[Tactics of surgical treatment of suppurative-necrotic lesions of the foot and leg in patients with diabetes mellitus].

Policy of surgical treatment of 200 patients with pyonecrotic lesions of the lower limbs and diabetes mellitus are analysed. The management of such patients should provide timely adequate surgical treatment of the focus of affection, correction of carbohydrate metabolism with increased doses of simple insulin, removal of intoxication, prevention of thromboembolic complications, and treatment of concomitant diseases. Necrectomy and drainage of the abscesses under epidural anesthesia are advisable in gangrene of the toes and phlegmon of the feet in patients suffering from diabetes mellitus. In the absence of a therapeutic effect amputation through the upper third of the leg is indicated. Amputation through the lower third of the thigh is indicated in phlegmon of the leg. But ketoacidosis must be completely relieved before the operation and the level of glycemia reduced to 12,0 mmol/l. Total mortality was 11%, postoperative mortality 8,5%.