Vacuum instillation therapy in the treatment of purulent-necrotic forms of diabetic foot
DOI:
https://doi.org/10.34287/MMT.4(47).2020.12Abstract
Lack of control over the course of the disease (diabetes), ignoring measures to prevent the development of complicated forms of diabetic foot, late referral of patients with existing complications on the foot, contributes to an increase in the number of patients with destructive forms of diabetic foot.
Purpose of the study. To evaluate the technique of vacuum instillation therapy (NPWTi) in comparison with the use of an isolated vacuum and the classical surgical method for treating purulentnecrotic forms of diabetic foot.
Materials and methods. The results of local treatment of 41 patients with purulent-necrotic forms of diabetic foot corresponding to III and IV stages (Meggitt-Wagner) were analyzed. The patients are divided into groups depending on the method of topical treatment. The cellular composition and microflora of the wounds were studied, and the change in the area of the wound surface was assessed before the start of treatment and in the 4–5th and 8–9th days.
Results and discussion. The use of NPWT showed better treatment results in comparison with group 1, where signs of phase II of the wound process were diagnosed by 8–9 days from the start of topical treatment in 83,3% of patients. The highest efficiency in topical treatment was noted in the 3rd group using the NPWTi method, where by the 4th–5th day, ½ patients were cytologically diagnosed with phase II of the wound process.
Conclusions. The NPWTi technique is most effective in the treatment of purulent-necrotic forms of diabetic foot, which makes it possible to reduce the time of wound cleaning, the time of the patient's stay in the hospital, and save the limb.
References
Беляева О.А., Радзиховский А.П., Крыжевский В.В., Рыбянец Ю.В., Уланович Л.И., Яковлева Э.И. Антимикробная терапия в комплексном лечении гнойно-некротических осложнений у пациентов с синдромом диабетической стопы. Хирургия Украины. 2012; 4 (44): 058–062.
Ельшин Е.Б. Современные подходы к лечению гнойно-некротических поражений стоп при сахарном диабете. Аспирантский вестник Поволжья. 2014; (5–6): 88–91.
Липатов К. В., Комарова Е. А., Гурьянов Р. А. Диагностика и хирургическое лечение стрептококковой некротизирующей инфекции мягких тканей. Раны и раневые инфекции. Журнал им. проф. Б. М. Костючёнка. 2015; 2 (1): 6–12.
Оболенский В.Н., Семенистый А.Ю., Никитин В.Г., Сычев Д.В. Вакуум-терапия в лечении ран и раневой инфекции. Русский медицинский журнал.2010, 17: 1064–1074.
Размахнин Е.В., Коновалова О.Г., Лобанов С.Л., Шангин В.А. Использование вакуумтерапии при лечении гнойных ран. Забайкальский медицинский журнал.2015, 2: 70–71.
Терехова РП, Пасхалова ЮС, Складан ГЕ, Прудникова СА, Блатун ЛА, Митиш ВА. Изменения в структуре возбудителей хирургической инфекции у больных сахарным диабетом в зависимости от стратегии их лечения. Раны и раневые инфекции. 2015; 2 (3): 22–29.
Терсков Д.В., Черданцев Д.В., Дятлов В.Ю., Коваленко А.А. Эволюция применения отрицательного давления для лечения ран// Современные проблемы науки и образования. 2016, 3: 22–25.
Третьяков А. А., Петров С. В., Неверов А. Н., Щетинин А. Ф. Лечение гнойных ран. Новости хирургии. 2015; 23 (6): 680–687.
