Peculiarities of microcirculatory disturbances in patients with foot sore complications caused by diabetes depending on clinical form

Abstract

Totally 328 patients with complicated diabetic foot syndrome with abscess, phlegmon, purulent tenosynovitis, purulent arthritis and gangrene were examined and diagnosed in Therapeutic center of Zaporozhye, Ukraine, for the period 2015-2017. All patients were diagnosed with type 2 diabetes; its average duration was 12.5±1.8 years. Patients were divided into clinical forms – 118 patients with neuropathic, 74 with ischemic and 136 with mixed. The study aimed to investigate the patients’ blood flow in lower limbs by using the laser Doppler flowmetry method and to reveal specific microcirculatory disturbances for each clinical form. The neuropathic form was noted with weakened arteriolar vascular tone and increased blood volume in the arterioles. A decrease in neurogenic and myogenic mechanisms of control was noted. Peripheral autosympathectomy results in the loss of neurogenic control and precapillary vasoconstriction, increased intracapillary pressure and increased blood flow through the arteriovenous shunts. The patients with ischemic form were noted with microcirculatory disorders; primarily, decrease in the volume of arterial influx and increase in the amplitudes of active and passive control factors were observed. Compensatory reaction in an attempt to improve microcirculation by increasing the respiratory amplitudes (passive factor). The patients with mixed form were noted with increase in the muscle tone of precapillary muscles and in the amplitude of the respiratory wave. Neurogenic and myogenic tone was increased due to the activity of the sympathetic component, which in its turn led to decrease in the diameter of the arterioles.