An Improved Method for Controlling Bleeding from The Bone Marrow Canal During Lower Limb Amputation in Patients with Diabetes Mellitus

Abstract

Objective: To clinically evaluate the effectiveness of a new plastic form of the local hemostatic agent Hemoben for controlling bleeding from the medullary canal during lower limb amputation in patients with diabetes mellitus.

Methods: The study was conducted in patients who underwent lower limb amputation due to complications of diabetes mellitus. In the control group, intraoperative hemostasis was achieved using conventional techniques, including vessel ligation, electrocautery, and standard local hemostatic agents. In the main group, a new plastic form of Hemoben was used to control bleeding from the medullary canal during femoral amputation. The plastic hemostatic material was prepared by mixing Hemoben powder with sterile physiological saline and combining it with a collagen hemostatic sponge. The prepared material was then placed into the medullary canal after transection of the femur. The following parameters were comparatively evaluated: time to achieve hemostasis, duration of surgery, intraoperative blood loss, incidence of postoperative local complications, wound healing time, and length of hospital stay.

Keywords:

References

International Diabetes Federation. IDF Diabetes Atlas. 10th ed. Brussels: International Diabetes Federation; 2021.

Armstrong D.G., Boulton A.J.M., Bus S.A. Diabetic foot ulcers and their recurrence. N Engl J Med. 2017;376(24):2367–2375.

Bus S.A., Lavery L.A., Monteiro-Soares M., et al. Guidelines on the prevention of foot ulcers in persons with diabetes. Diabetes Metab Res Rev. 2023;39(S1).

Schaper N.C., van Netten J.J., Apelqvist J., et al. Practical guidelines on the prevention and management of diabetic foot disease. Diabetes Metab Res Rev. 2024;40(S1).

Edmonds M., Foster A. Managing the Diabetic Foot. 4th ed. Wiley-Blackwell; 2021.

Frykberg R.G., Banks J. Challenges in the treatment of chronic wounds. Adv Wound Care. 2015;4(9):560–582.

Hingorani A., LaMuraglia G.M., Henke P., et al. The management of diabetic foot. J Vasc Surg. 2016;63(2 Suppl):3S–21S.

World Health Organization. Global report on diabetes. Geneva: WHO; 2016.