The dissertation is dedicated to the study of clinical features of development and dynamics of wound healing in order to improve the results of the treatment patients with chronic leg ulcers of atherosclerotic and diabetic genesis.
The first part of research focused on the assessment of treatment efficacy of cilostazol administered after open revascularization in 152 patients with chronic ischemia and ulcers of the lower extremities of atherosclerotic genesis. All patients had the chronic ischemia of the IVth stage according to the classification of Fontein. The patients were related to 3-4 stages conforming to the WIfI system.
The control group consisted of 75 participants and the treatment one involved 77 patients who were given the cilostazol in a twice-daily dosage of 100 mgs for a year after revascularization. The patients of two groups were also divided into subgroups depending on whether they were diagnosed with diabetes mellitus. The groups of patients were comparable by age, sex and concomitant pathology. The comparative estimation of quality of life changes, quantitative indexes of the speed of ulcer healing, histochemistry changes of ulcer tissues and long-term results of treatment of patients from basic and control groups in the dynamics of treatment were the criteria of efficiency of cilostazol.
To sum up, the application of cilostazol for patients with the chronic ischemia and leg ulcers when the open revascularization was performed, as the preparation favorably influences on quality of life of patients, provides the increase of relative speed of ulcer healing and level of 1-year follow-up ulcer healing of both analyzable cilostazol subgroups (without and with a diabetes mellitus).
The second part of the work was to analyze the results of examinatoin and treatment of 65 patients with chronic diabetic foot ulcers with the signs of infection. Vacuum-assisted closure therapy was performed for all patients. In general, the status of patients was in line with the classification of PEDIS: P1-2ED1I2-4S1-2. The first group consisted of 20 patients with chronic diabetes superficial foot ulcers with mild infection (P1-2ED1I2S1-2), who did not receive antibacterial therapy. Both ІІ and ІІІ experimental groups included 40 patients with chronic diabetes foot ulcers with the signs of severe infection, who were administered the antibacterial therapy. For patients of group III vacuum-assisted closure therapy was added with antiseptic instillation. In the separate sub-groups of patients determination of the bacterial loading level of ulcers was conducted before and after 3 daily impositions of the vacuum-assisted bandage (accordingly sub-groups of ІА, ІІА and ІІІА, 10 people in the group). The determination was being conducted every 24 hours during 96 hours for the sub-groups ІВ, ІІВ and ІІІВ to find out the dynamics of changes of bacterial loading level of ulcers. All the groups of patients were comparable by sex and age parameters.
The considerable increase of the bacterial loading of ulcers in 3 days of display of a vacuum-assisted bandage for the patients in ІА sub-group (on 31,9 %, р<0,05) was observed by the results of microbiological research. For the patients of the sub-group ІB, the increase of bacterial loading has been already fixed in 24 hours of display of bandage (р<0,05). For the patients of ІІ group the reliable increase of the bacterial loading of ulcers (on 31, 8 %, р<0,05) was educed only through 96 hours of display of a vacuum bandage.
At application of the vacuum-assisted closure therapy with the instillation (ІІІ group), the reliable decline of the bacterial loading level of ulcers was set through 24, 48 and 72 hours displays of vacuum-assisted bandage, through 96 hours the value of this index grew, but for certain not exceeding initial sizes (p>0,05). Thus, the application of the vacuum-assisted closure therapy with the instillation of antiseptic following antibacterial therapy provides control of the bacterial loading level of ulcers during 4 days of display of a vacuum-assisted bandage.
Developed schemes of vacuum-assisted closure therapy application at the treatment of patients with chronic diabetic foot ulcers with the signs of infection give an opportunity of the rational and effective use of the method, minimizing the possibility of infectious complications.
