Negative pressure therapy in combination with tissue therapy in the treatment of chronic wounds in patients with diabetes mellitus

Objective. To study the effectiveness of the technology of combined use of negative pressure wound therapy and tissue therapy in different phases of the wound process in patients with diabetes mellitus. Materials and methods. We analysed the results of treatment of 18 patients with type II diabetes mellitus and grade IV Fontaine limb ischemia at the Department of Acute Vascular Diseases of the Zaitsev Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine in 2022–2024. Diagnostic angiography by Seldinger and endovascular or hybrid revascularisation of the limb were performed. In the first phase of the wound process, a combination of negative pressure therapy (–125 mm Hg) with hydrogel dressings was used, and in the second phase – a combination of negative pressure therapy (–75 – –115 mm Hg) with an amniotic membrane. A planimetric study of wounds was performed, the dynamics of the wound process and the rate of marginal epithelialisation were assessed. Results. On the 5th–11th day of local treatment, wound contamination decreased below critical values (less than 105 colony–forming units/g). The rate of wound healing by the 5th – 11th day of treatment was (1.58 ± 0.44)%, by the 21st day – (4.72 ± 0.63)% (p < 0.01). In all patients, spontaneous wound epithelialisation was achieved within 25 to 41 days. The average number of bed days was 22.4 ± 1.8. Conclusions. Negative pressure therapy (provided that the main circulation of the limb is restored) is safe and effective for the treatment of diabetic wounds at all stages, helps to reduce the number of high amputations and expand the possibilities of treatment of this category of patients. The use of amniotic membrane in wound treatment is promising. This method of final wound closure reduces the need for plastic surgery. Low immunogenicity and absence of rejection reactions, significant acceleration of epithelialisation, inhibition of angiogenesis, fibrosis and inflammation, restoration of the morphology of the epithelial cover are significant advantages of amnioplasty.