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3 . 2021

Using high-intensity laser and photodynamic therapy in treatment of purulent diseases of hand in patients with diabetes mellitus

Abstract

One of the most formidable comorbidities in patients with diabetes mellitus is purulent pathology, which is a frequent reason for hospitalization for this category of patients. It is known that in this group of patients purulent diseases are especially difficult and long lasting. A special place among purulent pathology is occupied by patients with purulent diseases of the hand. Often the sad consequences of prolonged treatment in this category of patients are operations that lead to the loss of a finger or even a limb, which causes a high level of disability, and, consequently, a special social and economic significance of this problem.

The aim - to analyse the effectiveness of high-intensity laser and photodynamic therapy in the treatment outcomes of purulent hand diseases in patients with diabetes mellitus.

Material and methods. This study analyzes the treatment of purulent hand diseases in patients with diabetes mellitus, hospitalized to purulent surgery department of our clinic. In the study we analyzed the treatment outcomes of 98 patients, who were divided into 4 groups depending on the method: the 1st group was given a surgical treatment with the installation of a drainage and irrigation system (DIS). The patients from the 2nd group were provided with open-wound treatment. The patients of the 3rd group received the installation of a drainage and irrigation system (DIS) with laser necrectomy. In the group 4 after open-wound treatment photodynamic therapy session in the postoperative period was performed. In the study we made a comparative analysis of the level of intoxication, the wound healing dynamics, the level of pain syndrome, and the duration of treatment.

Results. When comparing the treatment outcomes in these groups, a positive effect of laser radiation on the course of the wound healing was revealed in patients in the group treated with laser necrectomy, the period of hospitalization was reduced by 5 days; the use of photodynamic therapy shortened the length of hospital stay by 6 days (p<0.0001). The dynamics of the wound healing treated with laser radiation was accelerated. Perifocal inflammation subsided significantly faster after using laser treatment, wound exudation ended and reparative processes began, which was reflected in the dynamics of changes in the size of the wound surface. When analyzing the level of the leukocyte intoxication index in the experimental groups, a more rapid relief of the inflammatory process was noted.

Conclusion. The use of laser necrectomy advanced the treatment outcomes when applying DIS in patients with diabetes mellitus, and photodynamic therapy had a positive effect on the process of the wound healing. Consequently, the laser treatment presents a broad prospects for use in the purulent surgery of hand for patients with diabetes mellitus.

Keywords:diabetes mellitus, high-intensity laser, photodynamic therapy, purulent diseases, hand, panaritium, phlegmon, necrectomy

Funding. The study was carried out with full material and technical support of City Clinical Hospital No. 4.

Conflict of interest. The authors declare no obvious and potential conflicts of interest related to the content of this article.

For citation: Chepurnaya Yu.L., Melkonyan G.G., Gulmuradova N.T., Sorokin A.A. Using high-intensity laser and photodynamic therapy in treatment of purulent diseases of hand in patients with diabetes mellitus. Endokrinologiya: novosti, mneniya, obuchenie [Endocrinology: News, Opinions, Training]. 2021; 10 (3): 22-30. DOI: https://doi.org/10.33029/2304-9529-2021-10-3-22-30 (in Russian)

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CHIEF EDITOR
CHIEF EDITOR
Ametov Alexander S.
Honored Scientist of the Russian Federation, Doctor of Medical Sciences, Professor, Head of Subdepartment of Endocrinology, Head of the UNESCO Network Chair on the subject «Bioethics of diabetes as a global problem» of the Russian Medical Academy of Continuous Professional Education (Moscow)
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