Die Gefäßmedizin braucht mehr Evidenz
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Die Gefäßmedizin braucht mehr Evidenz : Aktuelle Ergebnisse und Metaanalysen zur Behandlung des diabetischen Fußes. / Torsello, G; Debus, S; Meyer, F; Grundmann, R T.
in: ZBL CHIR, Jahrgang 140, Nr. 2, 04.2015, S. 219-227.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Die Gefäßmedizin braucht mehr Evidenz
T2 - Aktuelle Ergebnisse und Metaanalysen zur Behandlung des diabetischen Fußes
AU - Torsello, G
AU - Debus, S
AU - Meyer, F
AU - Grundmann, R T
N1 - Georg Thieme Verlag KG Stuttgart · New York.
PY - 2015/4
Y1 - 2015/4
N2 - BACKGROUND: This overview comments on clinical trials and meta-analyses from the literature on the treatment of diabetic feet.METHODS: For the literature review, the MEDLINE database (PUBMED) was searched under the key words "diabetic foot". Publications of the last three years (2012 to 2014) were extracted.RESULTS: For patients with diabetic feet, both endovascular (ER) and open (OR) revascularisation techniques are possible. There are not sufficient data to demonstrate whether open bypass surgery or endovascular interventions are more effective in these patients. However, registries show that ER has now in terms of quantity become the preferred method. Angiosome-targeted revascularisation has to be considered in these situations. For the local treatment of a diabetic foot ulcer a variety of dressings are available, the evidence for their recommendation is low. Dressing cost and the wound management properties, e.g. exudate management therefore can influence the choice of dressing. There is no evidence that more expensive dressings as compared to basic dressings offer advantages in terms of healing. In plantar diabetic foot ulcers, non-removable off-loading devices regardless of type are more likely to result in ulcer healing than removable off-loading devices, presumably, because patient compliance with off-loading is facilitated. Meaningful pressure-relieving interventions for treating diabetic foot ulcers also include Achilles tendon lengthening, a plantar fascia release and percutaneous flexor tenotomy. The value of a standardised treatment protocol carried out by a specialist team could be proven in large registries based on decreasing amputation rates.CONCLUSION: This survey reveals a significant disparity between the large number of treatment recommendations and their evidence. For the future, therefore it is imperative to implement nationwide register surveys with respect to treatment and outcome of these patients.
AB - BACKGROUND: This overview comments on clinical trials and meta-analyses from the literature on the treatment of diabetic feet.METHODS: For the literature review, the MEDLINE database (PUBMED) was searched under the key words "diabetic foot". Publications of the last three years (2012 to 2014) were extracted.RESULTS: For patients with diabetic feet, both endovascular (ER) and open (OR) revascularisation techniques are possible. There are not sufficient data to demonstrate whether open bypass surgery or endovascular interventions are more effective in these patients. However, registries show that ER has now in terms of quantity become the preferred method. Angiosome-targeted revascularisation has to be considered in these situations. For the local treatment of a diabetic foot ulcer a variety of dressings are available, the evidence for their recommendation is low. Dressing cost and the wound management properties, e.g. exudate management therefore can influence the choice of dressing. There is no evidence that more expensive dressings as compared to basic dressings offer advantages in terms of healing. In plantar diabetic foot ulcers, non-removable off-loading devices regardless of type are more likely to result in ulcer healing than removable off-loading devices, presumably, because patient compliance with off-loading is facilitated. Meaningful pressure-relieving interventions for treating diabetic foot ulcers also include Achilles tendon lengthening, a plantar fascia release and percutaneous flexor tenotomy. The value of a standardised treatment protocol carried out by a specialist team could be proven in large registries based on decreasing amputation rates.CONCLUSION: This survey reveals a significant disparity between the large number of treatment recommendations and their evidence. For the future, therefore it is imperative to implement nationwide register surveys with respect to treatment and outcome of these patients.
KW - Cooperative Behavior
KW - Evidence-Based Medicine
KW - Foot/blood supply
KW - Humans
KW - Interdisciplinary Communication
KW - Microsurgery/methods
KW - Postoperative Care/methods
KW - Postoperative Complications/etiology
KW - Reconstructive Surgical Procedures/methods
KW - Registries
KW - Surgical Flaps/surgery
KW - Vascular Surgical Procedures/methods
KW - Weight-Bearing/physiology
U2 - 10.1055/s-0035-1545683
DO - 10.1055/s-0035-1545683
M3 - SCORING: Zeitschriftenaufsatz
C2 - 25874473
VL - 140
SP - 219
EP - 227
JO - ZBL CHIR
JF - ZBL CHIR
SN - 0044-409X
IS - 2
ER -