Immediate And Long-Term Outcomes Of The Treatment Of Patients With Purulent-Necrotic Complications Of The Diabetic Foot Syndrome With The Use Of Programmable Sanation Technologies

Diabetes mellitus (DM) is one of the most urgent problems of modern medicine inflicting colossal economic losses, early disability and mortality. Prevalence rate of diabetes is 1.5 to 6% of the population, and by 2035, experts of the International Diabetes Federation (IDF) expect an increase in the number of such patients of up to 600 million, with about 80% of these patients living in developing countries. Healing of wound defects in diabetes is characterized by a longer duration of the inflammation phase and a decrease in the activity of macrophages producing growth factors. There is a constant interest in the development of new methods for intra- and postoperative sanation of purulent foci in DFS. The immediate and long-term outcomes of treatment for 106 patients with purulent-necrotic complications of DFS without the phenomena of critical ischemia were analyzed. The patients were treated at the Orel Regional Clinical Hospital in the Orel city from 2008-2015. The main group of the study (the study group) included 55 patients. Their surgical treatment of the purulent foci was supplemented by ultrasonic cavitation using the Sonos 185 apparatus, Spring GmbH; the wound was drained by tubular drainage system withdrawn through counter openings. The wound was then oversewn, and after the operation, programmable satiation was applied using the original AMP-01 device. The control group consisted of 51 patients. After surgery on the purulent focus, the patients underwent standard local therapy - polyethylene glycol-based ointments, iodophor solutions; after resolution of the infection, we performed a foot plastic reconstruction, some patients wounds were healed by secondary tension. An analysis of the long-term outcomes of treatment for 35 patients with a neuroischemic form of the disease showed that the provided therapeutic and prophylactic measures in most cases allow maintaining a satisfactory blood supply to the feet and, thus, avoiding "high" limb amputation. Treatment activities included, as a rule, administration of lipostatic drugs and aspirin, quitting smoking, maintaining a sufficiently stable level of glycemia (not higher than 9 mmol/l). The long-term follow-up outcomes of the treatment were also better in the study group compared to the control group: there were significantly lower values for the number of late purulent complications (p = 0.0112), number of deaths (p = 0.0112) and number of cases of ischemia progression (p = 0.0095), while the number of cases of preserving the support ability of the foot was significantly higher (p = 0.0158). Programmable sanation technologies have a significant advantage over traditional techniques in the treatment of patients with purulent-necrotic complications of diabetic foot syndrome without critical ischemia. Their use reliably improves the quality of purulent focus sanation in diabetic foot syndrome, stimulates regenerative processes, which contributes to shortening the hospital stays and improving the immediate and long-term outcomes of the treatment.