BANEOTSIN® (POWDER, OINTMENT) – PERSPECTIVE FOR USE IN COMPLEX SURGICAL TREATMENT OF PURULONECROTIC DISEASES OF THE LOWER EXTREMITIES IN PATIENTS WITH DIABETIC FOOT SYNDROME

Abstract

Objective – to improve the results of the topical medical treatment of wounds in patients with various forms of diabetic foot syndrome (DFS). Materials and methods. A comparative in vitro study of the antimicrobial and osmotic activity of Baneotsin® and ointments on the basis of polyethylene glycol was done. The subject of the clinical study were 18 patients with DFS. Out of these patients 8 (44.4 %) had the neuro-ischemic form and 10 (55.6 %) had the neuropathic form. According to depth and prevalence of purulonecrotic process, in 3 (16.7 %) cases there was indicated Stage II of the process according to Wagner, in 9 (50.0 %) cases – Stage III and in 6 (33.3 %) patients – Stage IV. All patients had type 2 diabetes of severe treatment, on insulin. Average age of the patients was 61.3 ± 1.4 years. The average rate of glycated hemoglobin of patients on ad- mission to hospital was 8.4 ± 1.3 %. After radical surgical treatment of purulent foci with careful removal of all necrotic tissue all patients had surgical wounds treated with 0.2 % solution of Lavasept®. 3 (16.7 %) patients with the ulcer surface without obvious signs of perifocal inflammation had bandage with Baneotsin® powder after treatment, and after 4–5 days after detecting signs of wound process during the transition to phase II the treatment was continued under the bandage with ointment Baneotsin®. In 10 (55.6 %) cases (in the results of microbiological tests were found aerobic and obligate anaerobes) the treatment of postoperative wound was done under the bandages with 5 % Dioxydine ointment for 2–3 days. 5 (27.8 %) patients (without clinical and bacteriological data of obligate anaerobes) were treated with ointment of Levomekol immediately after the operation. After 7–10 days, the patients were discharged to the outpatient treatment phase with recommendations to continue treatment with bandages with Baneotsin® powder (for 4–5 days) and then with ointment Baneotsin®. Systemic antibiotic therapy at the hospital stage of treatment lasting more than 7 days, was used only in 4 (22.2 %) cases. Results. In patients with trophic anabrosis (3 (16.7 %) persons) it was managed to heal the defects by secondary intention in the period of up to 1 month after surgical treatment. The other wounds were prepared to run the final stage of treatment – the plastic reconstruction of the foot in the period from 10–14 days to 1 month. High ablations and fatal cases in the researched group of patients were not recorded. Conclusion. Application of the algorithm of topical drug treatment of wounds with Baneotsin® powder and ointment, polyethylene glycol based ointments having different osmotic activity, depending on the severity and extent of purulent process in soft tissues, lets to avoid the prescription of long-term systemic antibiotic therapy and to accelerate the transition of purulonecrotic wounds in the phase II of wound process.