The study involved 120 patients with ischemic form of diabetic foot syndrome, and a histopathological analysis of 30 amputation materials was performed, which allowed for a comprehensive assessment of the morphological and clinical features of the course of the disease, to establish key pathogenetic links of tissue damage, and to substantiate approaches to optimizing treatment tactics. The morphological analysis showed that the ischemic form of diabetic foot syndrome is characterized by systemic damage to the vascular bed and soft tissues of the lower limb, which is formed as a result of a combination of macro- and microangiopathic changes against the background of long-term metabolic disorders. In particular, in 73.3% of cases, pronounced atherosclerotic lesions of the main and medium-sized arteries were detected with a predominance of the stage of atheromatosis (40.9%) and atherocalcinosis (27.3%), which was accompanied by significant narrowing or obliteration of the lumen of the vessels, impaired laminar blood flow and the development of chronic tissue ischemia. At the same time, in all studied cases, the presence of diabetic microangiopathy was established, which was manifested by thickening of the capillary basement membrane, vascular hyalinosis (93.3%), obliteration of their lumen (63.3%), blood stasis (76.7%) and the formation of thrombotic masses (30%), which led to a pronounced violation of microcirculation, reduction of the capillary bed and the formation of hypovascularization zones, detected in 70% of cases. The combination of these changes forms the morphological basis of chronic tissue hypoxia and determines the severity of the disease. Against the background of vascular disorders, deep structural changes in soft tissues were found, reflecting the progressive nature of dystrophic and degenerative processes. In the skin, hyperkeratosis was determined in 80% of cases, a combination of acanthosis and parakeratosis, as well as areas of epidermal atrophy, which indicates a violation of the processes of proliferation, differentiation and regeneration of cells. In the dermis, in 73.3% of cases, pronounced fibrous changes were detected with the formation of coarse-fibrous structures, which were combined with chronic inflammatory infiltration and a violation of tissue architectonics. Subcutaneous adipose tissue was characterized by dystrophic changes in adipocytes in 70% of cases, fibrous restructuring in 63.3%, as well as the presence of necrotic changes and lipophagy, which indicates a long-term existence of the ischemic process and depletion of trophic tissue supply. In muscle tissue, atrophy of muscle fibers was detected in 63.3% of cases, necrotic changes in 46.7%, lipomatosis in 50% and neurogenic changes in 36.7%, which were manifested by disorganization of the structure of muscle fibers, their fragmentation and replacement by connective and fatty tissue. The changes identified indicate a deep violation of the functional state of the muscular apparatus and a progressive loss of its contractile ability. Based on the clinical analysis, it was established that the use of laser vaporization as part of complex treatment is pathogenetically justified and contributes to a significant improvement in the course of the wound process. In particular, patients in the main group noted a reduction in wound cleansing time by an average of 3-5 days, an acceleration of granulation tissue formation by 4-6 days, as well as a decrease in the frequency of purulent-necrotic complications from 38% to 22%. The use of laser vaporization was accompanied by a decrease in bacterial contamination of the wound by more than two times, improvement of local microcirculation and creation of favorable conditions for tissue regeneration. It was established that the frequency of major amputations in patients of the main group was 9-12%, while in the control group this figure reached 18-24%, which indicates a decrease in the risk of amputations by 1.8-2.2 times and confirms the clinical effectiveness of the proposed treatment method.
