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Systematik der Fußulzera

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Das diabetische Fußsyndrom – Über die Entität zur Therapie

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Zusammenfassung

In diesem Kapitel werden Wunden beim diabetischen Fußsyndrom anhand ihrer Lokalisation und der dort typischen schädigenden Auslöser in Entitäten eingeteilt. Druckulzera befinden sich über Knochenvorsprüngen, venöse Ulzera in der Knöchelregion, Dekubitalulzera an der Ferse, thermische Schädigung flächig an üblicherweise unbelasteten Stellen, und akzidentelle Traumata betreffen die Fußsohle auch in nicht tragenden Bereichen und gelegentlich den Fußrücken. Wenn unterschiedliche Schädigungsmuster und damit verschiedene therapeutische Ansätze infrage kommen, werden die erforderlichen Untersuchungen aufgeführt, mit deren Hilfe die Unterscheidung vorgenommen werden kann. Die Entitäten sind in 12 Abschnitten mit Untersuchung, statistischer Betrachtung der Risiken sowie konservativen und operativen Entlastungskonzepten dargestellt. Dies ist das zentrale Kapitel des Buchs und soll aus der Blickdiagnose einen Behandlungskorridor für den individuellen Patienten eröffnen.

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Literatur

  • Apelqvist J, Castenfors J, Larsson J, Stenstrom A, Agardh CD (1989) Wound classification is more important than site of ulceration in the outcome of diabetic foot ulcers. Diabet Med 6(6):526–530

    Article  CAS  PubMed  Google Scholar 

  • Apelqvist J, Larsson J, Agardh CD (1990) The influence of external precipitating factors and peripheral neuropathy on the development and outcome of diabetic foot ulcers. J Diabet Complications 4(1):21–25

    Article  CAS  PubMed  Google Scholar 

  • Battum P van, Schaper N, Prompers L, Apelqvist J, Jude E, Piaggesi A, Bakker K, Edmonds M, Holstein P, Jirkovska A, Mauricio D, Ragnarson Tennvall G, Reike H, Spraul M, Uccioli L, Urbancic V, Acker K van, Baal J van, Ferreira I, Huijberts M (2011) Differences in minor amputation rate in diabetic foot disease throughout Europe are in part explained by differences in disease severity at presentation. Diabet Med 28(2):199–205. doi:10.1111/j.1464-5491.2010.03192.x

    Article  PubMed  Google Scholar 

  • Blume PA, Donegan R, Schmidt BM (2014) The role of plastic surgery for soft tissue coverage of the diabetic foot and ankle. Clin Podiatr Med Surg 31(1):127–150. doi:10.1016/ j.cpm.2013.09.006

    Article  PubMed  Google Scholar 

  • Borgers M, Degreef H, Cauwenbergh G (2005) Fungal infections of the skin: infection process and antimycotic therapy. Curr Drug Targets 6(8):849–862

    Article  CAS  PubMed  Google Scholar 

  • Brash PD, Foster J, Vennart W, Anthony P, Tooke JE (1999) Magnetic resonance imaging techniques demonstrate soft tissue damage in the diabetic foot. Diabet Med 16(1):55–61

    Article  CAS  PubMed  Google Scholar 

  • Cichowitz A, Pan WR, Ashton M (2009) The heel: anatomy, blood supply, and the pathophysiology of pressure ulcers. Ann Plast Surg 62(4):423–429. doi:10.1097/SAP.0b013e3181851b55

    Article  CAS  PubMed  Google Scholar 

  • Debrunner HU, Jacob HAC (1998) Biomechanik des Fußes, Bd 49. Bücherei des Orthopäden. Enke, Stuttgart

    Google Scholar 

  • Dubsky M, Jirkovska A, Bem R, Fejfarova V, Skibova J, Schaper NC, Lipsky BA (2013) Risk factors for recurrence of diabetic foot ulcers: prospective follow-up analysis of a Eurodiale subgroup. Int Wound J 10(5):555–561. doi:10.1111/j.1742-481X.2012.01022.x

    Article  PubMed  Google Scholar 

  • Gefen A (2010) The biomechanics of heel ulcers. J Tissue Viability 19(4):124–131. doi:10.1016/j.jtv.2010.06.003

    Article  PubMed  Google Scholar 

  • Gent W van, Wittens C (2013) Influence of perforating vein surgery in patients with venous ulceration. Phlebology. doi:10.1177/0268355513517685

    Google Scholar 

  • Gilcreast DM, Warren JB, Yoder LH, Clark JJ, Wilson JA, Mays MZ (2005) Research comparing three heel ulcer-prevention devices. J Wound Ostomy Continence Nurs 32(2): 112–120

    Google Scholar 

  • Ignatiadis, II, Tsiampa VA, Papalois AE (2011) A systematic approach to the failed plastic surgical reconstruction of the diabetic foot. Diabet Foot Ankle 2. doi:10.3402/dfa. v2i0.6435

    Google Scholar 

  • Ince P, Abbas ZG, Lutale JK, Basit A, Ali SM, Chohan F, Morbach S, Mollenberg J, Game FL, Jeffcoate WJ (2008) Use of the SINBAD classification system and score in comparing outcome of foot ulcer management on three continents. Diabetes Care 31(5):964–967

    Google Scholar 

  • Junkin J, Gray M (2009) Are pressure redistribution surfaces or heel protection devices effective for preventing heel pressure ulcers? J Wound Ostomy Continence Nurs 36(6):602–608. doi:10.1097/WON.0b013e3181be282f

    Google Scholar 

  • Kearney TP, Hunt NA, Lavery LA (2010) Safety and effectiveness of flexor tenotomies to heal toe ulcers in persons with diabetes. Diabetes Res Clin Pract 89(3):224–226. doi:10.1016/j.diabres.2010.05.025

    Google Scholar 

  • Klein A (2012) Die Tenotomie der Flexor-hallucis-longus- Sehne und Flexer-digitorum-longus-Sehne zur Behandlung on Zehenkuppenläsionen bei Patienten mir Diabetischem Fußsyndrom. Dissertation, Universität zu Köln

    Google Scholar 

  • Laborde JM (2007) Neuropathic toe ulcers treated with toe flexor tenotomies. Foot Ankle Int 28(11):1160–1164. doi:10.3113/FAI.2007.1160

    Article  PubMed  Google Scholar 

  • Lountzis N, Parenti J, Cush G, Urik M, Miller OF III (2007) Percutaneous Flexor Tenontomy - Office Procedure for Diabetic Toe Ulcerations. Wounds 19(3)

    Google Scholar 

  • Masaki N, Sugama J, Okuwa M, Inagaki M, Matsuo J, Nakatani T, Sanada H (2013) Heel blood flow during loading and off-loading in bedridden older adults with low and normal ankle-brachial pressure index: a quasi-experimental study. Biol Res Nurs 15(3):285–291. doi:10.1177/1099800412437929

    Article  PubMed  Google Scholar 

  • Netten JJ van, Bril A, Baal JG van (2013) The effect of flexor tenotomy on healing and prevention of neuropathic diabetic foot ulcers on the distal end of the toe. J Foot Ankle Res 6(1):3. doi:10.1186/1757-1146-6-3

    Article  PubMed  PubMed Central  Google Scholar 

  • Papini M, Cicoletti M, Fabrizi V, Landucci P (2013) Skin and nail mycoses in patients with diabetic foot. G Ital Dermatol Venereol 148(6):603–608

    CAS  PubMed  Google Scholar 

  • Pickwell KM, Siersma VD, Kars M, Holstein PE, Schaper NC, on behalf of the Eurodiale C (2013) Diabetic foot disease: impact of ulcer location on ulcer healing. Diabetes Metab Res Rev. doi:10.1002/dmrr.2400

    PubMed  Google Scholar 

  • Pollard JP, Morrison PJ (1975) Flexor tenotomy in the treatment of curly toes. Proc R Soc Med 68(8):480–481

    CAS  PubMed  PubMed Central  Google Scholar 

  • Risse A, Grafenkamp T, Hüppler M, Wimmer J, Birgel B (2010) Wundtherapie bei diabetischem Fußsyndrom. Der Diabetologe 6(7):587–596. doi:10.1007/s11428-010-0613-8

    Article  Google Scholar 

  • Salcido R, Lee A, Ahn C (2011) Heel pressure ulcers: purple heel and deep tissue injury. Adv Skin Wound Care 24(8):374–380; quiz 381–372. doi:10.1097/01.ASW.0000403250.85131.b9

    Google Scholar 

  • Schirmer S, Ritter RG, Fansa H (2013) Vascular surgery, microsurgery and supramicrosurgery for treatment of chronic diabetic foot ulcers to prevent amputations. PloS One 8(9):e7470–4. doi:10.1371/journal.pone.0074704

    Google Scholar 

  • Scholz N (2000) Konservative Behandlung eingewachsener Zehennägel mit Nagel-Korrekturspangen. Dtsch Arzteblatt 97(22):A153–2

    Google Scholar 

  • Sopher R, Nixon J, McGinnis E, Gefen A (2011) The influence of foot posture, support stiffness, heel pad loading and tissue mechanical properties on biomechanical factors associated with a risk of heel ulceration. J Mech Behav Biomed Mater 4(4):572–582. doi:10.1016/j.jmbbm. 2011.01.004

    Article  PubMed  Google Scholar 

  • Tamir E, McLaren AM, Gadgil A, Daniels TR (2008) Outpatient percutaneous flexor tenotomies for management of diabetic claw toe deformities with ulcers: a preliminary report. Can J Surg 51(1):41–44

    PubMed  PubMed Central  Google Scholar 

  • Tietz HJ (2012) Nagelpilz ist heilbar. Der Hausarzt (16) Tovey FI (1984) The manufacture of diabetic footwear. Diabet Med 1(1):69–71

    Google Scholar 

  • Treiman GS, Oderich GS, Ashrafi A, Schneider PA (2000) Management of ischemic heel ulceration and gangrene: An evaluation of factors associated with successful healing. J Vasc Surg 31(6):1110–1118

    Google Scholar 

  • Waldeck M (2012) Unguis incarnatus: Die Emmert-Plastik und ihre Alternativen. ChirurgenMagazin 10(4):42–46

    Google Scholar 

  • Wolfring A (2006) Operative Verfahren beim Hallux rigidus. Implantationsarthroplastik im metaanalytischen Vergleich zur Resektionsarthroplastik und Arthrodese.

    Google Scholar 

  • Wong VK, Stotts NA, Hopf HW, Froelicher ES, Dowling GA (2007) How heel oxygenation changes under pressure. Wound Repair Regen 15(6):786–794. doi:10.1111/j.1524-475X.2007.00309.x

    Article  PubMed  Google Scholar 

  • Zimny S, Schatz H, Pfohl M (2004) The role of limited joint mobility in diabetic patients with an at-risk foot. Diabetes Care 27(4):942–946

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Centrum für Diabetologie Endoskopie und Wundheilung, Köln, Germany

    Dr. Dirk Hochlenert

  2. Chirurgische Praxis am Bayenthalgürtel, Köln, Germany

    Gerald Engels

  3. Marienkrankenhaus Soest, Soest, Germany

    Dr. Stephan Morbach

Authors
  1. Dr. Dirk Hochlenert
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  2. Gerald Engels
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  3. Dr. Stephan Morbach
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Hochlenert, D., Engels, G., Morbach, S. (2014). Systematik der Fußulzera. In: Das diabetische Fußsyndrom – Über die Entität zur Therapie. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-43944-9_5

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  • DOI: https://doi.org/10.1007/978-3-662-43944-9_5

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-43943-2

  • Online ISBN: 978-3-662-43944-9

  • eBook Packages: Medicine (German Language)

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