Treatment of chronic wounds of patients with diabetes mellitus using heterografts

Abstract

The aim . To investigate the reduction of wound healing time of various etiologies on the background of diabetes mellitus with arteries and veins with the help of combined treatment with the use of heterografts. The article uses the results of treatment of 18 patients with chronic wounds of different etiology with diabetes which were treated in the department of vascular disease in “Institute of General and Emergency Surgery Named after V.T. Zaitsev NAMS of Ukraine” in 2019–2020 years. All patients had diabetes of II type, and 8 of them had III and IV level of limb ischemia according to Fontaine, and 7 of them had chronical venous insufficiency (CVI) C6 (according to CEAP), and 2 patients were diagnosed arterial and venous pathologies, one patient had vast chronic post-traumatic wound of a shin. All patients underwent analysis of clinical, laboratory, non-invasive and invasive methods of patients’ examination to determine the degree of the main blood flow disturbance, the nature of collateral blood circulation and microcirculation of the level of wound contamination, as well as the phase of the wound developing. Among the patients of the studied group with CVI, 2 patients underwent femoral shin shunting, 2 patients underwent hybrid reconstructive surgery, and 4 patients underwent endovascular interventions on the shin’s arteries. Patients with CVI underwent scleroobliteration of disabled perforators under ultrasound navigation. The patients were prescribed the following scheme: compensation of diabetes, metabolic therapy, antibacterial, anticoagulant and angiotropic therapy, physical therapy, local treatment: photodynamic therapy and staged closure of tissue defects by a heterograft membrane. Results . The area of wounds surface in the patients with obliterating lesions of the arteries of the lower extremities before the start of treatment was in average of 391.3±100.42 cm 2 , against the background of complex treatment and wound closure with a heterograft on days 10–12 of treatment – 4.72±0.63 (p<0.01), and complete closure of the wounds was achieved within 3 weeks. In the patients with chronic venous insufficiency after performing sclerobliteration of incompetent perforants and PDT, the wound area was 16.92±0.18 cm 2 , on days 7–10 – 7.82±0.68 3 (by 50.63 %, p<0.01 ), and complete healing of the tissue defect was reached by the 4th week. Conclusions. Use of a heterograft, namely the amniotic membrane makes it possible to achieve shorter periods of healing of chronic wounds in patients with diabetes mellitus. The healing is 2-3 times faster than other modern methods of treatment. It reduces cost of treatment and reduces the period of disability. Shorter treatment period also reduces workload on medical staff and improve the quality of life of patients with diabetes mellitus. Faster wound cleaning lowers risks of local infectious complications