Ultrasonic cavitation for managing wounds in patients with purulent-necrotic complications of diabetic foot syndrome
Authors: Kaziev U. K. , Musaev U. S. , Imankulova A. S. , Miklukhin D. S. 
Published: October 2024

Objective: to evaluate the effectiveness of ultrasonic wound cavitation in patients with complicated forms of diabetic foot syndrome (DFS).

Material and methods. A comparative analysis of outcomes after surgical treatment with ultrasonic cavitation in 90 patients having purulentnecrotic complications of diabetic foot syndrome, aged 16–75, was carried out. The first (studied) group included 30 patients who had ultrasonic cavitation sessions at the intra- and postoperative periods; the second (comparison) group included 60 patients who had no any ultrasonic cavitation sessions during their treatment. Clinical effectiveness was assessed on day 10 by the dynamics of wound cleansing from purulent separated and tissue detritus, growth activation, granulation tissue maturation and wound epithelization, as well as by the intensity of pain syndrome according to the visual analogue scale (VAS).

Research results. Of all 90 patients, 37 (41.1 %) were women, 53 (58.9 %) were men. Predominant age was 60–74 years – 35 (38.9 ± 1.2 %); 45–59 years – 33 (36.7 ± 1.6 %); less were patients over 75 – 12 (13.3 ± 1.1 %) and up to 44 – 10 (11.1 ± 1.1 %). Among patients with DFS, neuropathic form was met most often – 56.8%; less often-neuroischemic form (31.1 %) and ischemic form (12.2 %). Localization: skin and subcutaneous fat were more often involved in the purulent-necrotic process (38.9 %); less often – surface fascia (33.4 %) and deep fascial structures (27.7 %). Surgical interventions: surgical wound debridement – 32.2 % and purulent foci incision – 26.7 %; less often finger disarticulation – 10.0 %, foot amputation – 6.7 %, necrectomy – 4.4 %.

Complete wound healing or epithelization of more than 70.0 % of the total area on day 10 since treatment beginning was observed in 70.0 % of patients in the studied group and in 21.7 % in the comparison group; wound epithelization over the area less than 70.0 % – in 23,3 % and 51.7 %, respectively; and no effect or wound healing over the area less than 10.0 % – in 6.7 % and 26.7 %, respectively. Unsatisfactory outcomes were mostly registered in patients with the ischemic form of diabetic foot syndrome and progressive ischemia. Pain intensity decreased by 6 points on day 3 ± 1.2 in patients of the studied group and on day 4 ± 1.4 – of the comparison group; normalization of leukocyte level, C-reactive protein and blood procalcitonin was on day 4 ± 1.3 and on day 5 ± 1.5, respectively.

Conclusion. Ultrasonic cavitation in the comprehensive surgical treatment of patients with complicated forms of diabetic foot syndrome is an effective and safe technique that allows to clean a purulent cavity in a short time, to control the pain syndrome and to create conditions for wound epithelization. Ultrasound cavitation applied in patients with complicated forms of diabetic foot syndrome statistically significantly contributes to complete healing or early epithelization of wound area over more than 70.0 %. Ultrasonic cavitation in patients with neuroischemic and ischemic forms of diabetic foot syndrome is recommended to be applied in the combination with critical ischemia relief