Morphological evaluation of the effectiveness of hydrosurgical system VersaJet® in conjunction with combined antibiotic therapy in the treatment of necrotic complications of diabetic foot syndrome with biofilm forms of bacteria
The article presents the results of a prospective randomized comparative clinical, microbiological and morphological (electron microscopic and electron radioautographic) researches of biopsy material of the wounds of 28 patients with neuropathic form of diabetic foot syndrome (DFS), complicated by purulent process, before treatment, after 5 and 10-14 days of treatment. Objective - to study the dynamics of reparative processes in the purulonecrotic wound in cases of diabetic foot syndrome. The subjects treated in this study included three groups of patients: Group 1 - after surgical treatment of wounds and topical treatment with ointments on polyethylene glycol basis; Group 2 - after surgical treatment of wounds with hydrosurgical system VersaJet® and intravenous systemic antibiotics therapy, chosen according to the results antibiogram; Group 3 - after surgical treatment of wounds with hydrosurgical system VersaJet® and combination systemic antibiotic therapy (a drug selected as a result of antibiogram plus clarithromycin). There is shown the ultrastructure of a microbial biofilm, the effect of antimicrobial agents on its destruction and the structural and functional state of microbial populations and injury cells. The high efficiency of the hydrosurgery system VersaJet® and combined systemic antibiotic therapy with clarithromycin in the treatment regimen, and dressings with ointments on PEG basis for the treatment of purulonecrotic wounds in patients with neuropathic form of diabetic foot syndrome. Already on the 5th day of the complex wound treatment the morphological study of the biopsy materials of the wounds showed no presence of biofilms on the surface of the wound, and in its deepest layers. Free (plankton-like) cells of microorganisms were also none. Effective purification of wounds from microbial and cellular detritus was indicated that led to the intensification of the functional and proliferative activity of the cells of the granulation tissue. Such dynamics of wound process in almost all Group 3 patients allowed to conduct the final stage of treatment (plastic reconstruction of the foot) in a shorter time. Introduced for the Group 3 of patients the algorithm of complex treatment prevents the formation of new microbial biofilms, increases the activity of systemic antimicrobials even in the identification of multiple-antibiotic resistant strains.