CYTOLOGICAL CHANGES IN THE COURSE OF THE WOUND PROCESS IN PATIENTS WITH PURULENT-NECROTIC COMPLICATIONS OF THE DIABETIC FOOT SYNDROME USING OFFLOADING DEVICES

Abstract

Evaluating the effectiveness of lower extremity relief in patients with purulent-necrotic complications of diabetic foot syndrome (DFS) remains an urgent task. The cytological method is one of the indicators that determines the objective course of the pathological process in these patients. Our goal is to conduct a comparative analysis of the dynamics of the cytological picture of the wound process in patients with purulent-necrotic complications of DFS during the use of a half boot and a device for offloading the foot at the stage of inpatient treatment. The first group included 33 patients who used half boots to relieve foot stress. There were 18 (54.5%) women in this group, 15 (45.5%) men. The average age of the patients was 63.8±2.3 years. The second group consisted of 41 patients who used a device for offloading the foot. Among them, there were 23 (56.1%) women and 18 (43.9%) men. The average age of patients in the second group is 62.3±2.4 years. Evaluation of cytograms was carried out by research on 1, 5, 10, 15 and 20 days. Also, on the 1st and 10th day, the general index of purulent-necrotic inflammation of the wound (GIPIW) was determined. In the case when GIPIW>9.5 on the 10th day, then the dynamics of the course of the postoperative wound process were assessed as insufficiently positive. In the case when GIPIW>9.5, the positive dynamics of the course of the pathological process were determined. All patients had stage 3 or 4 of the pathological process on the foot according to the Meggitt-Wagner classification, a neuroischemic form of DFS. We found no statistically significant differences in age, sex and the nature of the pathological process on the foot in both groups. According to the results of the comparison of cytograms in the two groups on the 1st and 5th day of the postoperative period, no significant differences were determined, since the degenerative-inflammatory and inflammatory types prevailed in the two groups of patients, respectively. The difference in the types of cytograms between the two groups of patients begins to be traced from the 10th day. In the second group, on the 10th day, GIPIW<9.5 in 81.8% of patients, in the first group in 50%, respectively. On the 15th day, the regenerative-inflammatory type of cytogram prevailed in the second group, and the inflammatoryregenerative type in the first group. On the 20th day, 51.2% of the patients in the second group had a regenerative cytogram type, 43.9% had a regenerative-inflammatory type, and only 4.9% had an inflammatory-regenerative type. Instead, the regenerativeinflammatory type of cytograms prevails in the first group. It is recorded in 72.7% of patients. Therefore, the dynamics of the course of cytological changes indicate the higher efficiency of the device for offloading the foot.

Keywords

• cytological changes in the wound process,purulent-necrotic complications,diabetic foot syndrome,offloading of the foot,general index of purulent-necrotic inflammation of the wound.