In addition to patients with paralysis due to carotid artery minimal invasive vascular surgery technique also yields successful results in situations such as diabetic foot, gangrene resulting from vascular congestion and Buerger’s disease. The method is applied with local anesthesia as in stroke surgery. We use minimal invasive vascular surgery techniques to treat patients in many different ways. In addition to diabetes, our patient group also suffers from many diseases such as kidney, blood pressure, heart and lung diseases at the same time. With this technique, we are able to keep them away from the risks of standard surgery.
There is a combined treatment and a team in the methods we apply. The treatment is carried out by specialists such as vascular surgeon, infectious diseases doctor, endocrine doctor, plastic surgeon and cardiologist as the doctor who conducts the operation. Because these are the patients in the risk group and they also experience many problems at the same time.
First of all, whatever the diameter of the vein, we can bypass any area that has a canal. But in diabetics, we usually have little chance of having a bypass, because in those patients, capillaries are almost completely dried out. If we can’t do this, we clean the lime within the veins with local anesthesia by opening small incisions. We also administer special drugs in the arteries. If we cannot recover them with these methods, we amputate in the same session if necessary. We’re trying to save the patient by only amputating the fingers and at worst, the heel. We benefit from hyperbaric oxygen therapy if there is an opening in those areas in the future. In the formation of tissue loss, we benefit from plastic surgeons. In an event that the plastic surgeon is not able to transfer the tissue we inject the growth hormone called epithelial growth hormone straight into the tissue.
How many of these patients’ legs can be saved?
All diabetic patients must be saved from the pain of getting their feet or legs cut. In many clinics and hospitals, there are patients who were said “This patient no longer has a chance. Take your patient and find a place to cut off their leg.” and we were able to save those patients. But we are not creating miracles when we are saying this. We just show a little interest in the patient, prepare the patient, and complete the missing things. Of course there are patients who go through amputation among these. The one’s we manage to save are not only our success but also the patient’s. So early diagnosis and treatment are extremely important in those patients. Every diabetic should check their foot every day. They should massage it with moisturizing cream every day whether or not there is a complaint. This provides both self-treatment and continuous control of the feet. If this happens, the amputation rates will drop or no amputation will be required. Patients caught early can be treated with the use of a simple drug treatment, simple wound care or hyperbaric oxygen therapy.
What should be the target in amputations?
In studies conducted between different diabetic groups abroad during the recent years it was published that diabetic foot had an amputation rate between 60 and 95. In Turkey, there is no clear information regarding the numbers. But from the statistics that we clearly know of show us that the chance for diabetics to develop diabetic foot in their life time is 15 percent. If we look at the statistics in my patient group, my amputation figure in the last 5-6 years is about 20.
On the other hand, the number of patients in which we just amputated the fingers and saved their leg from the heel is quite high. In amputations, the target should always be able to cut as low as possible and to save the leg. We always try to push the gangrene down in diabetic patients or in leg cuts. We try to save one finger, two fingers and at worst, the heel. In amputations, the knee joint is important for us for the patient to be able to use the part of their leg below the knee. But there are such patients that they lose the leg starting from the hip and whatever you do, it does not help. At that, the job is more about saving a life than saving a leg. Sometimes there are such patients that while other centers have decided amputate the leg starting from the hip but we have managed to save the leg in question from the heel.