Options of autodermoplasty of wound defects with a free skin flap in patients with complicated diabetic foot syndrome

Abstract

Introduction. Today, surgical treatment of complicated forms of diabetic foot syndrome is aimed at performing radical surgical procedures and "small" amputations of the foot, aimed at preserving the lower limb and its supporting function. After performing such surgical interventions, large wound defects often occur that require plastic closure. Autodermoplasty with free skin flaps can be considered the most rational method of closing wounds in this category of patients. However, the currently known methods of preparing wounds for autodermoplasty and the timing of its implementation remain insufficiently studied, which requires further research in this direction. Objective. To improve the results of wound treatment after surgical treatment of patients with complicated forms of diabetic foot syndrome by improving the methods of autodermoplasty of wound defects using free skin flaps. Materials and methods. The study is based on the results of treatment of 147 patients in hospital with complicated forms of diabetic foot syndrome during 2020-2025, who underwent autodermoplasty of foot wounds with free skin flaps during the treatment process. Central hemodynamics of the lower extremities were studied using ultrasound Doppler examination, and microhemodynamics were studied using laser Doppler flowmetry. The quantitative and qualitative composition of wound microflora at the stages of treatment was studied using standard methods, which were supplemented by microscopy of smears-prints from the wound, stained by Gram. Material for morphological research was obtained by incisional biopsy and staining of histological preparations with hematoxylin and eosin, followed by examination of the preparations by light microscopy. In the postoperative period, vacuum therapy was used to prepare the wounds for autodermoplasty, which was performed using a GENADYNE XLR8 Plus device (USA). Results and Discussion: Autodermoplasty of wounds with a free skin flap is a simple and quite effective method of closing wound defects in patients with diabetic foot syndrome. It should be performed in a differentiated manner, using different methods depending on the clinical situation. The most effective method of performing it is autodermoplasty using a relief flap. Conclusions. Performing wound autodermoplasty allows to reduce the duration of treatment of patients in hospital, to achieve the fastest healing of wounds and restore the supporting function of the limb, which has not only medical but also social significance.