Assessment of proliferative potential using the local influence of cell technologies and negative pressure therapy in the complex treatment of trophic defects in patients with chronic disease of the veins of the lower extremities C6

November 21, 2023
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УДК:  616.147.3-007.64-002.44-7-089.819:576.7:57.086.83:615.47:621.3.032.11
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The aim: to determine the difference in the expression of the marker of proliferative potential Ki-67 in the treatment of patients with C6 chronic disease of the veins with the use of PRP and NPWT in comparison with traditional methods of wound care and elimination of vertical reflux.

Materials and methods. The study included 75 patients with C6 chronic disease of the veins. The main group: 34 patients, 16 (47.1%) men and 18 (52.9%) women who underwent preoperative preparation with mechanical and enzymatic debridement, the use of modern super absorbent hydroactive wound dressings, PRP and NPWT, and minimally invasive surgery. Comparison group: 41 patients, 14 (34.2%) men and 27 (65.8%) women who underwent standard surgical intervention with crossectomy and stripping, miniphlebectomy or scleroobliteration in combination with local treatment.

Results. The use of the proposed tactics of preoperative preparation makes it possible to reduce the duration of the preparation of the wound bed for surgical intervention from 15.39 to 6.03 days. Immunohistochemically, the significant effectiveness of the use of PRP in the treatment of trophic ulcers on the background of chronic disease of the veins was confirmed, which is manifested in a significantly higher expression of the Ki-67 antibody, whereas the main group, on average, there were 19 to 24 mitotically active cells per field of view, in the comparison group, from 8 to 16.

Conclusions. Due to the creation of negative pressure, through physical contraction — dermotension, it leads to the removal of toxins and excessive interstitial fluid from the wound, improvement of trophic and neoangiogenesis. The proposed tactic of preoperative preparation and treatment of patients with C6 chronic disease of the veins allows reducing the time of preparing the wound bed and the patient for surgical intervention by 2.55 times. The use of PRP and NPWT has several advantages and biological effects that lead to the reduction of inflammation, cleansing of the trophic ulcer, reduction of edema, elimination of the biological film, stimulation of neoangiogenesis and, as a result, healing of the trophic ulcer.

References

  • 1. Mansilha A. (2020) Early Stages of Chronic Venous Disease: Medical Treatment Alone or in Addition to Endovenous Treatments. Adv. Ther., 37(S1): 13–18.
  • 2. Nicolaides A., Kakkos S., Baekgaard N. et al. (2018) Management of chronic venous disorders of the lower limbs. Guidelines According to Scientific Evidence PART I, 37: 181–254.
  • 3. Brand F., Dannenberg A., Abbott R., Kannel W. (1988) The epidemiology of varicose veins: the Framingham Study. Am. J. Prev. Med., 4: 96–101.
  • 4. Quarto G., Amato B., Giani U. et al. (2016) Comparison of traditional surgery and laser treatment of incontinent great saphenous vein. Results of a meta-Analysis. Ann. Ital. Chir., 87: 7–61.
  • 5. Vemuri M.C., Chase L.G., Rao M.S. (2011) Mesenchymal Stem Cell Assays and Applications. Methods in Molecular Biology, 698: 3–8.
  • 6. Malgieri A., Kantzari E., Patrizi M.P., Gambardella S. (2010) Bone marrow and umbilical cord blood human mesenchymal stem cells: state of the art. Int. J. Clin. Exp. Med., 3: 248–269.
  • 7. Yang M., Li Q., Sheng L. et al. (2011) Bone marrow — derived mesenchymal stem cells transplantation accelerates tissue expansion by promoting skin regeneration during expansion. Ann. Surg., 253: 202–209.
  • 8. Werner S., Krieg T., Smola Н. (2007) Keratinocyte–fibroblast interactions in wound healing. J. Investigat. Dermatol., 127: 998–1008.
  • 9. Lupaltsov V.I., Kitchenko S.S. (2017) Modern types of treatment of patients with chronic venous insufficiency complicated by trophic ulcers (literature review). Ukr. J. Surg., 2: 61–66.
  • 10. Stadelmann W.K., Digenis A.G., Tobin G.R. (1998) Physiology and healing dynamics of chronic cutaneous wounds. Am. J. Surg., 176: 26S–38S.
  • 11. Martin P. (1997) Wound Healing — Aiming for Perfect Skin Regeneration. Science, 276: 75–81.
  • 12. Broughton G., Janis J.E., Attinger C.E. (2006) Wound healing: An overview. Plast. Reconstr. Surg. doi.org/10.1097/01.PRS.0000222562.60260.F9.
  • 13. Saad Setta H., Elshahat A., Elsherbiny K. et al. (2011) Platelet-rich plasma versus platelet-poor plasma in the management of chronic diabetic foot ulcers: a comparative study. Int. Wound J., 8: 307–312.
  • 14. Dos Santos R.G., Santos G.S., Alkass N. et al. (2021) The regenerative mechanisms of platelet-rich plasma: A review. Cytokine, 144: 1–8.
  • 15. Jonat W., Arnold N. (2011) Is the Ki-67 labelling index ready for clinical use? Ann Oncol., 22: 500–502.
  • 16. Lindley L.E., Stojadinovic O., Pastar I., Tomic-Canic M. (2016) Biology and Biomarkers for Wound Healing. Plast. Reconstr. Surg., 138: 18–28.
  • 17. Morin C., Roumegous A., Carpentier G. et al. (2012) Modulation of Inflammation by Cicaderma Ointment Accelerates Skin Wound Healing. J. Pharmacol. Experiment. Therapeut., 343: 115–124.
  • 18. Tallis A., Motley T.A., Wunderlich R.P. et al. (2013) Clinical and Economic Assessment of Diabetic Foot Ulcer Debridement with Collagenase: Results of a Randomized Controlled Study. Clin. Ther., 35: 1805–1820.
  • 19. Agha R., Ogawa R., Pietramaggiori G., Orgill D.P. (2011) A Review of the Role of Mechanical Forces in Cutaneous Wound Healing. J. Surg. Res., 171: 700–708.
  • 20. Profyris C., Tziotzios C., Do Vale I. (2012) Cutaneous scarring: Pathophysiology, molecular mechanisms, and scar reduction therapeutics: Part I. The molecular basis of scar formation. J. Am. Acad. Dermatol., 66: 1–10.
  • 21. Choi D.S., Kim S., Lim Y.M. et al. (2012) Hydrogel incorporated with chestnut honey accelerates wound healing and promotes early HO-1 protein expression in diabetic (db/db) mice. Tissue Eng. Regen. Med., 9: 36–42.