No abstract

The article presents the experience of an interdisciplinary approach to the management of diabetic foot syndrome using the example of treating a patient with a neuropathic form, which manifests itself as a chronic wound of the foot plantar surface.

The article presents literature review (web-site PubMed is used) on the use of gentamicin-impregnated collagen matrices in prevention and treatment of surgical site infections-background information, clinical and pharmacological reasoning of the use of this composite product, clinical efficiency. Meta-analysis of published research on the application of this product in treatment of patients with diabetic foot syndrome has been carried out. The authors analyzed the results of their own research of topical application of antibiotic-impregnated collagen matrices in surgical treatment of 161 patients with diabetic foot syndrome and Charcot foot in purulent stage and with osteomyelitis.

The analysis of the results of treatment of 76 patients with Charcot’s foot in the stage of purulent complications with the localization of the pathological process in the middle section of the foot was carried out. Surgical tactics consisted in excising a ulcerative defect with the formation of flaps for subsequent plasty, wedge-shaped resection of the tarsal bones, fixing the physiological position of the foot with cannulated screws, closing the wound defect on the collagen sponge impregnated with the antibiotic with primary sutures. In 6 cases, septic instability of screws was noted at different times, which required their removal without loss of foot correction; one patient has a screw fracture; in 2 cases — recurrence of ulcer formation. All other patients showed persistent good clinical effect.

The treatment results of 30 patients with non-specific purulent diseases of the spine were analyzed using various methods — primary or secondary stabilization of the spinal column, local negative pressure method, prolonged local antibiotic therapy method and various implants. The results were rated as «excellent» in 16 patients, «good» in 7 people, «satisfactory» in 4 cases (relapses) and 3 patients died. The results obtained indicate the need for a personalized approach to treatment tactics, the feasibility of staged treatment and the use of additional methods.