Diabetes: Rescue for Diabetes-Feet

23. April 2008

It sounds weird but is considered the future special therapy worldwide: The scalpel of all things is supposed to prevent amputations among others on diabetes patients. One of the first places where this new method was applied is the hospital of the medical university in Hannover/Germany.

Prognoses are more than gloomy. Whoever has patients with Diabetes mellitus knows: About 30 to 50 percent develop neuropathy. And it is nothing new that this diabetic impairment of the nerves after an extreme burning pain and an extensive asensibility of hands and feet finally causes the total loss of protective sensibility. However, the major reason for the diabetic foot-syndrome not really treatable yet is new. Just in Germany, about 25,000 amputations of foot, lower – and upper leg are related to that syndrome. But this is not the end of this horror-diagnosis just yet: More than 30 percent of diabetics die within two years after an amputation of the lower leg.

This is exactly, what might change very soon. Because A. Lee Dellon, Professor in the field of plastic- and neuro-surgery and teaching at the Johns-Hopkins-University in Baltimore/USA, developed a downright sensational treatment method. The gimmick: Whenever the American wants to prevent amputation he takes the scalpel. His approach is based on a preventive relief of the leg nerves on three different bottlenecks: The fibula head, the arch of the foot and the tarsal tunnel behind the inner ankle are the targets for his scalpel.

Triumphal procession worlwide

Precondition for the surgery saving limbs is the verification of a nerve compression in hand or leg as cause of a neuropathy – and the adequate adjustment of blood sugar plus blood circulation in the leg. The extent of the neuropathy is determined by a device testing the sensibility (PSSD) by measuring the contact threshold and the two-spots discrimination. The surgery in the last resort before amputation – which was considered a flight of fancy for a long time – now convinces physicians worldwide. Indeed, Dellon’s knife-sharp extrications and nerve separations result in a considerable pain relief and return of the protective sensibility. Effect of the ultimate intervention: Ulcers as well as amputations can be avoided.
“More than 1,000 patients were operated in the US, in more than 80 percent of the cases the pain, sometimes hardly tolerable, was relieved considerably. The sensibility came back to an extent, where no patient developed any ulcers afterwards or amputations became necessary”, the physician Andreas Gohritz at the MHH-Klinik für Plastische, Hand- und Wiederherstellungschirurgie (hospital for plastic-, hand- and reconstructive surgery) in Hanover raves of the new method.

The fact that the MHH is joining the first hospitals in Europe wanting to apply the American therapy concept shows just how promising the potential of the method really is. The surgical nerve relief “is able to prevent diabetics from pain, foot ulcers and amputations”, informs the medical university in Hanover – and offers the “novel therapy for cases with nerve damages as a result of Diabetes mellitus”.

Economically appealing

In our republic – save a few exceptions – the old doctrine still applies that a diabetic nerve damage can be slowed down by drugs but even with a good adjustment of blood sugar it remains irreversible. “But it has been disambiguated by animal tests and clinically that the diabetic neuropathy can be caused by a long-lasting constriction of the nerves. Here an effective therapy approach is possible”, explains Professor Dr. Peter Vogt, head of the applying hospital. In anatomically given bottlenecks such as alongside bones or in connective tissue septums it gets down to a chronical pressure damage of the diabetic nerve. “In those cases a therapy would be obvious.
The therapy approaches of the people in Hanover are perhaps based on solid ground with economically appealing perspectives. More than four million people in Germany alone are suffering from Diabetes mellitus.

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