NEW METHODS OF TREATMENT FOR TROPHIC LESIONS OF THE LOWER EXTREMITIES IN PATIENTS WITH DIABETES MELLITUS

State Institution “Institute of Endocrinology and Metabolism named after V.P. Komisarenko of the National Academy of Medical Sciences of Ukraine”, Kyiv, Ukraine
Zaporizhzhia State Medical University, Zaporizhzhia, Ukraine


Summary.

Relevance. Complications in the form of trophic ulcers of the lower extremities are one of the serious consequences of diabetes mellitus (DM), as they often lead to severe health and social problems, up to high amputations.

The aim of the study was the development and clinical testing of diagnostic and therapeutic algorithm for comprehensive treatment of trophic ulcers of the lower extremities in patients with DM.

Materials and methods. Here are presented the results of treatment of 63 patients (42 women and 21 men) with neuropathic trophic lesions of the lower extremities or postoperative defects at the stage of granulation. Of them, 32 patients (treatment group) received local intradermal injections of hyaluronic acid and sodium succinate preparations (Lacerta) into the extracellular matrix. Patients of the comparison group were treated with hydrocolloid materials (hydrocoll, granuflex). In patients, the level of glycated hemoglobin, degree of circulatory disorders (by determining ankle brachial index, before and after the load test) and neuropathic disorders (on a scale for evaluation of neurologic dysfunction – NDS (Neuropathy Disability Score)) were assessed. Results of treatment were assessed by the rate of defect healing during 2 or more months. In the treatment group, 24 patients showed complete healing of the defect (75 %), while in the control group the healing was observed in 16 patients (51.6 %). Within a year, relapses occurred in 22.2 % of cases in the treatment group, and in 46.9 % – in the control one (p < 0.05). Conclusion. The developed method of treatment using Lacerta allowed to increase the efficacy of therapy, accelerate recovery and decrease a number of complications in patients with DM and trophic ulcers of the lower extremities.

Кey words: diabetes mellitus, trophic ulcers of the lower extremities, method of treatment.