scholarly journals APPLICATION OF GRAFTSKIN TO ACCELERATE HEALING OF ULCERS IN DIABETIC FOOT SYNDROME

2016 ◽  
Vol 175 (5) ◽  
pp. 63-68 ◽  
Author(s):  
M. A. Binienko ◽  
A. A. Kotslova ◽  
V. V. Davydenko ◽  
T. D. Vlasov
Keyword(s):  
Diabetic Foot ◽  
Soft Tissues ◽  
Standard Treatment ◽  
Vascular System ◽  
Main Group ◽  
Diabetic Foot Syndrome ◽  
Control Group ◽  
Saint Petersburg ◽  
Dermal Equivalent ◽  
Method Factors

Diabetic foot syndrome (DFS) is one of the severe and more frequent complications of diabetes. It is characterized by occurrence of chronic purulent necrotic processes (trophic ulcers) on the foot with damage of skin, soft tissues and osteoarticular system due to pathological changes in the peripheral nervous system (diabetic neuropathy) and vascular system (diabetic angiopathy). This study aimed to evaluate the possibility of accelerating of wound healing in DFS by using the dermal equivalent (graftskin) and determine the safety of the method, factors and indications for its application. The research included 60 patients with DFS who were cured at the period from 2013 to 2016 in departments of purulent surgery of Hospital of war veterans and Municipal hospital № 14 of Saint-Petersburg. The patients were divided into 2 groups by random sampling of two comparable groups in age and sex. The patients of main group were treated by standard method and using application of dermal equivalent (DE) on the area of trophic ulcers. The patients of control group had only standard treatment. The DE showed a high efficacy in the main group of patients. The application of DE in complex treatment of patients with DFS stimulated processes of healing and accelerated the rate of epithelization. The application of DE was the most effective in patients with neuropathic form of DFS.

scholarly journals Comparative evaluation of dermal equivalent effectiveness in neuropathic/and neuroischemic form of diabetic foot syndrome

2016 ◽  
Vol 20 (3) ◽  
pp. 62 ◽  
Author(s):  
A A Kotslova ◽  
M A Binienko ◽  
A N Galileeva ◽  
N M Yudintseva ◽  
S D Sheyanov ◽  
...  
Keyword(s):  
Conflict Of Interest ◽  
Diabetic Foot ◽  
Conventional Treatment ◽  
Diabetic Foot Syndrome ◽  
Control Group ◽  
Study Group ◽  
City Hospital ◽  
Control Groups ◽  
Saint Petersburg ◽  
Dermal Equivalent

<p><strong>Aim.</strong> It was to evaluate the effectiveness of dermal equivalent application when treating ulcers in patients with neuropathic and neuroischemic forms of diabetic foot syndrome (DFS), as well as to compare it with conventional treatment. <br /><strong>Methods.</strong> The study included 60 patients with DFS neuropathic and neuroischemic forms who were treated at Purulent Surgery Departments of War Veterans Hospital and City Hospital No. 14 (Saint Petersburg, Russia) in 2013–2016 years. The patients were divided in two subgroups comparable in age and sex: subgroup A included patients with DFS neuropatic form, subgroup B – those with DFS neuroischemic form. Thus, the study group of patients was formed, who, in addition to conventional treatment of diabetic ulcers, received dermal equivalent application. To assess the effectiveness of dermal equivalent use, two control groups: 10 patients with a neuropathic form and 10 patients with a neuroischemic form of DFS were formed and routinely managed. <br /><strong>Results.</strong> 33 patients (82.5%) (18 patients from subgroup A and 15 patients from subgroup B) out of 40 patients of the study group demonstrated a significantly higher rate of epithelization (p&lt;0.05) as compared to the corresponding subgroup in the control group. <br /><strong>Conclusion.</strong> The efficacy of dermal equivalent is higher when treating a neuropathic form of DFS. The speed of epithelization after the use of dermal equivalent in patients with a neuropathic form of DFS is higher in comparison with a neuroischemic form of DFS.</p><p>Received 5 August 2016. Accepted 23 September 2016.</p><p><strong>Funding:</strong> The study has not been sponsored or awarded a grant.<br /><strong>Conflict of interest:</strong> The authors declare no conflict interests.</p>

scholarly journals Plastic coverage of the ulcer-necrotic affections of the foot soft tissues in patients, suffering an ischemic form of diabetic foot syndrome

2018 ◽  
Vol 85 (6) ◽  
pp. 40-43
Author(s):  
S. M. Didenko
Keyword(s):  
Diabetic Foot ◽  
Soft Tissues ◽  
Standard Treatment ◽  
Complete Healing ◽  
Diabetic Foot Syndrome ◽  
Control Group ◽  
Standard Methods ◽  
Results Of Treatment ◽  
Methods Of Treatment

Objective. To improve the results of treatment of the ulcer-necrotic affections of the foot soft tissues in patients, suffering an ischemic form of diabetic foot syndrome (DFS). Маterials and methods. The investigated group have consisted of 48 patients, to whom necrectomy was performed, because a tendency for the wounds healing under the influence of standard methods of treatment through two weeks was absent. Results. After application of the tactics elaborated a complete healing of the wounds was registered in 89.6%, and a partial one - in 10.4% patients. Of 38 patients of a control group, to whom a standard treatment was conducted, the wounds have healed completely in 11 (28.9%), and partially - in 12 (31.6%) patients. Conclusion. Plastic coverage of the foot wounds after necrectomy and early performed revascularization operation for the ischemic form of DFS is indicated to patients, in whom the wounds are lacking a tendency towards healing under the influence of standard methods of treatment through two weeks.

scholarly journals Bubbling Treatment Option in the Complex Therapy of Diabetic Foot Syndrome

2021 ◽  
Vol 14 (3) ◽  
pp. 210-215
Author(s):  
Anton Petrovich Ostroushko ◽  
Alexander Alekseevich Andreev ◽  
Alexander Alexandrovich Shmarin ◽  
Vladislav Valeryevich Novomlinsky ◽  
Anastasia Yurievna Laptiyova ◽  
...  
Keyword(s):  
Treatment Option ◽  
Diabetic Foot ◽  
Soft Tissues ◽  
Treatment Method ◽  
Late Complications ◽  
Diabetic Foot Syndrome ◽  
Control Group ◽  
Results Of Treatment ◽  
Patients With Diabetes ◽  
After Cancer

Diabetes mellitus (DM) is the most common and socially significant endocrine disease that leads to early disability and is the most common cause of mortality in patients after cancer and cardiovascular pathology. The cost of managing patients with diabetes can reach 30% of the country's health budget, 90% of which is spent on the treatment of its complications. Diabetic foot syndrome (DFS) is developed in 20-80% of patients and is one of the most dangerous late complications. In clinical practice, various approaches to its treatment are used, but the number of high amputation and mortality rate in this group of patients remains significant. The aim of the study was to improve the results of treatment of patients with diabetic foot syndrome (DFS) by including the bubbling treatment method in the program of therapeutic measures. Forty-eight patients with neuropathic and neuroischemic forms of DFS were treated. The control group consisted of 23 patients receiving conventional treatment, the main group included 26 patients, who were applied bubbling treatment option locally. The analysis of groups of patients showed no significant differences by gender, age, stages of diabetic foot syndrome, depth of necrotic defect, complications and concomitant diseases. The use of the bubbling treatment method in the complex treatment of patients with DFS allowed more effectively arresting symptoms of local (edema, hyperemia, wound exudate, necrolysis) and general inflammation, anemia and intoxication syndromes, contributed to the activation of regeneration processes in soft tissues, which, combined with complex FDS treatment, together, reduced the number of amputations by 18.7%.

scholarly journals Features of organ-saving foot amputation associated with ozone therapy, local application of autologous platelet-rich plasma and vacuum sanitization of postoperative wound in patients with ischemic-gangrenous form of diabetic foot syndrome

2021 ◽  
Vol 11 (5) ◽  
pp. 237-245
Author(s):  
V. D. Fundiur ◽  
V. K. Grodetskyi ◽  
S. O. Yakobchuk ◽  
O. Y. Khomko ◽  
I. M. Kozlovska ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Platelet Rich Plasma ◽  
Main Group ◽  
Diabetic Foot Syndrome ◽  
Local Application ◽  
Control Group ◽  
Ozone Therapy ◽  
Reparative Process ◽  
Autologous Platelet Rich Plasma ◽  
Autologous Platelet

Improvement of reparative process of the chronic wounds with the insufficiency of peripheral blood suppling in patients suffering from diabetes mellitus is an important issue requiring further investigation. An optimal choice of surgery, effective renewal of blood supply and active stimulation of tissue repair on the cellular level are essential components of success treatment of this problem.Objective of research: From 2017 to 2020, the efficiency of one of the variants of organ-saving surgery performed on 210 patients with an ischemic-gangrenous form of diabetic foot syndrome was studied.Materials and methods. Control group included 104 patients (49.52%), were the treatment carried out in accordance with the standard scheme. The main group (106 patients - 50.47%) in addition to the standard therapy have used regional ozone therapy, vacuum sanitization and local application of autologous platelet-rich plasma (APRP).Results. These proposed measures reduced the period of clinical treatment to 24±1,2 days in the main group compared to 37±2,4 in the control one. 2 years later, patients of the main group confirmed the formation of a foot stump functionally adapted for walking with angular dislocation of fragments of the cuboid and scaphoid bones.Two years after foot amputation due to the ischemic-gangrenous form of diabetic foot syndrome (DFS), the amount of repeated above knee amputations was 1.8 times higher in the control group in comparison with the main group, which is indicative of a reasonable use of the complex of activate a reparative process in the wound.Conclusions: The suggested modification of the organ-saving and partial foot amputation in patients with IV degree of ischemia and DFS is indicative of a possibility to perform such kind of surgery as a variant of choice.The complex of proposed additional measures including regional ozone therapy, vacuum sanitization and local administration of autologous platelet-rich plasma activates a reparative process of a chronic foot wound and promotes an effective treatment of patients with ischemic-gangrenous form of DFS.

Mini-invasive revascularization operations in the complex treatment of neuroischemic and ischemic forms of diabetic foot syndrome

2021 ◽  
Vol 20 (4) ◽  
pp. 817-825
Author(s):  
Bazylbek Zhakiyev ◽  
Murat Jakanov ◽  
Bernat Zhanabaev ◽  
Anuar Koyshibaev ◽  
Samat Mukanov ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Treatment Success ◽  
Medical Science ◽  
Blood Flow Rate ◽  
Main Group ◽  
Lower Limbs ◽  
Diabetic Foot Syndrome ◽  
Control Group ◽  
Complex Treatment ◽  
Endovascular Interventions

Objective: Diabetic foot syndrome is the most dramatic complication of diabetes mellitus. The treatment success is impossible without improving blood circulation and the elimination of hemodynamic disorders in the affected limb.The study aim was to evaluate mini-invasive revascularization operations effectiveness on the lower limbs peripheral arteries in neuro-ischemic and ischemic diabetic foot syndrome forms. Materials and methods: The study enrolled 104 patients with purulent-necrotic complications of diabetic foot syndrome. 54 (51.9%) patients underwent stenting and balloon angioplasty (the main group). The comparison group included 50 (48.1%) patients, undergoing indirect revascularization surgeries in complex treatment. Results and discussion:After endovascular interventions, the API index increased by 47.6% (p<0.01) after 20 days compared to the admission index, the average blood flow rate increased by 1.8 times (p<0.01), and the tPo2 value improved by 67.8% (p<0.01). In the control group, the tPo2 value increased by 40.3% after 20 days, and API – by 34.4%. In the main group, the swelling disappearance in the foot wounds area was by 3.7±0.5 days faster (p<0.001), wounds purification by 4.1 days (p<0.001), granulation appearance by 3.5±0.4 days (p<0.001), wound margins infiltration disappearance happened 3.3±0.9 days earlier (p<0.001), and the wound epithelization was 2.9 days earlier (p<0.01) than in the control group patients. Conclusion: Foot support function at discharge from hospital was preserved in 94.4% of the main group and in 84% of the control group. Bangladesh Journal of Medical Science Vol.20(4) 2021 p.817-825

scholarly journals PECULIARITIES OF PERFORMING ORGAN-SAVING AMPUTATION OF THE FOOT COMBINED WITH OZONE THERAPY, LOCAL APPLICATION OF AUTOLOGOUS PLATELET-RICH PLASMA AND VACUUM SANATION OF POSTOPERATIVE WOUND IN PATIENTS WITH ISCHEMIC-GANGRENOUS FORM OF DIABETIC FOOT SYNDROM

2021 ◽  
Vol 20 (2) ◽  
Author(s):  
V.D. Fundiur ◽  
V.K. Grodetskyi ◽  
S.O. Yakobchuk ◽  
O.Y. Khomko ◽  
I.M. Kozlovska ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Platelet Rich Plasma ◽  
Main Group ◽  
Diabetic Foot Syndrome ◽  
Local Application ◽  
Control Group ◽  
Ozone Therapy ◽  
Reparative Process ◽  
Autologous Platelet Rich Plasma ◽  
Autologous Platelet

A positive result of treatment of patients suffering from ischemic-gangrenous form ofdiabetic foot syndrome (DFS) becomes possible with an optimal choice of surgery,effective renewal of blood supply and active stimulation of tissue restoration processon the cellular level.Objective – to study efficiency of the suggested organ-saving variant of surgery combinedwith the use of a complex of auxiliary factors of a reparative process activation in thewound including regional ozone therapy, vacuum sanitation and local application ofautologous platelet-rich plasma (PRP).Material and methods. The treatment of 210 patients with ischemic-gangrenous formof diabetic foot syndrome was carried out from 2017 to 2020. The efficiency of one ofthe variants of organ-saving operative intervention was studied. In the control group -104 (49.52%), the treatment was carried out in accordance with the standard scheme.In the main group (106 patients - 50.47%), in addition to the standard scheme, regionalozone therapy, vacuum sanitation and local application of autologous-rich plasma(PRP) were carried out.Results. These measures reduced the period of treatment of patients in the hospital to24 ± 1.2 days in the main group compared to 37 ± 2, 4 in the control one. 2 years later, patients of the main group confirmed the formation of a foot stumpfunctionally adapted for walking with angular dislocation of fragments of the cuboidand scaphoid bones.Conclusions. The suggested modification of the organ-saving and partial foot amputationin patients with IV degree of ischemia and DFS is indicative of a possibility to performsuch kind of surgery as a variant of choice for patients with ischemic-gangrenousform of diabetic foot syndrome. The complex of auxiliary measures (regional ozonetherapy, vacuum sanitation and local administration of autologous platelet-rich plasma(APRP)), activates a reparative process of healing of a chronic foot wound whichenables to make the period of hospital staying for patients shorter – to 24±1,2 days inthe main group as compared to 37±2,4 days in the control one. Clinical observation ofa remote postoperative period (2 years later) confirms a possibility to form a foot stumpfunctionally adapted for walking with angular dislocation of fragments of the cuboidand scaphoid bones, functionally advantageous for supporting load.

scholarly journals Ways to reduce the frequency of high amputations, post-amputation complications and mortality in diabetic foot syndrome

2021 ◽  
Vol 8 (1) ◽  
pp. 12-23
Author(s):  
V. M. Bensman ◽  
A. G. Baryshev ◽  
S. N. Pyatakov ◽  
K. G. Triandafilov ◽  
V. N. Ponomarev ◽  
...  
Keyword(s):  
Critical Limb Ischemia ◽  
Diabetic Foot ◽  
Soft Tissues ◽  
Comparison Group ◽  
Lower Extremities ◽  
Limb Ischemia ◽  
Main Group ◽  
Diabetic Foot Syndrome ◽  
Wound Complications ◽  
Comparison Groups

Despite the success in treatment, currently 30.0% of patients with diabetic foot syndrome (DFS) still undergo high amputations with a mortality rate of up to 54.0–68.0 %. The causes of high low limb amputations in 28.0 % of patients are infection, and in 46.0 % – arterial insufficiency in the stage of critical limb ischemia.Objective: to improve the results of patients treatment by reducing the number of high amputations of the lower extremities, reducing the occurrence of complications and deaths of the disease.Materials and methods. To study the results of treatment of patients with DFS, they were divided into two comparison groups and two main groups. From 1982 to 2019, the frequency of amputations, mainly at the hip level, was 71.0 % (177 amputations in 248 patients). These patients formed the first comparison group of observations. The second comparison group (1988–1994) included 58.3 % of patients in whom amputations were performed according to more stringent indications (157 amputations in 269 patients). The first main group of observations (1995–2013) included 9.9 % of patients with DFS who were amputated only for wet gangrene, incurable critical limb ischemia, and infection with a systemic inflammatory response (130 amputations out of 1312 patients). In ischemia with preserved blood flow through the deep artery of the thigh, amputation of the lower leg was performed in a sequential-two-flap method with removal of the soleus muscle. Amputations were completed with the imposition of drainage removable muscle-fascial sutures. The second main group (2014) consisted of 11.4 % of patients who underwent amputations only for sepsis or wet gangrene (124 amputations in 1083 patients). The difference between the second main group and the first was the division of the high amputation intervention into 2 stages.Results. Comparison of the treatment results in the main groups and in the comparison groups revealed a 6-fold decrease in the number of high amputations (from 64.6 to 10.69 %) and a significant improvement in the main quality indicators. This concerns a 6-fold decrease in mortality, which was a consequence of the introduction of a two-stage tactic for high amputation treatment of the most severe patients and the limitation of indications for amputation of the hip. Using of removable drainage muscle-fascial sutures decreased postoperative wound complications from 51.9 to 13.0 %, and the number of re-amputations decreased in 17th times.Conclusion. Amputation of the lower extremities for irreversible critical limb ischemia can be performed with a decrease in TcP02 of the stitched stump tissues to no more than 30 mm Hg. Preserving the knee joint improves the possibilities of prosthetics, which allows older diabetics to lead an active life. Methods of performing parallel- or sequential-two-flap high amputation improve the conditions for cutting out racquet-shaped wound flaps, which provides free displacement of the soft tissues of the stump connected by removable drainage sutures.

scholarly journals Effect of negative pressure therapy on repair of soft tissues of the lower extremities in patients with neuropathic and neuroischaemic forms of diabetic foot syndrome

2014 ◽  
Vol 17 (3) ◽  
pp. 113-121
Author(s):  
Ekaterina Leonidovna Zaytseva ◽  
Ludmila Petrovna Doronina ◽  
Roman Vakhtangovich Molchkov ◽  
Iya Alexandrovna Voronkova ◽  
Valeriy Afanasievich Mitish ◽  
...  
Keyword(s):  
Negative Pressure ◽  
Diabetic Foot ◽  
Standard Therapy ◽  
Soft Tissues ◽  
Lower Extremities ◽  
Perioperative Period ◽  
Diabetic Foot Syndrome ◽  
Control Group ◽  
Negative Pressure Therapy ◽  
Pressure Therapy

Aim. To evaluate the efficiency of topical negative pressure wound therapy (NPWT) compared with standard therapy for the regeneration of the soft tissues of the lower extremities in patients with diabetic foot syndrome. Materials and Methods. The effects of negative pressure therapy on the clinical (size, tissue oxygenation), histological (light microscopy) and immunohistochemical (CD68, MMP-9, TIMP-1) aspects of repair of the soft tissue of the lower extremities in patients with diabetes mellitus were compared with those of standard treatment. Thirty-one patients with diabetic foot ulcers were included in the study from the moment of debridement until the plastic closure of the wound. During the perioperative period, 13 patients received NPWT (-90 to -120 mmHg) and 18 patients received standard therapy. Results. A reduction of the wound area (26.6%?17.2%) and the depth of the defects (40.5%?25.6%) were achieved with negative pressure therapy compared with baseline data. In the control group, the corresponding values were 25.3%?19.4% and 21.8%?21.6%, respectively. The results of transcutaneous oximetry showed a greater increase in the level of local hemodynamics in the study group (p

Application of Nasomer in surgical treatment of patients with polyposis rhinosinusitis

2018 ◽  
pp. 39-42
Author(s):  
Vladimir Bereznyuk ◽  
Alexander Chernokur ◽  
Oleg Gospod
Keyword(s):  
Nasal Cavity ◽  
Postoperative Period ◽  
Paranasal Sinuses ◽  
Standard Treatment ◽  
Surgical Intervention ◽  
Sodium Hyaluronate ◽  
Main Group ◽  
Control Group ◽  
Nasal Breathing ◽  
Minimal Invasiveness

Relevance: Modern endonasal surgery allows to remove polyps from all affected paranasal sinuses, following the principles of minimal invasiveness. Minimal traumatic of surgical intervention gives the best results, accompanied by less progression of the disease. Minimal invasiveness of surgical intervention and its obligatory combination with postoperative medical treatment are common practice in many countries. One of the drugs that actively effect the restoration of the mucous membrane of the nasal cavity and paranasal sinuses in the early postoperative period is Nazomer, which includes sodium hyaluronate and dexpanthenol in saline solution. The purpose of the study is to investigate the effectiveness of the drug Nazomer in patients with polyposis rhinosinusitis after endoscopic polyposynosotomy. Results and discussion: The main group consisted of 30 patients with polyposis rhinosinusitis, who were prescribed Nasomer in addition to standard treatment in the postoperative period. The control group included 30 patients who underwent standard treatment in the postoperative period. As criteria for clinical efficacy, data from endoscopic examination of the nasal cavity and indicators of anterior rhinomatometry, measured by the «Optimus» device, were selected. In the main group, the index of nasal breathing according to rhinomatometry was better than the results of patients in the control group on the 3rd and 5th day of the postoperative period by 26% and 24%, respectively. Conclusion: The use of the drug Nazomer in the postoperative period in patients with polyposis rhinosinusitis contributes to more active restoration of respiratory function of the nasal cavity compared with the control group, according to rhinomatometry, up to 26%. Based on the results obtained, the drug Nazomer is an effective anti-inflammatory and regenerative agent in the postoperative period in patients with polyposis rhinosinusitis.

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