XEROSIS OF THE FOOT AMPUTATION STUMP IN THE PATIENT WITH TYPE 2 DIABETES MELLITUS: TREATMENT USING PHOTODYNAMIC THERAPY
DOI:
https://doi.org/10.21856/j-PEP.2023.4.12Keywords:
xerosis, type 2 diabetes, photodynamic therapyAbstract
Background. The incidence of xerosis of lower limbs in patients with type 2 diabetes varies within 22% and 40%. Aim of the current study is to determine the effectiveness of photodynamic therapy for xerosis of the lower limbs in patients with complicated type 2 diabetes.
Case report. Patient S., 61 years old, was admitted to the Department of Acute Diseases of the Main Arteries of V.T. Zaitsev Institute of General and Urgent Surgery of the National Academy of Medical Sciences of Ukraine. He presented symptoms of chronic ischemia of the left lower extremity against the background of type 2 diabetes. The daily blood glucose fluctuations were about 6.8-14.7 mmol/L, glycated haemoglobin (HbAlc) level was 7.46%. Dry necrosis of the distal phalanges of five toes of the left foot, atherosclerotic occlusion of the left anterior and posterior tibial arteries, dryness and peeling of left shin and foot skin were diagnosed. The clinical diagnosis was: obliterating atherosclerosis of the lower extremities, atherosclerotic occlusion of left anterior and posterior tibial arteries, chronic ischemia, stage IV, type 2 diabetes, xerosis of the left lower limb, grade II. The management also included diabetes compensation, metabolic, anticoagulant and angiotropic therapy. On day 3 percutaneous balloon angioplasty of left anterior and posterior tibial arteries and distal amputation of the left foot was performed. The patient was discharged in satisfactory condition on the 7th day. A follow-up examination on the 21st day revealed IV grade xerosis of foot amputation stump. On the same day a single photodynamic therapy session was carried out using “Levuderm” gel as a photosensitizer. Fourteen days after photodynamic therapy itching, dryness, peeling and skin fissures were absent.
Conclusion. Photodynamic monotherapy is an effective modality for the treatment of lower limb xerosis on the background of complicated type 2 diabetes. Further clinical studies are needed to determine the effective tactics and limits of the method.
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