Abstract
The nature of reparative and morphological changes in wounds was examined against the background of vacuum therapy in the comprehensive treatment of purulent and necrotic lesions of diabetic foot syndrome. We conducted comprehensive examination and treatment of 107 patients with DFS of grade II-IV according to Meggit-Wagner. The average age of patients was 53.2–4.3 years; there were 39 (36.4%) male and 68 (63.6%) female patients. Depending on the methods of topical treatment, patients were divided into two groups. The main group consisted of 55 (51.4%) subjects who underwent vacuum therapy during the topical treatment, and the comparison group comprised 52 (48.6%) patients who received standardized local treatment depending on the course of the wound process. In addition to the clinical studies, all patients underwent a comprehensive laboratory and instrumental examination, as well as measuring the area and pH of wounds on the 1st, 4th, 7th, 10th and 13th day after surgery. The analysis of the obtained results gives ground to establish that at a certain level of pH, there is a corresponding cytological pattern. The wide range of fluctuations in the pH of the wound medium in patients with purulent and necrotic lesions of diabetic foot syndrome leads to corresponding changes in cells, which is manifested by a long-lasting inflammatory process. In the main group, the rate of wound reduction was greatest on the 8th-10th days, and in the comparison group – on the 14th-15th days. Inpatient treatment was 14.2 bed-days in the main group and 23.5 ± 2.9 in the comparison group (p <0.05), respectively. Therefore, there is an acceleration of positive changes in clinical manifestations, cytological, morphological and pH-metric pattern against the background of conducting VT for an average of 5-7 days. The use of vacuum therapy makes it possible to accelerate the transition to the second phase of the wound process, which affects not only the time of treatment but also the outcome – preservation of the lower extremity in patients with diabetic foot syndrome.
Highlights
Purulent and necrotic (PN) foot lesions in patients with diabetes mellitus (DM) constitute a significant medical, social and economic problem all over the world
The main group included 55 people (51.4%) who underwent Vacuum therapy (VT) for local treatment, and 52 patients (48.6%), who received standardized local treatment, depending on the course of the wound process, comprised the comparison group. Patients in both groups received treatment in accordance with the international protocols for treatment of Diabetic foot syndrome (DFS), which included the prescription of antibacterial therapy, depending on the sensitivity of microflora derived from wounds, insulin therapy, angioprotectors, alpha lipoic acid preparations, medications that improve the rheological properties of the blood, disaggregation drugs
Manifestations of neuropathy were characteristic of all patients with DFS
Summary
Purulent and necrotic (PN) foot lesions in patients with diabetes mellitus (DM) constitute a significant medical, social and economic problem all over the world. The risk of developing purulent ulcer in diabetic patients during lifetime is up to 25%, and the frequency of nontraumatic amputation of the lower limb is almost by 22 times higher in patients with DM than in those without it [4, 10]. Diabetic foot syndrome (DFS) is one of the most common complications of DM, which occurs in 15% of diabetic patients [8]. In 30% of patients with this pathology, amputations of the other limb are performed 3 years after the first one, and in 5 years they are performed in almost 54% of patients [7, 12]. Trophic changes in the DFS create favorable conditions for the development of infection with the onset of PN processes on the foot, while the inflammation phase is prolonged, resulting in the secondary necrosis; the formation of granulation bank slows down, which together with the uncompleted phagocytosis facilitates the multiplying of microorganisms in the wound [8, 13]
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