Modern Technologies in the Treatment of Purulent Wounds of Gerontological Patients with Diabetic Foot Syndrome

Introduction. Violation of all types of metabolism leads to the development of purulent-necrotic lesions of the feet in more than 25% of patients with diabetes mellitus. Often these patients receive repeated courses of antibiotic therapy, which sometimes leads to the formation of antibiotic intolerance, as well as the development of resistance of microorganisms to most antibiotics. The presence of diabetic angiopathy and severe purulent infection on the foot may hinder the penetration of certain antibacterial drugs into the purulent site. Microbiological studies, both on the wound surface and deep in the tissues, most often reveal a mixed microflora that is resistant to most antibiotics. In most cases, with a complex wound configuration or the development of a severe surgical infection, it is not possible to completely transform the lesion into a clean wound during one operation. This leads to the need to perform repeated surgical treatments, respectively, to an increase in the number of surgical interventions and lengthening the treatment period. The use of hydrosurgical technologies during surgical treatment in the complex of laser photodynamic therapy (PDT) of wounds in the postoperative period provides the most complete and rapid cleansing of wounds from necrosis, fibrinous-purulent plaque, which is associated both with sterilization of the wound by laser radiation and the weakening of disturbances in the microvasculature, and stimulation of regenerative processes due to activation of oxygen transport in the developing granulation tissue.

Aim of the study was to evaluate the efficacy of the combined use of laser PDT and hydrosurgical system (VersaJet) in the complex treatment of purulent wounds in patients with diabetic foot syndrome (DFS).

Materials and methods. We proposed the treatment of purulent wounds in patients with diabetic foot syndrome based on the combined use of PDT and hydrosurgical technologies to stimulate regeneration and sterilization of wounds. The work summarizes the experience of treating purulent wounds in 44 patients with diabetic foot syndrome. The age of the patients ranged from 65 to 89 years, the area of the wound surface was from 10 to 25 cm2. In group 1, 21 patients (control) received traditional treatment; the main group included 23 patients whose wounds were treated using laser PDT and a hydrosurgical system.

Results. As a result of treating wounds with laser PDT together with a hydrosurgical system, resolution of inflammatory phenomena on the foot in patients of the main group was noted 4–9 days earlier than in the control. A decrease in microbial contamination of wound tissue below the “critical level” in patients of the main group was detected on days 5–7 after the start of treatment, and in the control group on days 10–15. Cleansing of wounds, the appearance of granulations and marginal epithelialization in patients of the main group were detected, respectively, after 5.2 ± 0.5; 4.8 ± 0.4 and 5.8 ± 0.5 days, in the control group — after 10.2 ± 0.8; 9.8 ± 0.8 and 12.6 ± 1.1 days.

Conclusions. The analysis of the results of clinical studies showed that the combined use of a hydrosurgical system and the addition of local treatment of purulent wounds of soft tissues with laser PDT promotes accelerated regression of inflammatory processes in the wound, reduces the time it takes to cleanse wounds from purulent-necrotic masses and non-viable tissues, accelerates the appearance of granulation tissue and the onset of marginal epithelization, which, in turn, creates favorable conditions for performing plastic surgeries — autodermaplasty and the application of primary or secondary sutures and leads to rapid wound healing.