Modern Approaches to the Choice of Treatment Regimen for Diabetic Foot Syndrome Complications
Introduction. Diabetic foot syndrome is one of the most frequent and serious complications of diabetes and occurs in 8-10 % of patients. When risk group includes about 50 % of patients with diabetes. Treatment methods of diabetic foot syndrome remain far from being perfect up till now. Purpose. To improve the results of surgical treatment of patients with complicated forms of diabetic foot syndrome by use of the cultivated tissue equivalents from allofibroblasts. Materials and Methods. The analysis of treatment results was conducted. 24 patients with complicated forms of diabetic foot syndrome were treated by conventional method and 33 patients - by the proposed method. In the second group of patients on the 2nd - 3rd day after the use of antiseptics, the cultivated tissue equivalents from allofibroblasts were used during bandaging. Cytological, bacteriological, laboratory, and planimetric methods were used to assess the progress of wound healing. Results and Discussion. Comparative evaluation of the treatment methods for patients of the first and the second group consisted of daily observation of the patients and the wounds. Depending on the treatment method the difference in cytology image of the wound was observed. Cytology image in the study of wound content on day 7 indicated a more rapid completion of the first phase of wound healing and stimulation of reparative regeneration in the second group of patients (94 %), while in the first group it corresponded to the first phase of wound healing. After two weeks of treatment in 91 % of patients from the second group the regenerative type of cytogramma was observed, in the other 9 % of patients - inflammatory and regenerative, which indicates the active epithelization of the wound. While in the first group all smears indicated the first phase of wound healing, and only in 2 patients on day 14 inflammatory and regenerative type of cytogramma which corresponds to the second phase of wound healing was observed. Bacteriological contamination of the wound in the first group after two weeks of treatment decreased from 1856 ± 154 to 1597 ± 138, in the second group it decreased from 1856 ± 154 to 986 ± 111. Due to low reparative activity in the wound which led to the restoration of the necrotic process, 6 patients from the first group had repeated surgery on their feet, while in the second group only 1 patient had repeated surgery. In the second group of patients, in combination with surgical treatment of complications of diabetic foot syndrome, the use of the cultivated tissue equivalents from allofibroblasts ensures the closure of wound defect of the foot, prevents the spread of purulentnecrotic process, accelerates the wounds cleaning from purulentnecrotic masses, speeds up the transition from the first phase of wound healing to the second, speeds up the stimulation of regeneration and wound epithelization processes, so that the progression of purulentnecrotic process stops. In patients from the first group the reparative processes ran much slower. Conclusion. Comparative evaluation of the results showed the effectiveness of the use of the cultivated tissue equivalents from allofibroblasts in the local treatment of diabetic foot syndrome complications compared to the traditionally used drugs. This method is available and convenient for clinical use, promotes rapid cleaning of the postoperative wounds and faster healing.