Kinetics of wound process with various methods of stimulation of regeneration in wounds

Abstract

Urgency. Objective indicators of the dynamics of the wound process are planimetric methods, including the determination of the area of ulcerative defects and the rate of their epithelialization. The aim of the work is to assess the kinetics of the wound process in venous, ischemic and neurotrophic ulcers of the lower extremities using various methods of stimulating regeneration in wounds. Materials and methods. 4 blocks of studies were carried out: in the first block, the healing of venous trophic ulcers up to 20 cm2 was evaluated; in the second - more than 20 cm2; in the third block, the course of the wound process was studied in patients with ischemic trophic ulcers of the lower extremities on; in the fourth - with neurotrophic ulcers of the lower extremities. In each block, patients were divided into 4 groups according to the methods of stimulation of regeneration: combination of platelet-rich donor plasma and collagen preparations was used; interactive bandages; collagen preparations; platelet-rich donor plasma. To assess changes in the area of wounds in time used the exponential function and the parameter τ (the characteristic time of wound healing), allowing a single number to characterize the kinetics of healing and to measure the period of wound healing. Results and their discussion. For venous trophic ulcers up to 20 cm2 complex use of collagen preparations and platelet-rich donor plasma provides the shortest reduction of the wound area in comparison with other considered methods. For venous trophic ulcers of large and giant size (more than 20 cm2), stimulation of regeneration before autodermoplasty with a split skin flap only using collagen-containing preparations (14.4 days) or platelet-rich donor plasma (11.6 days) provided a greater percentage of survival of the autodermograft. The complex use of collagen preparations and platelet-rich donor plasma is most effective among other methods in reducing the area of neurotrophic ulcers, the characteristic time of reducing the wound area is 48.9 days, which is faster than other methods by 1.25 - 2, 93 times. The healing process of ischemic trophic ulcers is more difficult to Express by mathematical formulas. However, among the compared methods, the use of the complex of drugs leads to a statistically faster decrease in the area of wounds - 24.3 days against 31.6, 29.3 and 88 days. Summary. The complex of preparations provides in General the best kinetics of healing of venous, ischemic and neurotrophic ulcers in comparison with the use of modern dressings and separate use of collagen-containing preparations and platelet-rich donor plasma.