Transport capacity of lymphatic system of lower extremities in patients with diabetic foot syndrome - a pilot study
Abstract
Introduction: Lymphatic system can play an important role in the development of some pathological processes in diabetic foot syndrome. It is associated with neurological abnormalities and various degree of peripheral vascular disease in the lower limbs which can increase the amount of interstitial fluid.
We, therefore, tested function of lymphatic system of lower extremities in diabetic patients. Material and methods: We evaluated 13 diabetic patients (4 male, 9 female, average age 64 years) with diabetic foot syndrome without skin defect.
We selected control group (13 matched patients without diabetes) from our historical database. Lymphoscintigraphy was performed after subcutaneous injection of radio-colloid in the web spaces of the feet.
Static images were performed immediately post injection, 30 minutes post injection at rest and after 30 minutes of walking. The transport capacity (percentage of the injected dose accumulated in the regional lymph nodes) was then calculated.
Paired t-test was used for comparison. Results: Mean transport capacity in diabetic and non- -diabetic pts on the right and left side at rest and after stress was 4.4%, 18.6%, 4.8%, 19.5%, 0.4%, 4.8%, 0.3%, and 2.9%, respectively (p=0.000-0.007).
Rest transport capacity in diabetics was at the level of stress transport capacity in non-diabetics while transport capacity reserve in non-diabetic pts was twice as higher as in diabetics. Conclusion: Transport capacity of lymphatic system of both lower extremities at rest is much higher in diabetic patients comparing to patients without diabetes while their transport capacity reserve is much lower.
We believe this is a sign of overload of lymphatics due to increased amount of interstitial fluid which can contribute to development of diabetic foot syndrome.