The rationale for use of adipose tissue graft for the surgical treatment of spacious postoperative wound defects on the foot in diabetic patients

Abstract

Objective : to search for objective criteria to determine the indications, optimal timing of dermal-fat postoperative wound plastic on the foot and evaluate its effectiveness in patients with diabetes mellitus (DM). Material and methods . We examined 120 patients with DM and destructive forms of diabetic foot syndrome. Area (E1 2 ; E2 >6 cm 2 ) and depth (D2-3) of postoperative wound tissue defects were estimated within 3-5 days after surgical treatment. We formed two clinical groups: 1-st group – 44 patients (group of comparison), who underwent conventional treatment in the postoperative period and 2-nd group – 76 patients (the main group), implemented by the main radical surgery on the foot on 5-7 day after the primary debridement with subsequent skin-fat plastic of postoperative wound defects (Е2D3). The control group consisted of 28 patients with purulent-necrotic lesions of the respective area and depth not suffering from DM. In all patients tyrosine kinase system and cytokine background were evaluated with definition of integral parameters in the form of coefficients. The data were processed statistically using the computer applied programs Statistika. Results . In 76 patients of the main group we have revealed high clinical efficiency of the skin-fat grafting of postoperative wounds (reduction of the time of wound healing to 1.5-2 months and the reduction of the frequency of high amputations to 4.2%) compared with the conventional treatment. Indications for application of the skin-fat flap (SFF) were initially low values of tyrosine kinase index (TKI) compared to the comparison group and the reduction of intercytokine coefficient (ICC) on the fifth day after the surgical treatment of the destructive lesion. Conclusions . A large area and depth of destructive tissue changes of the lower extremities at the background of low values of ТКI (below 50% of control) could serve as indication for use of skin-fat grafting in postoperative wound defects. Efficacy prognosis of skin-fat plastic could be based on the dynamics of the values of ICC after primary surgical treatment, which reflects the reactivity of the systemic mechanisms that limit the alteration phase in the wound and induce proliferative processes.