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Year 2019 Vol. 27 No 6

SCIENTIFIC PUBLICATIONS
GENERAL & SPECIAL SURGE

I.R. TERLETSKYI 1, M.R. VERKHOLA 1, I.V. TYMCHUK 2, V.S. ZHYKOVSKIY 2, YU.H. OREL 2

VACUUM-ASSISTED THERAPY FOR PATIENTS WITH DIABETES MELLITUS AND CHRONIC FOOT ULCERS

Lviv Regional Clinical Hospital 1,
Danylo Halytsky Lviv National Medical University 2, Lviv,
Ukraine

Objective. To determine the bacterial load of wounds at the application of vacuum-assisted therapy for patients with diabetes mellitus and chronic foot ulcers.
Methods. The object of the research was patients with diabetes mellitus with chronic superficial (skin, subcutaneous tissues) wounds of the foot with the signs of mild infection according to the classification for determination of presence and severity of infection of IWGDF/IDSA. Oncopathology, heavy concomitant pathology and lesions of the osteoarticular apparatus were the criteria of exception. Patients were treated as out-patients and did not get system antibiotic therapy. Therapy of wounds was conducted by negative pressure – 125 mm Hg in the continuous mode. The first stage of work was conducted to find out the level of the bacterial load of wounds before and 3 days after the vacuum-assisted therapy (the group was of 10 patients). The second group (10 patients) was selected to determine the dynamics of changes of the wound bioburden level after every 24 hours of vacuum-assisted therapy, the observation was performed during 96 hours of the bandage exposure. The level of the bacterial load was controlled according to the changes of index of colony-forming units in the gram of tissue (CFU/g) of the wound biopsy material.
Results. The average bioburden level of wounds for the 1st group patients after the removal of bandage was 8.11±1.27 lg CFU/g, this exceeds the initial level by 31.9 % (ð<0.05). The investigation of the material from the wounds of the 2nd group patients established a considerable increase of the average bioburden level of wounds in 24, 48, 72 and 96 hours after the beginning of the therapy, 10.8 %, 16.4 %, 38.9 % and 58.6 % accordingly (ð<0.05).
Conclusions. In patients with diabetes mellitus and chronic wounds of the foot with signs of infection, vacuum-assisted therapy does not provide essential control of the bioburden level and should be used in combination with systemic antibiotic therapy.

Keywords: vacuum-assisted therapy, diabetes, wound, bacterial load, infection
p. 656-661 of the original issue
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Address for correspondence:
79010, Ukraine,
Lviv, Chernihivska Str., 7,
Lviv Regional Clinical Hospital,
Surgical Department ¹1.
Tel. mobile: +380 98 449-11-61,
e-mail: teriva86@gmail.com,
Ivan R. Terletskyi
Information about the authors:
Terletskyi Ivan R., Surgeon, the Surgical Department ¹1, Lviv Regional Clinical Hospital, Lviv, Ukraine.
http://orcid.org/0000-0002-8751-0489
Verkhola Markiian R., Surgeon, the Surgical Department ¹1, Lviv Regional Clinical Hospital, Lviv, Ukraine.
http://orcid.org/0000-0002-9762-4236
Tymchuk Iryna V., PhD, Assistant, Microbiology Department, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
https://orcid.org/0000-0002-9290-2954
Zhykovskiy Volodymyr S., PhD, Assistant, Department of Disaster Medicine and Military Medicine, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
https://orcid.org/0000-0002-0594-5316
Orel Yuriy H., MD, Professor, the Surgery Department ¹ 2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
http://orcid.org/0000-0002-2283-7843
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