Novosti
Khirurgii

 This journal is
indexed in Scopus
journal cover
android icon Android Applicaion

Year 2018 Vol. 26 No 3

GENERAL & SPECIAL SURGERY

A.A. GLUKHOV 1, V.A. SERGEEV 2

ASSESSMENT OF EFFICIENCY OF THE PROGRAMMED ASPIRATION AND IRRIGATION REHABILITATION METHOD IN SUPPURATIVE NECROTIC COMPLICATIONS OF DIABETIC FOOT SYNDROME

Voronezh State Medical University named after N.N. Burdenko 1, Voronezh,
Orel Regional Clinical Hospital 2, Orel
The Russian Federation

Objective. To assess the efficiency of the programmed aspiration and irrigation rehabilitation (PAIR) method in the combined treatment of patients with suppurative necrotic complications of diabetic foot syndrome (DFS).
Methods. The treatment results of 84 patients with suppurative necrotic complications of DFS without critical ischemia of 52 to 63 years of age have been analyzed. The patients with DFS were divided into two groups depending on the way of postoperative rehabilitation of the suppurative focus. In the reference group, conventional therapy was carried out with the use of iodophors and polyethylene glycol ointments. In the study group, postoperative rehabilitation of the suppurative foci was performed using the programmed technique with the original equipment. The device was equipped with a pressure switch providing automatic setting and maintenance of a definite vacuum level in the cavity of a suppurative focus.
Results. In the study group, the reduction below the threshold levels in the bacterial load for suppurative necrotic foci proved to occur earlier than in the reference group (p<0.001). Alkalinization of the wound effluent and reduction in the protein amount in the wound discharge were faster in the study group (p<0.001). Hospital length of stay in the study group was significantly lower compared to the reference group (p<0.001). The number of suppurative complications was significantly smaller (p=0.014) than in the reference group. The frequency of high amputations performed in the study group was less than in the reference group.
Conclusions. The results of the conducted investigations confirmed the efficiency of programmed aspiration and irrigation rehabilitation method in the combined treatment of patients with suppurative necrotic tissue injury in diabetic foot syndrome, which significantly improves the rehabilitation of the suppurative focus, providing in turn the significant improvement of the treatment efficacy.
Keywords: diabetic foot syndrome, suppurative necrotic complications, active surgical approach, programmed aspiration and irrigation rehabilitation, surgical treatment of suppurative focus, plastic resection of the foot

Keywords: diabetic foot syndrome, suppurative necrotic complications, active surgical approach, programmed aspiration and irrigation rehabilitation, surgical treatment of suppurative focus, plastic resection of the foot
p. 311-320 of the original issue
References
  1. Dedov II, Omelyanovskiy VV, Shestakova MV, Avksentieva MV, Ignatieva VI. Diabetes mellitus as an economic problem in Russian Federation. Sakhar Diabet. 2016;19(1):30-43. (in Russ.)
  2. Mezhdunarodnoe soglashenie po diabeticheskoi stope. Moscow, RF: Bereg; 2000. 96 p. (in Russ.).
  3. Striapukhin VV, Lishchenko AN. Surgical treatment of the “diabetic” foot. Khirurgiia Zhurn im NI Pirogova. 2011;(2):73-78. https://www.mediasphera.ru/issues/khirurgiya-zhurnal-im-n-i-pirogova/2011/2 (in Russ.)
  4. Reiber GE, Boyko EJ, Smith DG. Lower extremity foot ulcers and amputation in diabetes. In: Harris MI, Cowie CC, Stern MP, Boyko EJ, Reiber GE, Bennett PH, eds. Diabetes in America. 2nd ed. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 1995. ð. 409-28. NIH publication 95-1468.
  5. Ragnarson-Tennvall G, Apelqvist J. Cost-effective management of diabetic foot ulcers. A review. Pharmacoeconomics. 1997 Jul;12(1):42-53. https://link.springer.com/article/10.2165/00019053-199712010-00005
  6. Gök ü, Selek ö, Selek A, Güdük A, Güner Mç. Survival evaluation of the patients with diabetic major lower-extremity amputations. Musculoskelet Surg. 2016 Aug;100(2):145-48. doi: 10.1007/s12306-016-0399-y
  7. Chekmareva IA, Mitish VA, Paklina OV, Blatun LA, Paskhalova YuS, Ushakov AA, Terekhova RP, Gordienko EN, Sokov SL, Mun’os Sepeda PA, Kachanzhi AP. Morphological evaluation of the effectiveness of hydrosurgical system VersaJet® in conjunction with combined antibiotic therapy in the treatment of necrotic complications of diabetic foot syndrome with biofilm forms of bacteria. Rany i Ranevye Infektsii. 2015;2(3):8-21. doi: 10.17650/2408-9613-2015-2-3-8-20 (in Russ.)
  8. Krishnan S, Nash F, Baker N, Fowler D, Rayman G. Reduction in diabetic amputations over 11 years in a defined U.K. population: benefits of multidisciplinary team work and continuous prospective audit. Diabetes Care. 2008 Jan;31(1):99-101. doi: 10.2337/dc07-1178
  9. Argoff CE, Cole BE, Fishbain DA, Irving GA. Diabetic peripheral neuropathic pain: clinical and quality-of-life issues. Mayo Clin Proc. 2006 Apr;81(4 Suppl):S3-11. doi: 10.1016/S0025-6196(11)61474-2
  10. Holman N, Young RJ, Jeffcoate WJ. Variation in the recorded incidence of amputation of the lower limb in England. Diabetologia. 2012 Jul;55(7):1919-25. doi: 10.1007/s00125-012-2468-6
  11. Galstyan GR, Tokmakova AYu, Egorova DN, Mitish VA, Paskhalova YuS, Antsiferov MB, Komelyagina EYu, Udovichenko OV, Gur’eva IV, Bregovskiy VB, Eroshkin IA, Eroshenko AnV, Eroshenko AlV. Klinical guidelines for diagnosis and treatment of diabetic foot syndrome. Rany i Ranevye Infektsii. 2015;(3):63-83. doi: 10.17650/2408-9613-2015-2-3-63-83 (in Russ.)
  12. International best practice guidelines: wound management in diabetic foot ulcers [Electronic resource]. Wounds International publication; 2013. 27 ð. Available from: http://www.woundsinternational.com/best-practices/view/best-practice-guidelines-wound-management-in-diabetic-foot-ulcers
  13. Bondarenko ON, Galstyan GR, Dedov II. The clinical course of critical limb ischaemia and the role of endovascular revascularisation in patients with diabetes. Sakhar Diabet. 2015;18(3):57-69. https://cyberleninka.ru/article/v/osobennosti-klinicheskogo-techeniya-kriticheskoy-ishemii-nizhnih-konechnostey-i-rol-endovaskulyarnoy-revaskulyarizatsii-u-bolnyh (in Russ.)
  14. Graziani L1, Piaggesi A. Indications and clinical outcomes for below knee endovascular therapy: review article. Catheter Cardiovasc Interv. 2010 Feb 15;75(3):433-43. doi: 10.1002/ccd.22287.
  15. Zaitseva EL, Doronina LP, Molchkov RV, Voronkova IA, Mitish VA, Tokmakova AYu. Features of angenesis against the background of negative pressure wound therapy in patients with neuropathic and neuroischemic forms of diabetic foot ulcers. Vestn Khirurgii im II Grekova. 2014;173(5):64-72. doi: 10.24884/0042-4625-2014-173-5-64-72 (in Russ.)
Address for correspondence:
302000, The Russian Federation,
Orel, Pobedy Boul., 10,
Orel Regional Clinical Hospital,
Coloproctological unit,
Tel: +7 905 165 09 92,
e-mail: sergeevdoc60@yandex.ru
Vladimir A. Sergeev
Information about the authors:
Glukhov Alexksandr A., MD, Professor, Head of the Department of General Surgery, Director of the Institute of Surgical Infection, Voronezh State Medical University named after N.N. Burdenko, Voronezh, Russian Federation.
https://orcid.org/0000-0001-9675-7611
Sergeev Vladimir A., PhD, Surgeon, the Coloproctological Unit, Orel Regional Clinical Hospital, Orel, Russian Federation.
https://orcid.org/0000-0002-6201-2440
Contacts | ©Vitebsk State Medical University, 2007-2023