The dissertation aims to solve one of the topical issues of surgery – improving the effectiveness of treatment of patients with trophic ulcers of the lower extremities associated with chronic venous insufficiency by developing a new method of local rehabilitation, detoxification, and acceleration of wound healing processes through studying the properties of nanocrystalline hydroxyapatite in an experiment on white rats and clinical testing of apatite polymer drainage dressing, which includes hydroxyapatite, alginate, chitosan, and zinc oxide. An experimental study on 55 white rats has confirmed the antibacterial, anti- inflammatory, and sorption-detoxification properties of hydroxyapatite. This made it possible to develop and create an apatite polymer drainage dressing, which is an alginate–chitosan porous scaffold based on nanostructured hydroxyapatite, and propose a method for its use. As a bioactive therapeutic agent, zinc oxide is added to hydroxyapatite, which exhibits antimicrobial properties and gives the material additional mechanical strength. Composite materials based on nanocrystalline hydroxyapatite with the addition of zinc have pronounced sorption properties inherent in hydrophilic and hydrophobic sorbents. Therefore, they can be effectively used in both phases of wound healing, have an antibacterial effect, accelerate fibroblast proliferation, and positively impact a vascular endothelial growth factor. The above creates conditions for removing nonviable tissues, suppressing infection, and stimulating reparative processes and epithelialization, thus reducing the duration of treatment. The dissertation is based on the analysis of the results of the treatment of 110 patients with trophic ulcers of venous origin in the Department of Vascular Surgery of the Sumy Regional Clinical Hospital in 2019-2021. Patients were divided into two groups to assess the effectiveness of the treatment. The treatment group included 57 patients treated according to our proposed method without using antibiotics. The treatment was based on the topical application of apatite polymer drainage dressing. The comparison group consisted of 53 patients who were treated according to the recommendations approved by the Association of Vascular Surgeons of Ukraine and clinical protocols approved by the Order of the Ministry of Health of Ukraine No. 1422 as of December 29, 2016, which included: phleboprotective drugs, antiseptic solutions that were applied topically, antibiotics taking into account the intensity of purulent-inflammatory processes in the ulcer area. Patients in both groups received compression therapy. The main clinical and laboratory indicators when studying the healing of trophic ulcers were the intensity of the inflammatory process (severity of pain, edema, hyperemia), changes in the contamination of the ulcer defect, the appearance of granulation tissue, and the beginning of epithelialization. In the first 6-7 days of treatment, depending on the intensity of contamination of the ulcerative surface and the area of the wound defect, there was a decrease in the intensity of the inflammatory process, cleaning the wound surface from purulent-fibrin layers and activation of granulation tissue growth, which contributed to the healing of trophic ulcers. Taking into account the research results, we believe that the use of nanocrystalline hydroxyapatite as the basic component of apatite polymer drainage dressing in the treatment of trophic ulcers of the lower extremities associated with chronic venous insufficiency is an effective, easy-to-use and safe treatment method. The absence of the need for the use of antibiotics emphasizes the economic feasibility of our proposed method.
