PREDICTION OF POSTOPERATIVE WOUND HEALING IN PATIENTS WITH DIABETIC FOOT SYNDROME

Abstract

Diabetes mellitus (DM) takes the 3rd place in the structure of causes of death, affects 4-5% of the world's population. Diabetic foot syndrome is a pathological change in the nervous system, arterial and capillary bed, which can lead to the formation of ulcerative necrotic processes, as well as gangrene. Approximately about 85% -90% of such cases are trophic foot ulcers, abscesses, cellulitis, osteomyelitis and purulent arthritis. Diabetic foot is manifested in patients suffering from diabetes mellitus, mainly type 2, suffering from an average of 15–20 years of diabetes mellitus. Due to the fact that the sensitivity of the tissues of the lower extremities is impaired in diabetes mellitus, any wounds go unnoticed and can soon become infected with damage to more and more skin, muscle and bone tissue, resulting in the development of a diabetic foot. Pathogenesis is due to three main causes: damage to the blood vessels of the lower extremities, diabetic neuropathy - this is the most common complication of diabetes mellitus, and infection, which usually always accompanies the first two factors. Of all the late complications of diabetes mellitus, leg lesions seem to be the most preventable. Comprehensive strategies can reduce the need for diabetic amputations by 49–85%. The World Health Organization (WHO) and the International Diabetes Federation (IDF) have set an immediate goal of reducing amputations by up to 50%.[4] Any trophic ulcer is characterized by a chronic wound process. With a history of diabetes mellitus of more than 20 years, the probability of damage to the lower extremities exceeds 80%, while 40-70% of all non-traumatic amputations are performed in patients with diabetes mellitus, and the immediate postoperative mortality can reach 20% or more [5, 6]. A long-term ulcer defect in the absence of proper care and treatment is a potential cause of not only abscesses, phlegmon, but also sometimes fatal complications such as wet gangrene and sepsis [7]. The key step in the treatment of trophic ulcers is surgical treatment and its main component is primary necrectomy. It is with it that the improvement of the results of surgical treatment of wound and ulcerative foot defects in patients with diabetic foot syndrome is currently associated. With its help, timely sanitation of the purulent-necrotic focus, removal of the wound biofilm and stimulation of the process of formation of granulation tissue in the ulcer are achieved