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Вестник хирургии Казахстана №2, 2014
Efficiency of the local treatment pyo-necrotic wounds in the diabetic foot syndrome with usage of hydrocolloid wound dressing.
Volokoncev, M.V. Berkut
V.A. Feoktistov, K.T. Shakeyev, S.B. Akhmetova, V.A. Karaganda state medical university, Karaganda city
According to epidemiological investigation, there has been a continuous increase in the number of diabetes patients in industrialized countries, including Kazakhstan. Such growth of the disease leads to increase of purulent-necrotic complications of the lower extremities, which are successfully treated depending on the extent of creating biocovering in the wound.
Objective was
to determine the effectiveness of the local treatment purulent-necrotic complications of diabetic foot syndrome with usage of hydrocolloid wound dressing.
Materials and methods
The clinical research was made with 78 patients with
2-3 stage of diabetic foot of the Wagner classification. The work was conducted on the base of surgical Department of the Regional Medical Center and the City hospital №1 of Karaganda from 2010 to 2013. Therapeutic protocols that are based on the theory of Wound Bed Preparation were followed. While conducting the work hydrocolloid wound dressing in group A, drug collagenase A in group B in comparison with typical treatment, which used in group C were used. The typical treatment was: hydrophilic ointments, washing wounds antiseptic solution, in combination with physiotherapeutic methods of treatment.
The severity of manifestations of wound process was estimated by mathematical analysis. The points are: 0-the characteristic is absent, 1-a low-grade, 2-moderately expressed,
3-sign strongly expressed. The significance of differences compared parameters was determined by the student's criterion (p). Control of wound process was carried out by the smears-print by M.V. Pokrovskaya method.
Results
Dynamics of wound process in the three groups were comparable. However, the speed of granulation development in the main group was significantly faster (0.91±0.40). The
distinct reduction of inflammatory changes is noticed in the field of purulent wounds in the group C in 2.43 times faster than in group B. This is probably connected with the development of contact dermatitis and eczema when enzyme therapy we used. In addition, the application in the group C modern hydrophilic ointments pathogenetically justified, because they have properties: anti-inflammatory, antimicrobial, anesthetic, regenerating. It allowed to increase the speed of occurrence zone epithelization comparable in group A and C (1.83±0.15 and 1.82±0.98 points). Subsequently this led to the reduction of the duration of treatment from 15 days to 13.5.
It should be noted that the swelling around the ulcer was stopped by 1.2 times faster in the first group A and the control group C (p<0.01) than in the group of application drug collagenase A. The situation is similar in relation of erythema- in the control group it was for 3.9 ± 0.2 days (p<0.01), and the group B continued to 4.94 ± 0,2 days (p<0.01).
When the effectiveness of methods for different phases of wound process is being studied. It is observed what hydrogel helps cleaning the wound 2,03 times more efficiently in the first phase of granulation development (0.91±0.40 points) and more intensive regeneration during the second phase. This allows in the shortest possible time to prepare wound to the imposition of secondary sutures and autotransplantation the closure of the wound defect.
In histological paints of group A the number of leukocytes after 4 days sharply reduced, which indicates the remitting inflammatory process. Fibroblasts and capillaries appeared along with macrophages, lymphocytes, and fat cells. The epithelization of skin defect is along with the growth of granulation tissue.
The conclusion
The technique which is based on hydrocolloid wound dressing has a higher efficiency than the 2 other methods. Thus, innovative method of cleansing the wound bed expands the possibility for rapid and selective purification of pyo-necrotic wounds. Especially when mechanical or surgical methods are not applicable or too traumatic.
