The use of biomedical technologies in surgical management of diabetic foot
Year: 2017
Type: other
Abstract: The Use of Biomedical Technologies in Surgical Management of Diabetic Foot. BackgroundIn accordance with data of International Diabetes Federation (IDF) there were 12.1 million people with diabetes mellitus (DM) on 01 Jan 2016. Diabetic foot syndrome (DFS) develops in 15-25% of diabetic patients, 85% of trophic ulcers in patients with DFS lead to lower limb amputations. Diabetic foot ulcer (DFU) is the chronic wound. Sequence of healing processes ranging from cell migration and restructuring of the extracellular matrix to the remodeling of the tissues are disturbed. Collagen formation slows down. Thus, the effective repair is impossible.AimTo study the implementation of treatment method for repair of soft tissue defects in patients with DFU (Russian Patent No. 2549459, 30 March 2015).MethodThe clinical data were obtained from 70 DFS patients. Ulcer defects had different anatomical locations over the lower extremities, namely, on the plantar and dorsal surfaces of the foot, the plantar surface of the fingers, inner or outer surface of the lower third of the tibia and in the area of postoperative wounds of the foot. According to Wagner Ulcer Grade Classification the ulcers were found to be in grade W1, W2 or W3. Stages of the treatment methodology include: 1 - debridement; 2 - implantation of modern biomaterials on the base of type I collagen Collost (Russia) / Salvecoll (Europe); 3 - creation favorable conditions for reparative-proliferative processes with application of interactive dressings, immobilization by the Total Contact Cast (TCC). The 1st stage is the wound bed preparation by ultrasonic cavitation with hydrosurgical debridement at the day of hospitalization. The 2nd stage is the implantation of bioplastic material based on native collagen type I u2013 injections of gel in paravulnar and vulnar tissues intraoperatively after wound cleansing. The biomaterial derived from bovine skin, through special processing by removal of epidermis, adipose tissue, and all dermal cells without disruption of the native collagen matrix. It has no antigenic structures. We used this material in the form of 7% or 15% gel. The use of type I collagen biomaterial is caused by understanding of pathological processes in chronic wounds in patients with DM. In neuroischemic form of DFS the relationship of protein fractions is broken that leads to collagen desorganization in wound. But collagen has the main role of reparative-proliferative phase of wound healing. Physiological course of wound healing is violated, chronic ulcer is formed and wound cachexia develops, that leads to disruption of metabolic processes in wound, delay healing, reduce reactivity, and lack of epithelialization. The implantation of biomaterial is technically perfomed on the
Author: Ruslan Gabitov
Institution: Sechenov University
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W4213045376