Biomedical Technologies in the Treatment of Skin and Soft Tissue Defects in Patients with Diabetic Foot Syndrome

ORIGINAL ARTICLE
Magomed D. Dibirov, MD, PhD, ScD¹; Rasul U. Gadzhimuradov, MD, PhD, ScD¹; Konstantin A. Koreiba, MD, PhD²,³*; Aidar R. Minabutdinov, MD²,³

¹Moscow State University of Medicine and Dentistry, Russia; ²Kazan State Medical University, Russia; ³«Diabetic Foot» Center, Kazan, Russia

*Corresponding author: Konstantin A Koreiba, MD, PhD, Associate Professor. Department of General Surgery, Kazan State Medical University, Russia; “Diabetic Foot” Center, Kazan, Russia. diabetstopa5gb@mail.ru

Published: March 16, 2016. DOI: 10.21103/Article6(1)_OA8

Abstract: 

The aim of our study was to investigate the effectiveness of collagen implants in the closure of tissue defects. We offer a method that enables us to avoid the drawbacks of autodermoplasty based on the free split-thickness skin graft. 

Materials and Methods: This paper describes all steps of treatment of skin and soft tissue defects in patients with diabetic foot syndrome (DFS), including ultrasonic cavitation (UC) with hydrosurgical debridement (HD) to remove necrotic debris, purulent pellicle and bacterial biofilm, and an alternative technique for wound defect closure using high-tech biomaterials based on type I collagen (“Collost”, “Salvecoll”).

Results: Use of type I collagen (“Collost”, “Salvecoll”) as a component of combination treatment of tissue defects in DFS allowed us to increase the relative rate of wound healing, reduce the incidence of high-level amputations, and significantly reduce inpatient surgical coverage around the clock and speed up a patient's transfer to outpatient care.

Conclusion: Ultrasonic cavitation  with hydrosurgical debridement is the most effective procedure for wound preparation for closure. The use of bioplastic collagen materials in patients with DFS is the most effective solution in the management of wound defects.

Keywords: 
diabetic foot syndrome; ultrasonic cavitation with hydrosurgical debridement; wound defect closure; bioplastic collagen materials; autodermoplasty.
References: 
  1. Dedov II, Antsyferov MB, Galstyan GR, Tokmakova AY. Diabetic foot syndrome. Moscow; 1998.
  2. Singh N., Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA. 2005; 293(2):217-28.
  3. Wagner FW. A classification and treatment program for diabetic neuropathic and dysvascular foot problems. Instr Course Lect 28:143-65, 1979.
  4.  Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 1999;22(Suppl 1):S5–S19.
  5. Standards of specialized diabetes care. Edited by Dedov II, Shestakova MV. 7th Edition.  Diabetes mellitus. 2015;18(1S):1-112. [Article in Russian].
  6. Lavery LA, Armstrong DG, Wunderlich RP, Tredwell J, Boulton AJ. Diabetic foot syndrome: evaluating the prevalence and incidence of foot pathology in Mexican Americans and non-Hispanic whites from a diabetes disease management cohort. J Diabetes Care. 2003; 26(5):1435-8.
  7. Bregovsky VB, Zaitsev АА,  Zapevskaya AG. Lower limb injuries in diabetes mellitus. St. Petersburg: Dilya Publishers, 2004.
  8. Chronopoulos A, Tang A, Beglova E, Trackman PC, Roy S. High glucose increases lysyl oxidase expression and activity in retinal endothelial cells: mechanism for compromised extracellular matrix barrier function. Diabetes. 2010;59(12):3159-66.
  9. Mazurov VI. Biochemistry of collagen proteins. Мoscow, 1974.
  10. Ortolan EV, Spadella CT, Caramori C, Machado JL, Gregorio EA, Rabello K.: Microscopic, morphometric and ultrastructural analysis of anastomotic healing in the intestine of normal and diabetic rats. Exp Clin Endocrinol Diabetes 2008;116:198–202 [PubMed]
  11. Singh VP, Bali A, Singh N, Jaggi AS. Advanced Glycation End Products and Diabetic Complications. Korean J Physiol Pharmacol. 2014; 18(1): 1–14.
  12. El-Mesallamy HO, Hamdy NM, Ezzat OA, Reda AM. Levels of soluble advanced glycation end product-receptors and other soluble serum markers as indicators of diabetic neuropathy in the foot. J Investig Med. 2011;59:1233–1238.
  13. Black E, Vibe-Petersen J, Jorgensen LN, Madsen SM, Agren MS, Holstein PE, et al. Decrease of collagen deposition in wound repair in type 1 diabetes independent of glycemic control. Arch Surg. 2003138(1):34-40.
  14. Schultz GS1, Wysocki A. Interactions between extracellular matrix and growth factors in wound healing. Wound Repair Regen. 2009;17(2):153-62.
  15. Briskin BS. Use of bioplastic material Collost in the treatment of wound defects in patients with complicated forms of diabetic foot syndrome. Мoscow, 2014.
  16. Safoian AA, Nesterenko VG, Nesterenko SV, Alekseeva NU. Bioresorbable collagen matrix, process of its preparation and use. Russian patent 2353397, A61L27/24, A61K35/32, A61K35/36, A61K38/39. 2009

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Int J Biomed. 2016; 6(1):41-45. © 2016 International Medical Research and Development Corporation. All rights reserved.