scholarly journals The use of the VersaJet hydrosurgical system in patients with diabetic foot syndrome

2010 ◽  
Vol 13 (3) ◽  
pp. 121-126
Author(s):  
Lyudmila Petrovna Doronina ◽  
Valeriy Afanas'evich Mitish ◽  
Gagik Radikovich Galstyan
Keyword(s):  
Wound Healing ◽  
Diabetic Foot ◽  
Treatment Duration ◽  
Diabetic Foot Syndrome ◽  
Adequate Treatment ◽  
Technical Problems ◽  
Medical Aid ◽  
Foot Lesions ◽  
Multifactor Approach

The management of chronic lesions in DM patients implies a multifactor approach, its important component being the adequate treatment of thewound bed. The new hydrosurgical technology for the purpose based on the VersaJet system poses a number of technical problems and requires assessmentof its applicability and efficiency in patients with different forms of diabetic foot syndrome. Results of the work with this system (62 patients)revealed its advantages, such as reduction of treatment duration and the number of repeat treatments, higher probability of wound healing at sitesdifficult to access (heel, tendon projection regions, etc.). It is concluded that the VersaJet system may be recommended for the use in surgical departmentsproviding specialized medical aid to patients with DM and pyonecrotic foot lesions.

scholarly journals Possibilities of combined surgical treatment of pyonecrotic lesions in the neuroischemic form of diabetic foot syndrome

2009 ◽  
Vol 12 (1) ◽  
pp. 8-13
Author(s):  
Valeriy Afanas'evich Mitish ◽  
I A Eroshkin ◽  
Gagik Radikovich Galstyan ◽  
Lyudmila Petrovna Doronina ◽  
Yu S Paskhalova ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Diabetic Foot ◽  
Lower Extremities ◽  
Lower Leg ◽  
Diabetic Foot Syndrome ◽  
Diagnostic Tools ◽  
Critical Ischemia ◽  
Adequate Treatment ◽  
Patients With Diabetes ◽  
Foot Lesions

Aim. To present results of combined surgical treatment of the ischemic form of diabetic foot syndrome complicated by pyonecrotic process. To show thatthe use of modern diagnostic tools and the choice of adequate treatment strategy permits to substantially reduce the number of above-the-knee amputations. Materials and methods. A total of 140 patients with diabetes mellitus and critical ischemia of lower extremities were under observation during 2004-2008.All of them had purulent and/or necrotic foot lesions. The patients were examined by X-ray, computed and magneto-resonance tomography of the feet,duplex scanning of lower leg vasculature, transcutaneous measurement of PO2, pelvic and lower leg arterial angiography. Results. A strategy of surgical treatment was developed to be used depending on the patients health status, clinical features and severity of pyonecroticprocesses in the foot, and the degree of involvement of the main blood vessels of lower extremities. Conclusion. Combination of endovascular surgery with various methods for plastic wound closure permits to extend the range of possibilities for the treatmentof high-risk patients, such as those with pyonecrotic lesions and neuroischemic form of diabetic foot syndrome. This approach opens up prospects fora significant decrease of percentage of above-the-knee amputations and improves the quality of life in these patients.

scholarly journals Biological Mechanisms of Chronic Wound and Diabetic Foot Healing: The Role of Collagen

2018 ◽  
Vol 19 (4) ◽  
pp. 373-382 ◽  
Author(s):  
Victor Alexandrovich Stupin ◽  
Ruslan Borisovich Gabitov ◽  
Tatiana Georgievna Sinelnikova ◽  
Ekaterina Vladimirovna Silina
Keyword(s):  
Wound Healing ◽  
Diabetic Foot ◽  
World Literature ◽  
Chronic Wounds ◽  
Chronic Wound ◽  
Treatment Algorithm ◽  
Diabetic Foot Syndrome ◽  
Results Of Treatment ◽  
Native Collagen ◽  
Chronic Ulcers

Abstract The treatment of chronic wounds is a continuously developing research focus. The problems of excessive mechanical forces, infection, inflammation, reduced production of growth factors, and lack of collagen will affect the results of treatment. The purpose of this study was to analysse the elements that lead to long-term non-healing of chronic wounds and trophic ulcers, including diabetic foot syndrome, by determining the optimal treatment algorithm. The paper presents an analysis of the world literature on the etiopathogenesis and principles of chronic wound treatment in diabetic foot syndrome. The epidemiology of chronic wounds of different genesis is presented. The issues of physiological and metabolic disorders in chronic ulcers affecting the process of wound healing are discussed. Particular attention is paid to collagen, which is a protein that forms the basis of connective tissue; collagen ensures the strength and elasticity of the skin, which confirms the importance of its role not only in aesthetics but also in the process of wound healing. Different types of collagen and their roles in the mechanisms of chronic wound healing in diabetic foot syndrome are described. The results of clinical studies evaluating the effectiveness of medical products and preparations, consisting of collagen with preserved (native collagen) and fractionated structures, in treating chronic wounds of diabetic foot syndrome are analysed. It has been shown that the use of native collagen preparations is a promising treatment for chronic ulcers and wounds, including diabetic foot syndrome, which makes it possible to increase the effectiveness of treatment and reduce the economic costs of managing these patients.

scholarly journals Modern approaches to local treatment of pyo-necrotic complications of the diabetic foot syndrome

2012 ◽  
Vol 93 (2) ◽  
pp. 301-303
Author(s):  
L E Slavin ◽  
B N Godzhaev ◽  
A Z Zamaleev
Keyword(s):  
Wound Healing ◽  
Diabetic Foot ◽  
Healing Process ◽  
Local Treatment ◽  
Water Soluble ◽  
Diabetic Foot Syndrome ◽  
Layered System ◽  
Second Phase ◽  
Bathing Solution ◽  
Optimal Conditions

The analysis of publications devoted to modern methods of treatment of pyo-necrotic complications of diabetic foot syndrome has been presented. Identified were the most important principles of therapeutic tactics for this type of pathology. In order to create optimal conditions for wound healing after surgical sanitation local drug treatment is carried out - a thorough wound detersion with application of the isotonic sodium chloride solution or a neutral bathing solution, periodic (as needed) necrectomies, application of bandages, in accordance with the phase of wound healing process. The choice of medication for local treatment depends on the one hand on the type of lesion of the lower limbs, on the other - on the diabetes related morbidity and phase of wound healing. In the first phase of wound healing antiseptics are used: iodophors, polyhexanide (lavasept), hydroxymethyl quinoxaline dioxide (dioxidine), and in the absence of ischemia - compositions based on gelevine, water-soluble base ointments. In the second phase used were various wound covers based on collagen, as well as oil and hydrogel dressings. Ready-to-use bandages are also used, which are multi-layered system, comprised of a cellulose substrate, collagen, fibroblasts, growth factor, coated with plates of silicon to control humidity. The disadvantage of the ready-to-use dressings is the impossibility of controlling the wound on a daily basis. One of the trends in the treatment of chronic diabetic wounds is the use of living skin cells that serve as a source of growth factors, cytokines and other proteins that stimulate the healing process. The use of local immunomodulators is seen as promising. Treatment should be individualized and systemic antibiotic therapy is required. The main principle of local treatment is the creation of optimal conditions for accelerating the healing process.

scholarly journals Morphological research of the effectiveness of perioperative local use of anesthetics and antiseptics in patients with purulent-necrotic lesions of lower extremities in diabetes mellitus

2021 ◽  
Vol 27 (3) ◽  
pp. 22-28
Author(s):  
Yu.M. Babina ◽  
D.V. Dmyrtriiev ◽  
O.A. Nazarchuk ◽  
P.P. Hormash
Keyword(s):  
Diabetes Mellitus ◽  
Wound Healing ◽  
Granulation Tissue ◽  
Diabetic Foot ◽  
Povidone Iodine ◽  
Local Treatment ◽  
Lower Extremities ◽  
Diabetic Foot Syndrome ◽  
Patients With Diabetes ◽  
Infiltration Anesthesia

Ulcer-necrotic lesions of the feet are detected in 5-15% of patients with diabetes mellitus (DM). According to the literature today in Ukraine, patients with DM perform high amputation of the lower extremities with diabetic foot syndrome with a frequency of 19.6-42.6%, at the same time, mortality ranges from 8.9% to 25.0%, and the total mortality rate at the DM varies from 6.6% to 13.5%, often associated with the occurrence of postoperative complications. The aim of the work was to study morphological indicators of reparation of soft tissues of the lower extremities in patients with diabetic foot syndrome on the background of local treatment during the perioperative period. We investigated changes in histologic structure and character of reactions of skin tissues, muscles and fascia during the period of visceral disease in patients with diabetes mellitus after different types of local treatment. Then, samples of skin tissues, muscles and fascia were photographed and analyzed using a light microscope OLIMPUS BX 41. In the first group of the comparison, which used standard methods of anesthesia and local antiseptic povidone-iodine, granulation tissue was characterized by the complete absence of fibrous structures (collagen fibers) and the presence of a small number of newly formed small diameter vessels with blistered endothelium. Vessels of young granulation tissue were dilated, full-blooded, the endothelium was swollen, there was significant perivascular edema. In the second group of patients (where povidone-iodine and infiltration anesthesia with 2% lidocaine solution anesthetic was used locally) there were almost no remains of necrotic tissues in the affected tissues. It should be noted that there was better granulation development with fewer inflammatory-cell elements, more young forms of fibroblasts and a moderate pathological vascular reaction. In the first (control) group, wound healing by 3-7 days is characterized by somewhat slow regeneration. Wound healing was most favorable in patients of the second group, where infiltration anesthesia was used by local anesthetic and antiseptic povidone-iodine.

Long-term outcome of successful percutaneous transluminal angioplasty of the fibular artery in diabetic foot syndrome and single-vessel calf perfusion depends on doppler wave pattern at the forefoot

VASA ◽  
2010 ◽  
Vol 39 (1) ◽  
pp. 67-75 ◽  
Author(s):  
Hering ◽  
Angelkort ◽  
Keck ◽  
Wilde ◽  
Amann
Keyword(s):  
Wound Healing ◽  
Diabetic Foot ◽  
Wave Pattern ◽  
Transluminal Angioplasty ◽  
Diabetic Foot Syndrome ◽  
Wave Form ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Wave Patterns

Background: In the diabetic foot syndrome (DFS) due to peripheral artery disease, the fibular artery is often the only vessel which can be revascularised. Because the fibular artery does not have a direct connection to the plantar arch, the clinical result of fibular artery PTA is dependent upon the extent of collateralization at the ankle. Therefore, successful PTA of the fibular artery with resulting biphasic doppler waves at the ankle can lead to either biphasic or monophasic post-occlusive doppler wave patterns at the forefoot. We evaluated prospectively the association of the forefoot doppler wave form on long-term clinical outcome in patients with DFS after successful PTA of the fibular artery. Patients and methods: 44 patients with occluded calf vessels and DFS Wagner 2-4 underwent primary successful fibular artery PTA resulting in biphasic ankle doppler wave. According to doppler wave form at the forefoot, patients were divided into 1) a biphasic or 2) a monophasic group. Up to 45 months, we documented doppler wave forms, clinical course, restenosis, reinterventions, wound healing, major- and minor amputations. Results: PTA resulted in a biphasic doppler wave at the forefoot in 26 (59 %), in 18 (41 %) in a monophasic wave pattern. Biphasic forefoot doppler wave was strongly correlated with longer event-free survival (35 bi- vs. 5.5 months monophasic, p = 0.0018) and complete wound healing (69 % s bi- vs. 44 % vs. monophasic p = 0.0309). Major amputations: 2 / 26 (8 %) in the biphasic and in 3 / 18 (17 %) in the monophasic group. Second revascularisation procedures were more often necessary in the monophasic group (7 / 18 (39 % vs. 2 / 26 (8 %)). Conclusion: After successful PTA of the fibular artery, monophasic doppler wave patterns at the forefoot denote insufficient collateralization and are associated with poor outcome. If successful fibular artery PTA results only in monophasic forefoot doppler, additional crural or pedal bypass should be strongly contemplated.

scholarly journals Nursing Care for a Patient in the Course of Diabetic Foot with the Use of Innovative URGO Dressings that Stimulate Wound Healing

2019 ◽  
Vol 4 (5) ◽  
Keyword(s):  
Wound Healing ◽  
Blood Glucose ◽  
Nursing Care ◽  
Diabetic Foot ◽  
Nerve Fibers ◽  
Diabetic Foot Syndrome ◽  
World Health ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Health Organization

In the 21st century, diabetic foot syndrome (ZSC) affects patients with advanced diabetes. Referring to the scope of the WHO World Health Organization, "diabetic foot syndrome" is the result of infection, small and large blood vessels in the features of neuropathic nerve fibers resulting from increased blood glucose levels, as well as ischemia of varying levels. Untreated diabetic foot can be completed even to amputation ends in different ways of healing managed by patients whose chances of improvement in health can also be used using therapy [1-5].

scholarly journals Clinical and morphological features of reparative processes in patients with the diabetic foot syndrome

2003 ◽  
Vol 49 (1) ◽  
pp. 20-25
Author(s):  
О. V. Udovichenko. ◽  
A. . Yu. Tokmakova ◽  
M. B. Antsiferov ◽  
P. V. Yushkov ◽  
I. I. Dedov
Keyword(s):  
Extracellular Matrix ◽  
Granulation Tissue ◽  
Diabetic Foot ◽  
Peak Load ◽  
Nerve Fibers ◽  
Diabetic Foot Syndrome ◽  
Foot Pressure ◽  
Adequate Treatment ◽  
History Of ◽  
Recurrent Ulcers

The purpose of the study was to examine structural abnormalities in the skin and granulation tissue, which explain long-term heal­ing and recurrent trophic ulcers in patients with the neuropathic diabetic foot syndrome who received adequate treatment. Biopsy specimens were taken from the granulation tissue and skin of the edge of a trophic ulcer in 12 patients (mean age 48.4+6.6 years) with types 1 and 2 diabetes mellitus (its duration was 14.0+4. 7 years). All the patients were treated for the neuropathic diabetic foot syndrome according to the generally accepted recommenda­tions. According to the duration of trophic ulcer, the patients were divided into 2 groups: 1) 4 patients with a history of under 3 months and 2) 8 patients with a history of above 3 months. Ac­cording to the presence or absence of trophic ulcers in the history, all the patients were again divided into Groups A (recurrent ul­cers, n = 5) and В (primary ulcers, n = 7). Patients with slowly healing ulcers were found to have an abnormal foot pressure more frequently, as evidenced by computerized pedography (the peak load in the ulcer area being in 63% of them versus 25% in Group 1) and some specific features of granulation tissue (excess of active fibroblasts, immaturity of the extracellular matrix, at­rophy and sclerosis of nerve fibers). Patients with recurrent ulcers were older, demonstrated lower vibration perception scores, mor­phological features, such as abundant active polymorphonuclear leukocytes, mast cells with signs of degranulation and T-helper cells, immature extracellular matrix, fibrinoid necrosis and young capillary vessels with microthrombi. Thus, the detection of the above granulation tissue and wound edge changes (especially with an abnormal foot pressure pattern, significantly low vibra­tion perception scale, and old age) makes it possible to suggest slow healing or recurrence of ulcer.

scholarly journals Collagen role in the mechanisms of chronic wounds healing diabetic foot syndrome.

2018 ◽  
Vol 96 (2) ◽  
pp. 106-115 ◽  
Author(s):  
Ekaterina V. Silina ◽  
V. A. Stupin ◽  
R. B. Gabitov
Keyword(s):  
Wound Healing ◽  
Diabetic Foot ◽  
World Literature ◽  
Chronic Wounds ◽  
Diabetic Foot Syndrome ◽  
Medical Products ◽  
The World ◽  
Native Collagen ◽  
Different Types

The review of the world literature, is devoted to the role of collagen in the process of wound healing. The problems of epidemiology of chronic wounds and ulcers of various genesis, physiology and pathophysiology of wound healing phases are considered. The pathogeneticrole of different types of collagen, as well as the mechanisms of collagen, macrophage, fibroblasts, matrix metalloproteinases and other cytokines in healing ulcers are discussed. The prospects of development and use of medical products and preparations based on collagen in the treatment of patients with chronic wounds and ulcers are shown. The results of clinical studies on the effectiveness of collagen with preserved (native) and unsaved (fractionated) structure are presented. The advantages of using native collagen in the treatment of diabetic foot syndrome are demonstrated.

scholarly journals Phototherapy in complex treatment of wounds in patients with ischemic and neuroischemic form of diabetic syndrome

2018 ◽  
Keyword(s):  
Wound Healing ◽  
Growth Factor ◽  
Diabetic Foot ◽  
Comparison Group ◽  
Local Treatment ◽  
Lower Extremities ◽  
Bone Defects ◽  
Main Group ◽  
Diabetic Foot Syndrome ◽  
Algorithm Analysis

The aim of the study was to improve results of wound healing in patients with ischemic and neuroischemic forms of diabetic foot syndrome by using a combination of phototherapy, platelet-derived growth factor and modern cover materials The results of surgical treatment of 48 patients with ischemic and neuroischemic diabetic foot syndrome, which were divided into main group (24 patients) and comparison group (24 patients). All these patients who underwent treatment in the Department of acute vascular diseases in the Clinic of the SI “Institute of General and Urgent Surgery named after V.T. Zaitsev of the National Academy of Sciences of Ukraine” suffered from diabetes mellitus type II and had IV degree of foot ischemia according to Fontaine. The diagnostic was performed for all patients according to a standard algorithm. Analysis of the results of clinical, laboratory, non-invasive and invasive methods of examination in the preoperative period enabled to determine the degree of disorder in blood flow, the nature of collateral circulation and microcirculation. Patients of both groups underwent femoro-tibial and femoro-popliteal bypass, as well as hybrid reconstructions. The parameters of regional hemodynamics in patients of main group and the comparison group before and after revascularization were comparable. The patients of main group used the treatment technology developed by us. In cases of development of phlegmons of the foot after the opening of the abscess, vacuum therapy was performed for 7–14 days until the wound was completely cleaned. In the preoperative preparation complex, phototherapy was performed, according to local situation, wounds were irradiated with different wavelengths (405, 470 or 525 nm). After the wounds were cleaned, the wound defect was covered with PCL coating (Nanopharma, Czech Republic) with the application of a fibrin clot and platelet-rich plasma without fibrin, after which further local treatment was accompanied by irradiation of wounds with A. Korobov-V. Korobov photon matrices “Barva-Flex” (the wavelength of the maximum of the emission band of 660 nm). In two cases, the closure of bone defects with ILAYAOSTEOGEN® “A.A. PARTNERS” L.L.C. bone implants of medical company “ilaya” was used. Using these tactics, allow to achieve complete wound healing in 91.7% of patients and partial healing (more than 50%) in 8.3% of patients in main group. The terms of treatment of these patients did not exceed 2 months, high amputations were not required. In patients of comparison group against the background of traditional local treatment, the wounds healed within 2–4 months; in eight cases, repeated hospitalization was required to perform a plastic closure; in two cases amputation was performed below the knee. Thus, phototherapy and plastic closure of wounds of the lower extremities after revascularization in isch- emic diabetic foot syndrome is indicated in cases where the wounds have no tendency to spontaneous healing; introduction of the developed tactics of treatment of “problem” wounds of the lower extremities allowed to achieve complete healing in 91.7% of patients, partial (more than 50%) healing in 8.3% of patients and avoid high amputations; the use of a complex of treatment including phototherapy, wound closure with a synthetic coating with platelet growth factor, and the closure of bone defects with implants is an extremely effective stim- ulator of development in the wound of granulation tissue suitable for further autodermoplasty

scholarly journals EFFECT OF SUBATMOSPHERIC NEGATIVE PRESSURE ON BIASED pH CHANGES IN PURULENT NECROTIC DEFECTS IN DIABETIC FOOT SYNDROME

2019 ◽  
Vol 19 (2) ◽  
pp. 26-30
Author(s):  
O.O. Kizimenko
Keyword(s):  
Wound Healing ◽  
Negative Pressure ◽  
Diabetic Foot ◽  
Negative Pressure Wound Therapy ◽  
Diabetic Foot Syndrome ◽  
Vacuum Therapy ◽  
Second Phase ◽  
Wound Therapy ◽  
Ph Changes ◽  
Therapy Efficacy

The number of patients with diabetes mellitus worldwide is increasing with geometric progression, and thus there is an increase in the percentage of related complications. Diabetic foot syndrome is one of the most serious chronic complications that often results in early disability, long stretches of hospitalization, mounting expenses, and an amputated limb. At present, vacuum therapy in the treatment of purulent necrotic lesions of diabetic foot syndrome is being successfully used in medical practice. The aim of our study was to search and verify for indirect methods of express control of the vacuum therapy efficacy. Based on applying our patented local treatment technique, which includes the negative pressure wound therapy, we determined the pH dynamic changes and the monitored the microbiological climate of wounds. According to the results obtained, the high efficacy of the proposed technique has been found out and statistically confirmed. Starting from the 4th day of applying this technique, the main group demonstrated induced, significantly accelerated pH changes in the wounds that create the conditions for early growth of granulation tissue; the reduction of microbial load in the wound indirectly enhances these processes that were found out twice as slow in the comparison group. Therefore, the contact pH monitoring of wound is quite helpful for checking the therapy efficacy as well as for predicting the course of wound healing. Our study has confirmed its effectiveness in pH changing that positively affects the course of wound healing. Applying negative pressure wound therapy as an integral component of combined treatment of purulent necrotic lesions of diabetic foot syndrome allows medical practitioners to accelerate pH changes to reach their optimum values and considerably promotes the beginning of the second phase of wound healing. The study has also proven the enhanced elimination of bacterial agents from the wound by using this technique that also promotes the early activation of the phase 2 and significantly reduces the percentage of suppurative complications in the future.

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