Pryimenko D. Surgical treatment of patients with diabetic foot syndrome use of offloading devices.

The purpose of the work is to improve the results of treatment of patients with purulent-necrotic complications of diabetic foot syndrome use of offloading devices of the lower limb. In the dissertation the scientific concepts about the possibility of using clinical and laboratory and anamnestic indicators of patients are expanded when creating a mathematical model for predicting the course of purulent-necrotic process in patients with diabetic foot syndrome to correct the tactics of their treatment. On the basis of multivariate analysis, an individualized method for assessing the direction of the course of the pathological process has been developed. The proposed model provides an increase in accuracy from 83,3 % to 88,9 %. To significantly simplify the process of calculations into clinical practice, a computer program was introduced. After entering the necessary indicators, the result of the prediction is displayed in the program window. The device for offloading the foot with new design features is developed. The semi-rigid immobilization is achieved thanks to the combination of modern polymer materials; the support element is made of wire, used a continuous cast, a strap, rubber lining and wheels. Using of the device in the complex treatment of patients allows accelerated healing of wounds. The use of the device in patients with purulent-necrotic complications of diabetic foot syndrome ensures the appearance of granulations at 12,6±0,3 days and the beginning of epithelization at 14,5±0,3 days. These data are statistically significant (p<0,05) differ from those in the groups where the shoemaker was used - on average 3 days earlier compared with patients who used gypsum longet; on average for 5 days with the patients who wore a half shoe. For the first time in order to optimize the approach to assessing the positive or negative dynamics of the postoperative wound process, a general index of purulent necrotic inflammation of the wound (GIPIW) is proposed. It consists in determining in the cytogram the ratio of the number of intact segmental neutrophils and various damaged cells and flat epitheliocytes, followed by the calculation of GIPIW in the conventional units. The data on HRQOL in patients with purulent-necrotic complications of diabetic foot syndrome, which used different devices of offloading of the lower limb, was supplemented. The dependence of the HRQOL indicators on the type of devices of offloading of the lower limb is proved.