Vacuum Therapy in the Treatment of Complicated Forms of Diabetic Foot Syndrome

According to the latest data from the International Diabetes Federation (IDF), the number of people with diabetes today is more than 415 million people on Earth, by 2030 it will increase to 439 million, and by 2035 it will reach 592 million. During the lifetime of diabetic patients, diabetic foot syndrome develops in 4.6-25 % with the subsequent formation of wounds, the treatment of which cannot be considered satisfactory at the current stage, since in 15-25 % of patients they are the direct cause of high amputations of the lower limbs. This requires specialists, both surgeons and endocrinologists, to find new effective methods of treating wound defects in this group of patients, one of which is vacuum wound therapy. The aim of this work was to study the effectiveness of vacuum therapy in the treatment of acute and chronic wound processes in patients with diabetic foot syndrome, depending on the pathogenetic form of the lesion. Materials and methods. The effect of vacuum therapy during acute and chronic wound healing in 187 patients with neuropathic and ischemic forms of diabetic foot syndrome was studied during 2018–2024. The dynamics of the wound process was evaluated on the basis of clinical, planimetric, microbiological, morphological methods and indicators of microcirculation in the area round the wound. Results. The effect of negative pressure in acute and chronic wounds in patients with different pathogenetic forms of diabetic foot syndrome allows to stabilize the course of the wound process, stimulate regenerative processes in the wound, and improve local microcirculation (p < 0.05). Which allows to prepare the wound for closure by one of the methods of plastic surgery in a shorter time, or to create favorable conditions for its independent epithelialization. In patients with an ischemic form of the lesion (chronic arterial insufficiency of the III degree), carrying out vacuum therapy according to the standard method leads to an intensification of pain syndrome. This causes the need to apply an initial negative pressure in the system in the range of 70-80 mm Hg, which makes it possible to stop pain during the day. Already on the 2-3 day of the postoperative period, negative pressure is established at standard values. Conclusions. Vacuum therapy of wounds in patients with diabetic foot syndrome is an effective method of treatment, which allows to reduce the duration of treatment of patients in hospital with a neuropathic form on average (4.1±1.6) bed-days and patients with an ischemic form - on average (4.6±2.3) bed-days, which has not only medical, but also social significance.