EFFICIENCY OF WOUND BED PREPARATION METHODS FOR PLASTIC CLOSURE OF CHRONIC WOUNDS IN PATIENTS WITH DIABETES MELLITUS

Diabetes mellitus (DM) disturbs the maturation process of the granulation tissue of the wound and promotes the development of its pathological changes (atrophy, hypertrophy, scarring). Histological signs of proliferation disorders determine the need for an additional surgical wound treatment in patients with DM at the stage of preparation of a chronic wound (CW) for autodermoplasty (ADP). Aim. To determine the most optimal method of surgical treatment of pathologically changed granulations in patients with CW and DM in preparation for ADP. Material and methods. The results of the complex treatment of CW for 94 patients, including 73 patients with DM, were studied. Several methods were used to prepare local wounds for ADP: excision of granulations using a necrotome knife, hardware treatment (double wound bed treatment with low-frequency ultrasound using controlled negative pressure between operations of the session) and a combination of these techniques (excision of granulations was performed during the first ultrasound session). Results. The smallest number of skin graft failure cases was obtained when using a combined method of chronic wound bed preparation with surgical excision of pathologically altered granulations. Conclusion. A combination of surgical excision of pathologically altered granulations and hardware treatment is the most effective way chronic wound bed preparation for skin grafting in patients with DM.