Treatment of trophic ulcers of the lower extremities of diabetic etiology depending on the stage of pathogenesis

Trophic ulcers of the lower extremities (TENS) are an urgent problem in medical practice due to their high prevalence. Every year 0.6–0.8% of patients suffering from diabetes mellitus (DM) undergo lower limb amputation at various levels. Despite the emergence of high-tech methods of examination, improvement of surgical and therapeutic methods of treatment, in some patients it is not possible to achieve the expected healing of TENS or the effect is unstable. The aim of the study is to analyze theliterature and present the main and complementary treatment modalities for TENS used today. Literature indexed in eLIBRARY, Web of Science, Web of Knowledge, Medline, ScienceDirect, CINAHL, Embase, PsycINFO databases from 2004 to 2024 was analyzed. The main methods used in the exudation (inflammation) phase include primary wound care, dressings, proteolytic enzyme therapy and negative pressure therapy; in the proliferation (repair) phase: negative pressure therapy and growth factor preparations; in the remodeling (epithelialization) phase: oxygen therapy, collagen-based preparations, reparants and hyaluronic acid-based regerants. General treatment methods include adequate antibiotic therapy, glycemic control and unloading of the affected area. Chronic wounds affect millions of people around the world, posing serious problems for health systems and placing a heavy economic burden on the world. The main task of treatment of diabetic foot is complex therapy, including on all links of the pathological process. The effectiveness of healing of TENS depends largely on the adequacy oflocal treatment, taking into account the stage of the process and based on objective criteria of timely correction.

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