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

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Abstract

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.

About the authors

L E Slavin

Kazan State Medical Academy, Kazan, Russia

B N Godzhaev

Kazan State Medical Academy, Kazan, Russia

Email: adma0816@mail.ru

A Z Zamaleev

Regional Clinical Hospital at the station Kazan, Kazan, Russia

References

  1. Бок И.Ли., Герца Бартон Л. Хирургическое лечение кожных и пролежневых язв / Пер. с англ. - М.: Медицина, 2003. - 457 с.
  2. Доброквашин С.В., Якупов Р.Р. Опыт хирургического лечения синдрома диабетической стопы // Каз. мед. ж. - 2010. - №5. - С. 630-633.
  3. Коваленко В.И., Калитко И.М., Кочубей В.П. Весел ду эф (сулодексид) в комплексном лечении облитерирующих заболеваний артерий нижних конечностей. Методическое пособие для врачей. - М., 2002. - 26 с.
  4. Корейба К.А., Демьянов С.Л. Современные повязки в комплексном лечении синдрома диабетической стопы // Каз. мед. ж. - 2010. - №5. - С. 702.
  5. Любарский М.С., Шевела А.И., Шумков О.А. и др. Синдром диабетической стопы. Патогенетические подходы к лечению // Русс. мед. ж. - 2001. - Т. 9, №24. - С. 13.
  6. Международное соглашение по диабетической стопе. Составлено международной рабочей группой по диабетической стопе. - М.: Берег, 2000. - С. 12.
  7. Светухин А.М., Земляной А.Б. Гнойно-некротические осложнения синдрома диабетической стопы // Consilium Medicum. - 2002. - Т. 4, №10. - С. 14.
  8. Храмилин В.Н. Оценка эффективности комплексной программы профилактики развития синдрома диабетической стопы и ампутаций у больных сахарным диабетом групп высокого риска // Вестн. Рос. госуд. мед. универ. - 2007. - №5. - С. 20-25.
  9. Behr B., Megerle K.O., Germann G. et al. New concepts in local burn wound therapy // Handchir Mikrochir Plast Chir. - 2008. - Vol. 40. - P. 361-366.
  10. Meier K., Nanney L.B. Emerging new drugs for wound repair // Expert Opin. Emerg. Drugs. - 2006. - Vol. 11. - P. 23-37.
  11. Grasset N., Raffoul W., Bigliardi P. Bioactive dressings // Rev. Med. Suisse. - 2010. - Vol. 6. - P. 354-357.
  12. Hilton J.R., Williams D.T., Beuker B. et al. Wound dressings in diabetic foot disease // Clin. Infect. Dis. - 2004. - Vol. 39. - P. 100-103.
  13. Hogge J., Krasner D., Nguyen H. et al. The potential benefits of advanced therapeutic modalities in the treatment of diabetic foot wounds // J. Am. Podiatr. Med. Assoc. - 2000. - Vol. 90. - P. 57-65.
  14. Kirsner R.S., Warriner R., Michela M. et al. Advanced biological therapies for diabetic foot ulcers // Arch. Dermatol. - 2010. - Vol. 146. - P. 857-862.
  15. Lipsky B.A. Medical treatment of diabetic foot infections // Clin. Infect. Dis. - 2004. - Vol. 39. - P. 104-114.
  16. Lorenzen H.P., Schunkert H. The diabetic foot syndrome-therapy // Dtsch. Med. Wochenschr. - 2004. - Vol. 129. - P. 751-754.
  17. Matricali G.A., Deroo K., Dereymaeker G. Outcome and recurrence rate of diabetic foot ulcers treated by a total contact cast: short-term follow-up // Foot. Ankle. Int. - 2003. - Vol. 24. - P. 680-684.
  18. Sweitzer S.M., Fann S.A., Borg T.K. et al. What is the future of diabetic wound care? // Diabetes Educ. - 2006. - Vol. 32. - P. 197-210.
  19. Weigelt J.A. Diabetic foot infections: diagnosis and management // Surg. Infect. (Larchmt.). - 2010 - Vol. 11. - P. 295-298.
  20. Zhang X.J., Meng C., Chinkes D.L. et al. Beneficial effects of insulin on cell proliferation and protein metabolism in skin donor site wound // J. Surg. Res. - 2009. - Vol. 44. - P. 342-345.

© 2012 Slavin L.E., Godzhaev B.N., Zamaleev A.Z.

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