PATHOGENETIC APPROACH IN TREATMENT OF DIABETIC AND VENOUS TROPHIC ULCERS USING PLASMATHERAPY AND LASER THERAPY

Abstract

Introduction. In Ukraine more than 13,000 lower limb amputations are performed per year, of which about 8,000 are due to vascular lesions, and more than 3,000 are associated with diabetes mellitus (DM).

Objective: to improve the effectiveness of treatment of patients with diabetic and venous trophic ulcers (TU) of the lower extremities by applying a pathogenetic approach using plasma therapy and laser therapy.

Materials and methods. The study involved 63 patients with TU, of which 32 were with chronic venous insufficiency (CVI) (group 1) and 31 patients with T2DM, moderate severity, compensation stage with diabetic foot syndrome II (group 2).

Results. The effectiveness of photodynamic therapy (PDT) in group 1 was assessed by the VCSS-1 and VCSS-2 scales. At baseline, the total score of clinical severity of CVI was 20.9 points, and two weeks later – 15.71 points, which shows an improvement by 24.83% (p≤0.05). The effectiveness of PDT in group 2 was assessed by the S(AD) SAD-1 scales at baseline and S(AD) SAD-2 at 2 weeks. The overall score on the scale S(AD) SAD-1 was 13.91 points, two weeks later it improved by 11.65% (12.29 points), which shows a much slower rate of normalization of the clinical picture in patients with diabetes compared with CVI.

The effectiveness of plasma therapy in group 1 was assessed by the VCSS-1 and VCSS-3 scales. The total score of clinical severity of CVI after 6 weeks of treatment was 9.72 points, indicating an improvement in clinical status by 53.49% from baseline (20.9 points) (p≤0.05). In group 2, the evaluation of the effectiveness of plasma therapy was based on a comparison of the scales S(AD) SAD-1 and S(AD) SAD-3. The overall score of clinical severity at 6 weeks was 6.39 points, indicating an improvement by 54.06% from baseline (13.91 points).

Analysis of the ulcer healing dynamics in group 1 revealed 0 points (no active ulcers) in 87.5% of patients (28 patients), while in the remaining 4 patients the size of active ulcers was 1 point. In group 2, the dynamics of the area reduction showed slower results: in 74.2% of patients the TU area was 2 points, 0 points were achieved in 12.9% patients, in the remaining patients (12.9%) – 4 points.

Conclusions. Due to using of combined scheme of basic therapy, supplemented with PDT at the initial stage and plasma therapy in the granulation phase, it was possible to improve the dynamics of the rate of healing of TU and reduce the duration of treatment.