The wound process variants course in patients with diabetic foot syndrome in the vacuum therapy background
DOI:
https://doi.org/10.34287/MMT.2(41).2019.8Abstract
Purpose of the study. Study the effectiveness of vacuum therapy in the treatment of acute and chronic wound process in patients with diabetic foot syndrome, depending on the pathogenetic form of the lesion.
Materials and methods. The effect of vacuum therapy on the course of acute and chronic wound process in 231 patients with neuropathic and ischemic form of diabetic foot syndrome was studied during 2014–2017. Evaluation of the dynamics of the wound process was carried out on the basis of clinical, planimetric, microbiological, morphological methods, as well as microcirculation indices in the area around the wound.
Results. Vacuum therapy of acute and chronic wounds in patients with different pathogenetic forms of diabetic foot syndrome, allows to stabilize the course of wound process, stimulate regenerative processes in the wound, improve local microcirculation (p < 0,05). This, in turn, allows a shorter time to prepare a wound for closure by one of the methods of plastic surgery or create favorable conditions for its independent epithelization.
Inpatientswithischemiclesions(chronicarterial insufficiency of the third degree), the carrying out of vacuum therapy by standard method leads to an intensification of the pain syndrome. This causes the need to apply an initial negative pressure in the system in the range of 70–80 mm Hg, which makes it possible to stop pain during the day. At 2–3 days of the postoperative period, negative pressure is established at standard values.
Conclusion. Vacuum therapy of wounds in patients with diabetic foot syndrome is an effective method of treatment that allows the doctor to reduce the duration of treatment of patients in hospital with a neuropathic form of diabetic foot syndrome on average 4,3 ± 1,7 bed-days, and patients with ischemic form on average 4,1 ± 1,9 bed-days, which has both medical and social significance.
References
Maslova OV, Suntsov YI. Epidemiologiya sakharnogo diabeta i mikrososudistykh oslozhnenii. Sakharnyi diabet. 2011; 3: 6–11.
Suntsov YI, Bolotskaya LL, Maslova OV, Kazakov IV. Epidemiologiya sakharnogo diabeta i prognoz ego rasprostraneniya v Rossiiskoi Federatsii. Sakharnyi diabet. 2011; 1: 15–19.
International Working Group on the Diabetic Foot. IWGDF Guidance on the management and prevention of foot problems in diabetes 2015. Amsterdam. 2015 [cited 2016 Sep 9]. Available from: http://iwgdf.org/guidelines/.
Donath MY, Shoelson SE. Type 2 diabetes as an inflammatory disease. Nat Rev Immunol. 2011; 11 (2): 98–107. DOI: 10.1038/nri2925
Shaw J.E, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract. 2010; 87 (1): 4–14. DOI: 10.1016/j.diabres.2009.10.007
Dedov II. Sakharnyi diabet – opasneishii vyzov mirovomu soobshchestvu. Vestnik RAMN. 2012; 1: 7–13. DOI: 10.15690/vramn.v67i1.103
Zaitseva EL, Tokmakova AY. Vakuumterapiya v lechenii khronicheskikh ran. Sakharnyi diabet. 2012; 3: 45–49.
Schintler MV. Negative pressure therapy: theory and practice. Diabetes Metab Res Rev. 2012; 28 (1): 72–77. DOI: 10.1002/dmrr.2243.
Krivoshchekov EP, Elshin EB. Rol vakuumterapii v kompleksnom lechenii oslozhnennykh form diabeticheskoi stopy. Izvestiya Samarskogo nauchnogo tsentra Rossiiskoi akademii nauk. 2014; 16 5(4): 1286–1288.
Abaev YK. Rany i ranevaya infektsiya: spravochnik khirurga. Rostov-na-Donu, Feniks, 2006, 427.
Pokrovskaya MP, Makarov MS. Tsitologiya ranevogo ekssudata, kak pokazatel protsessa zazhivleniya ran. Moscva, 1942, 42.
Kamaev MF. Infitsirovannaya rana i ee lechenie. Moscva, Meditsina, 1970.
Metody obshchei bakteriologii: in three volumes, translation from Englishv – F. Gerkhardta (ed). Moscow, Mir, 1984.
Khoulta D et al (ed). Opredelitel bakterii Berdzhi: in two volumes, translation from Englishv. Moscva, Mir, 1997.
