Journal «Angiology and Vascular Surgery» • 

2020 • VOLUME 26 • №4

Ways of limbs salvage in postoperative period of treatment of complications of diabetic foot syndrome

Krivoshchekov E.P.1, Elshin E.B.2, Romanov V.E.1, Alyapyshev G.S.3, Rodnyansky D.V.4

1) Department of Surgery, Institute of Postgraduate Education, Samara State Medical University,
2) Department of Purulent Surgery, Samara Municipal Clinical Hospital №8, Samara,
3) Department of Vascular Surgery, Ulyanovsk Regional Clinical Hospital, Ulyanovsk,
4) Department of Vascular Surgery, Railway Clinical Hospital at the Chelyabinsk Station of the Open Joint-Stock Company «Russian Railways», Chelyabinsk, Russia

The article deals with the use of a genetically engineered drug for stimulation of angiogenesis as a component of combined treatment of complications of ischaemic form of diabetic foot syndrome, showing comparative results of using therapeutic angiogenesis in patients in whom it was impossible to perform operative revascularization of the affected extremity, also providing a detailed description of the methodology of combined treatment of pyonecrotic complications of diabetic foot syndrome.

The study included a total of 62 patients with pyonecrotic complications of Wagner grade III-IV diabetic foot syndrome. The patients were divided into two groups. Group One patients after minor amputation on the foot were assigned to receive conventional basic therapy and topical treatment of the foot wound with antiseptics and modern dressings. Group Two patients, besides basic therapy, additionally received combined treatment which was carried out in two stages and included urokinase, sulodexide, and a venotonic agent. Local treatment of the foot wound was performed with the help of two-stage vacuum therapy. Both groups were further subdivided into subgroups A and B. The patients in subgroups B of both groups in order to prevent progression of limb ischaemia were additionally given Neovasculgen, a genetically engineered drug for stimulation of angiogenesis. The patients of subgroups A of both groups did not receive this drug. The immediate results were assessed on the 1st, 7th and 14th days of treatment by the dynamics of changes in subjective symptoms, cytograms of the wound surface, level of partial pressure of oxygen in capillary blood of foot tissues, and the necessity to perform repeated necrectomy. The remote results were evaluated by the dynamics of changes in the pain-free walking distance, maximum distance walked, ankle-brachial index, linear velocity of blood flow through tibial arteries and partial pressure of oxygen in capillary blood of the affected limb at the 6th, 12th and 36th months after the performed treatment, as well as by the limb salvage and patients’ survival during 3 years.

KEY WORDS: ischaemic form of diabetic foot syndrome, combined treatment, gene therapy, stimulation of angiogenesis, thrombolytic therapy, vacuum therapy.

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