DFS

verfasst von : Gerhard Rümenapf, Dirk Hochlenert, Gerald Engels, Stephan Morbach, Stefanie Schliwa, Frances L. Game

Erschienen in: Das Diabetische Fußsyndrom

Verlag: Springer Berlin Heidelberg

Zusammenfassung

Was macht den eigentlich so robust angelegten Fuß beim Menschen mit Diabetes mellitus verletzlich? Ist diese Frage beantwortet, geht es an die Therapie – wenn es eine gibt. In diesem Kapitel geht es um die Therapie der schmerzhaften Polyneuropathie, der pAVK und der Infektion beim DFS.
Literatur
Zurück zum Zitat Alexandrescu V, Hubermont G (2012) The challenging topic of diabetic foot revascularization: does the angiosome-guided angioplasty may improve outcome. J Cardiovasc Surg 53(1):3–12 Alexandrescu V, Hubermont G (2012) The challenging topic of diabetic foot revascularization: does the angiosome-guided angioplasty may improve outcome. J Cardiovasc Surg 53(1):3–12
Zurück zum Zitat Aszmann O, Tassler PL, Dellon AL (2004) Changing the natural history of diabetic neuropathy: incidence of ulcer/amputation in the contralateral limb of patients with a unilateral nerve decompression procedure. Ann Plast Surg 53(6):517–522CrossRefPubMed Aszmann O, Tassler PL, Dellon AL (2004) Changing the natural history of diabetic neuropathy: incidence of ulcer/amputation in the contralateral limb of patients with a unilateral nerve decompression procedure. Ann Plast Surg 53(6):517–522CrossRefPubMed
Zurück zum Zitat Bauer H, Germann G, Gries FA, Morbach S, Riepe G, Rothe U, Rümenapf G, Stiegler H, Tepe G, Uebel T, Weck M, Witte M. (2007) Nationale Versorgungsleitlinie Typ-2-Diabetes-Prävention und Therapie von Fußkomplikationen. Dtsch Ärzteblatt 104:B591–B598 Bauer H, Germann G, Gries FA, Morbach S, Riepe G, Rothe U, Rümenapf G, Stiegler H, Tepe G, Uebel T, Weck M, Witte M. (2007) Nationale Versorgungsleitlinie Typ-2-Diabetes-Prävention und Therapie von Fußkomplikationen. Dtsch Ärzteblatt 104:B591–B598
Zurück zum Zitat Bergamini TM, George SM, Jr., Massey HT, Henke PK, Klamer TW, Lambert GE, Jr., Banis JC, Jr., Miller FB, Garrison RN, Richardson JD (1994) Pedal or peroneal bypass: which is better when both are patent? J Vascular Surg 20 (3):347–355; discussion 355–346 Bergamini TM, George SM, Jr., Massey HT, Henke PK, Klamer TW, Lambert GE, Jr., Banis JC, Jr., Miller FB, Garrison RN, Richardson JD (1994) Pedal or peroneal bypass: which is better when both are patent? J Vascular Surg 20 (3):347–355; discussion 355–346
Zurück zum Zitat Chantelau E, Tanudjaja T, Altenhofer F, Ersanli Z, Lacigova S, Metzger C (1996) Antibiotic treatment for uncomplicated neuropathic forefoot ulcers in diabetes: a controlled trial. Diabet Med 13(2):156–159CrossRefPubMed Chantelau E, Tanudjaja T, Altenhofer F, Ersanli Z, Lacigova S, Metzger C (1996) Antibiotic treatment for uncomplicated neuropathic forefoot ulcers in diabetes: a controlled trial. Diabet Med 13(2):156–159CrossRefPubMed
Zurück zum Zitat Emanuele MA, Buchanan BJ, Abraira C (1981) Elevated leg systolic pressures and arterial calcification in diabetic occlusive vascular disease. Diabetes Care 4(2):289–292CrossRefPubMed Emanuele MA, Buchanan BJ, Abraira C (1981) Elevated leg systolic pressures and arterial calcification in diabetic occlusive vascular disease. Diabetes Care 4(2):289–292CrossRefPubMed
Zurück zum Zitat Hinchliffe RJ, Forsythe RO, Apelqvist J, Boyko EJ, Fitridge R, Hong JP, Katsanos K, Mills JL, Nikol S, Reekers J, Venermo M, Zierler RE, Schaper N, International Working Group on the Diabetic F (2019) IWGDF Guideline on diagnosis, prognosis and management of peripheral artery disease in patients with a foot ulcer and diabetes. 2019 IWGDF Guidelines on the Prevention and Management of Diabetic Foot Disease Hinchliffe RJ, Forsythe RO, Apelqvist J, Boyko EJ, Fitridge R, Hong JP, Katsanos K, Mills JL, Nikol S, Reekers J, Venermo M, Zierler RE, Schaper N, International Working Group on the Diabetic F (2019) IWGDF Guideline on diagnosis, prognosis and management of peripheral artery disease in patients with a foot ulcer and diabetes. 2019 IWGDF Guidelines on the Prevention and Management of Diabetic Foot Disease
Zurück zum Zitat Hinchliffe RJ, Forsythe RO, Apelqvist J, Boyko EJ, Fitridge R, Hong JP, Katsanos K, Mills JL, Nikol S, Reekers J, Venermo M, Zierler RE, Schaper NC, International Working Group on the Diabetic F (2020) Guidelines on diagnosis, prognosis, and management of peripheral artery disease in patients with foot ulcers and diabetes (IWGDF 2019 update). Diabetes Metab Res Rev 36(Suppl 1):e3276. https://doi.org/10.1002/dmrr.3276 Hinchliffe RJ, Forsythe RO, Apelqvist J, Boyko EJ, Fitridge R, Hong JP, Katsanos K, Mills JL, Nikol S, Reekers J, Venermo M, Zierler RE, Schaper NC, International Working Group on the Diabetic F (2020) Guidelines on diagnosis, prognosis, and management of peripheral artery disease in patients with foot ulcers and diabetes (IWGDF 2019 update). Diabetes Metab Res Rev 36(Suppl 1):e3276. https://​doi.​org/​10.​1002/​dmrr.​3276
Zurück zum Zitat Hirsch AT, Criqui MH, Treat-Jacobson D, Regensteiner JG, Creager MA, Olin JW, Krook SH, Hunninghake DB, Comerota AJ, Walsh ME, McDermott MM, Hiatt WR (2001) Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA, J Am Med Assoc 286(11):1317–1324CrossRef Hirsch AT, Criqui MH, Treat-Jacobson D, Regensteiner JG, Creager MA, Olin JW, Krook SH, Hunninghake DB, Comerota AJ, Walsh ME, McDermott MM, Hiatt WR (2001) Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA, J Am Med Assoc 286(11):1317–1324CrossRef
Zurück zum Zitat Jude EB, Oyibo SO, Chalmers N, Boulton AJ (2001) Peripheral arterial disease in diabetic and nondiabetic patients: a comparison of severity and outcome. Diabetes Care 24(8):1433–1437CrossRefPubMed Jude EB, Oyibo SO, Chalmers N, Boulton AJ (2001) Peripheral arterial disease in diabetic and nondiabetic patients: a comparison of severity and outcome. Diabetes Care 24(8):1433–1437CrossRefPubMed
Zurück zum Zitat Lipsky BA, Senneville E, Abbas ZG, Aragon-Sanchez J, Diggle M, Embil JM, Kono S, Lavery LA, Malone M, van Asten SA, Urbancic-Rovan V, Peters EJG, International Working Group on the Diabetic F (2020) Guidelines on the diagnosis and treatment of foot infection in persons with diabetes (IWGDF 2019 update). Diabetes Metab Res Rev 36(Suppl 1):e3280. https://doi.org/10.1002/dmrr.3280 Lipsky BA, Senneville E, Abbas ZG, Aragon-Sanchez J, Diggle M, Embil JM, Kono S, Lavery LA, Malone M, van Asten SA, Urbancic-Rovan V, Peters EJG, International Working Group on the Diabetic F (2020) Guidelines on the diagnosis and treatment of foot infection in persons with diabetes (IWGDF 2019 update). Diabetes Metab Res Rev 36(Suppl 1):e3280. https://​doi.​org/​10.​1002/​dmrr.​3280
Zurück zum Zitat Lumsden AB, Rice TW (2006) Medical management of peripheral arterial disease: a therapeutic algorithm. Journal of endovascular therapy: an official journal of the International Society of Endovascular Specialists 13 Suppl 2:Ii19–29 Lumsden AB, Rice TW (2006) Medical management of peripheral arterial disease: a therapeutic algorithm. Journal of endovascular therapy: an official journal of the International Society of Endovascular Specialists 13 Suppl 2:Ii19–29
Zurück zum Zitat Mills JL, Sr., Conte MS, Armstrong DG, Pomposelli FB, Schanzer A, Sidawy AN, Andros G, the Society for Vascular Surgery Lower Extremity Guidelines C (2013) The society for vascular surgery lower extremity threatened limb classification system: risk stratification based on wound, ischemia, and foot infection (WIfI). J Vasc Surg. https://doi.org/10.1016/j.jvs.2013.08.003CrossRef Mills JL, Sr., Conte MS, Armstrong DG, Pomposelli FB, Schanzer A, Sidawy AN, Andros G, the Society for Vascular Surgery Lower Extremity Guidelines C (2013) The society for vascular surgery lower extremity threatened limb classification system: risk stratification based on wound, ischemia, and foot infection (WIfI). J Vasc Surg. https://​doi.​org/​10.​1016/​j.​jvs.​2013.​08.​003CrossRef
Zurück zum Zitat Monteiro-Soares M, Russell D, Boyko EJ, Jeffcoate W, Mills JL, Morbach S, Game F, International Working Group on the Diabetic F (2019) IWGDF Guideline on the classification of diabetic foot ulcers. 2019 IWGDF Guidelineson the Prevention and Managementof Diabetic Foot Disease Monteiro-Soares M, Russell D, Boyko EJ, Jeffcoate W, Mills JL, Morbach S, Game F, International Working Group on the Diabetic F (2019) IWGDF Guideline on the classification of diabetic foot ulcers. 2019 IWGDF Guidelineson the Prevention and Managementof Diabetic Foot Disease
Zurück zum Zitat Morbach S, Furchert H, Groblinghoff U, Hoffmeier H, Kersten K, Klauke GT, Klemp U, Roden T, Icks A, Haastert B, Rümenapf G, Abbas ZG, Bharara M, Armstrong DG (2012) Long-term prognosis of diabetic foot patients and their limbs: amputation and death over the course of a decade. Diabetes Care 35(10):2021–2027. https://doi.org/10.2337/dc12-0200CrossRefPubMedPubMedCentral Morbach S, Furchert H, Groblinghoff U, Hoffmeier H, Kersten K, Klauke GT, Klemp U, Roden T, Icks A, Haastert B, Rümenapf G, Abbas ZG, Bharara M, Armstrong DG (2012) Long-term prognosis of diabetic foot patients and their limbs: amputation and death over the course of a decade. Diabetes Care 35(10):2021–2027. https://​doi.​org/​10.​2337/​dc12-0200CrossRefPubMedPubMedCentral
Zurück zum Zitat Nickerson DS, Rader AJ (2013) Low long-term risk of foot ulcer recurrence after nerve decompression in a diabetes neuropathy cohort. J Am Podiatr Med Assoc 103(5):380–386CrossRefPubMed Nickerson DS, Rader AJ (2013) Low long-term risk of foot ulcer recurrence after nerve decompression in a diabetes neuropathy cohort. J Am Podiatr Med Assoc 103(5):380–386CrossRefPubMed
Zurück zum Zitat Pecoraro RE, Reiber GE, Burgess EM (1990) Pathways to diabetic limb amputation. Basis for prevention. Diabetes Care 13(5):513–521CrossRefPubMed Pecoraro RE, Reiber GE, Burgess EM (1990) Pathways to diabetic limb amputation. Basis for prevention. Diabetes Care 13(5):513–521CrossRefPubMed
Zurück zum Zitat Prompers L, Schaper N, Apelqvist J, Edmonds M, Jude E, Mauricio D, Uccioli L, Urbancic V, Bakker K, Holstein P, Jirkovska A, Piaggesi A, Ragnarson-Tennvall G, Reike H, Spraul M, Van Acker K, Van Baal J, Van Merode F, Ferreira I, Huijberts M (2008) Prediction of outcome in individuals with diabetic foot ulcers: focus on the differences between individuals with and without peripheral arterial disease The EURODIALE study. Diabetologia 51(5):747–755. https://doi.org/10.1007/s00125-008-0940-0CrossRefPubMedPubMedCentral Prompers L, Schaper N, Apelqvist J, Edmonds M, Jude E, Mauricio D, Uccioli L, Urbancic V, Bakker K, Holstein P, Jirkovska A, Piaggesi A, Ragnarson-Tennvall G, Reike H, Spraul M, Van Acker K, Van Baal J, Van Merode F, Ferreira I, Huijberts M (2008) Prediction of outcome in individuals with diabetic foot ulcers: focus on the differences between individuals with and without peripheral arterial disease The EURODIALE study. Diabetologia 51(5):747–755. https://​doi.​org/​10.​1007/​s00125-008-0940-0CrossRefPubMedPubMedCentral
Zurück zum Zitat Reiber GE, Vileikyte L, Boyko EJ, del Aguila M, Smith DG, Lavery LA, Boulton AJ (1999) Causal pathways for incident lower-extremity ulcers in patients with diabetes from two settings. Diabetes Care 22(1):157–162CrossRefPubMed Reiber GE, Vileikyte L, Boyko EJ, del Aguila M, Smith DG, Lavery LA, Boulton AJ (1999) Causal pathways for incident lower-extremity ulcers in patients with diabetes from two settings. Diabetes Care 22(1):157–162CrossRefPubMed
Zurück zum Zitat Smith FC, Shearman CP, Simms MH, Gwynn BR (1994) Falsely elevated ankle pressures in severe leg ischaemia: the pole test–an alternative approach. Eur J Vasc Surg 8(4):408–412CrossRefPubMed Smith FC, Shearman CP, Simms MH, Gwynn BR (1994) Falsely elevated ankle pressures in severe leg ischaemia: the pole test–an alternative approach. Eur J Vasc Surg 8(4):408–412CrossRefPubMed
Zurück zum Zitat Taylor GI, Pan WR (1998) Angiosomes of the leg: anatomic study and clinical implications. Plastic and reconstructive surgery 102 (3):599–616; discussion 617–598 Taylor GI, Pan WR (1998) Angiosomes of the leg: anatomic study and clinical implications. Plastic and reconstructive surgery 102 (3):599–616; discussion 617–598
Zurück zum Zitat Taylor SM, Cull DL, Kalbaugh CA, Senter HF, Langan EM, 3rd, Carsten CG, 3rd, York JW, Snyder BA, Gray BH, Androes MP, Blackhurst DW (2009) Comparison of interventional outcomes according to preoperative indication: a single center analysis of 2,240 limb revascularizations. Journal of the American College of Surgeons 208 (5):770–778; discussion 778–780. https://doi.org/10.1016/j.jamcollsurg.2009.01.025 Taylor SM, Cull DL, Kalbaugh CA, Senter HF, Langan EM, 3rd, Carsten CG, 3rd, York JW, Snyder BA, Gray BH, Androes MP, Blackhurst DW (2009) Comparison of interventional outcomes according to preoperative indication: a single center analysis of 2,240 limb revascularizations. Journal of the American College of Surgeons 208 (5):770–778; discussion 778–780. https://​doi.​org/​10.​1016/​j.​jamcollsurg.​2009.​01.​025
Zurück zum Zitat Veves A, Manes C, Murray HJ, Young MJ, Boulton AJ (1993) Painful neuropathy and foot ulceration in diabetic patients. Diabetes Care 16(8):1187–1189CrossRefPubMed Veves A, Manes C, Murray HJ, Young MJ, Boulton AJ (1993) Painful neuropathy and foot ulceration in diabetic patients. Diabetes Care 16(8):1187–1189CrossRefPubMed
Metadaten
Titel
Therapiepfad der Bedingungen für ein DFS
verfasst von
Gerhard Rümenapf
Dirk Hochlenert
Gerald Engels
Stephan Morbach
Stefanie Schliwa
Frances L. Game
Copyright-Jahr
2022
Verlag
Springer Berlin Heidelberg
DOI
https://doi.org/10.1007/978-3-662-64972-5_6

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Ein Drittel der jungen Ärztinnen und Ärzte erwägt abzuwandern

07.05.2024 Klinik aktuell Nachrichten

Extreme Arbeitsverdichtung und kaum Supervision: Dr. Andrea Martini, Sprecherin des Bündnisses Junge Ärztinnen und Ärzte (BJÄ) über den Frust des ärztlichen Nachwuchses und die Vorteile des Rucksack-Modells.

Aquatherapie bei Fibromyalgie wirksamer als Trockenübungen

03.05.2024 Fibromyalgiesyndrom Nachrichten

Bewegungs-, Dehnungs- und Entspannungsübungen im Wasser lindern die Beschwerden von Patientinnen mit Fibromyalgie besser als das Üben auf trockenem Land. Das geht aus einer spanisch-brasilianischen Vergleichsstudie hervor.

Endlich: Zi zeigt, mit welchen PVS Praxen zufrieden sind

IT für Ärzte Nachrichten

Darauf haben viele Praxen gewartet: Das Zi hat eine Liste von Praxisverwaltungssystemen veröffentlicht, die von Nutzern positiv bewertet werden. Eine gute Grundlage für wechselwillige Ärztinnen und Psychotherapeuten.

Proximale Humerusfraktur: Auch 100-Jährige operieren?

01.05.2024 DCK 2024 Kongressbericht

Mit dem demographischen Wandel versorgt auch die Chirurgie immer mehr betagte Menschen. Von Entwicklungen wie Fast-Track können auch ältere Menschen profitieren und bei proximaler Humerusfraktur können selbst manche 100-Jährige noch sicher operiert werden.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.