THE PARTICULARITY PLASTIC CLOSURE OF WOUND DEFECTS IN PATIENTS WITH CHRONIC DIABETIC WOUNDS

Abstract

Background. Chronic diabetic foot wounds and ulcers are serious complications of the course of diabetes mellitus (DM), which account for 85% of purulent-necrotic lesions of the lower extremities. Pathogenetic mechanisms of "chronization" of wounds in the form of hyperglycemia, neuropathy, and existing infection lead to metabolic disorders in the form of tissue hypoxia and activation of matrix metalloproteinase (MMP) proteolytic enzymes.
 Aim: to study the role of autologous plasminogen on healing processes in diabetic wounds by modulating MMP activity.
 Materials and methods. 45 patients with chronic diabetic wounds, who were divided into 2 groups, participated in the study. Patients of the control group (n=25) were treated according to standard methods. Autologous plasminogen applications were used for treatment in 20 patients of the main group.
 Results. On the 18th day of treatment, a 3.5-fold decrease in the activity of MMP-2,-9 and complete healing of wounds was noted in 16 patients. In 4 patients, the wound defects were closed by the method of autodermoplasty with complete engraftment of grafts. In the patients of the control group, the level of MMP activity remained stably high throughout the observation period.
 Conclusions. The use of applications of autologous plasminogen allows to modulate the activity of MMP and create favorable conditions for the healing of chronic diabetic wounds.