The dissertation is devoted to solving the problem of improving the treatment results of patients with neuropathic and mixed forms of DFS, which had wounds in the foot in the repair phase, by the local use of the PRP.
The work is based on the analysis of the results of treatment of 140 patients with various forms of DFS. The main group consisted of 58 patients with a mixed and neuropathic form of DFS, wound treatment in 42 of them was carried out by local application of PRP, and in 16 patients, PRP was used to prepare wounds for dermatoplasty. The comparison group included 52 similar patients, in which wounds in the second phase were prepared for dermatoplasty with ointments on a water-soluble base.
A separate group was formed from 30 patients with foot wounds (10 patients with neuropathic, 10 with ischemic and 10 with mixed forms of DFS) to study the differences in the processes of repairing various forms of DFS.
In patients with neuropathic, ischemic and mixed forms of DFS morphologically, no significant differences were found in the features of cellular reaction in the formation of granulation tissue. However, the morphometric study of the microvascular channel revealed a significant difference between ischemic and two other forms of DFS.
It was established that under the influence of the epidermal factor, stimulation of the repair processes in patients with DFS occurs, which ultimately leads to healing of the wound. However, the processes of the formation of connective tissue and skin epithelium qualitatively different from the physiological: the edema of the granulation tissue remains, the parts of the fibrosis are morphologically similar to the keloid scar, the epithelial layer in places with necrobiotic changes. Consequently, healing of wounds with the help of dermal plastics occurs through a mandatory stage of inflammation, which can occur latently, especially in patients with neuropathic form.
Under the influence of PRP, due to perfect neoanogiogenesis, a qualitative granulation tissue develops, which stimulates active edge wound epithelization. The rate of wound epithelization was 7.6 ± 0.4%, complete epithelization occurred in 29.1 ± 2.9 days. In patients of the comparison group, the wound healing period was 41.7 ± 3.3 days, and the adhesion of the skin was observed in 79.5% of patients.
