Photodynamic therapy in treatment of trophic ulcers in patients, suffering chronic venous insufficiency

Keywords: chronic venous insufficiency, trophic ulcer, photodynamical therapy

Abstract

Objective. Elaboration of complex approach to treatment of trophic ulcers of venous etiology, using photodynamical tissue therapy and modern types of the wound coverage.

Materials and methods. Into the investigation 24 patients were included, suffering venous ulcers on background of postthrombophlebitic disease and ageing from 31 to 79 yrs old. Into the comparison group there were included 14 patients, in whom a standard treatment (venotonic preparations, elastic compression, local application of multicomponent ointments depending on the wound phase present) was used. Into the main group10 patients were included, in whom the elaborated procedure of photodynamical therapy was applied. In treatment of the patients the Korobov’s photonic matrix «Barva Flex», owing spectral diapason 700-630 nm, corresponding to red light, was applied. Gel «Levuderm» (6% gel 5-aminolevulinic acid phosphate, which constitutes a natural predecessor of endogenous photosensitizer protoporphyrin IX) was applied.

Results. Transition of the wound process to the second stage in the comparison group was durable, in 50% of patients epithelization did not complete up to 45th day of treatment. In the main group, under the impact of the treatment method proposed, the term of granulations appearance have had shortened as well as filling in of the wound by mature granulation tissue, and epithelization have accelerated by 29.8%, comparing with standard therapy.

Conclusion. This investigation owes a shortage because of insufficient volume of sampling. Thus, it is necessary to perform further controlled investigations to discover the mechanisms of basic impact of the 5-aminolevulinic acid photodynamical therapy on the wound healing process.

Author Biographies

Yu. V. Іvanova, Kharkiv National Medical University

Yu. V. Ivanova, Kharkov National Medical University

Ivanova Julia – MD, DSci(Med), Professor,
Department of Surgery No. 1,
Kharkiv National Medical University,
1 Balakirev entry, 61018, Kharkov, Ukraine;
057-349-41-94;
dr.ivanova23@gmail.com;
https://orcid.org/0000-0001-8773-6827

S. M. Gramatyuk, Іnstitute of Cellular Biorehabilitation, Kharkiv

S. M. Gramatiuk, Institute of Cellular Biorehabilitation, Kharkiv
Gramatiuk Svitlana, MD, PhD(Med), Director
Institute of Clinical Bioreabilitation, Kharkiv
191 Moskovsky ave, Kharkiv, Ukraine
+38 099 154 91 44,
https://orcid.org/0000-0003-4238-7031

І. A. Kryvoruchko, Kharkiv National Medical University

I. A. Kryvoruchko, Kharkov National Medical University
Kryvoruchko Igor Andriiovych – MD, DSci(Med), Professor,
Head Department of Surgery No. 2,
Kharkiv National Medical University,
ikryvoruchko60@gmail.com
https://orcid.org/0000-0002-5525-701X

O. O. Zarudnyi, Zaytsev Іnstitute of General and Urgent Surgery, Kharkiv

O. O. Zarudnyi, Zaytsev Іnstitute of General and Urgent Surgery
Zarudnyi Oleg Oleksandrovich – MD, PhD(Med),
Head of the department of transfusiology, biomaterials and extracorporeal technologies
Zaytsev Іnstitute of General and Urgent Surgery, Kharkiv
1 Balakirev entry, 61018, Kharkov, Ukraine;
https://orcid.org/0000-0001-9775-8501

K. V. Miasoiedov, Kharkiv National Medical University

K. V. Miasoiedov, Kharkov National Medical University
Miasoiedov Kyrylo – MD, PhD(Med), Assistent
Department of Surgery No. 1,
Kharkiv National Medical University,
1 Balakirev entry, 61018, Kharkov, Ukraine;
vonmiasoiedov@gmail.com
https://orcid.org/0000-0002-3878-7713

References

Kudykin MN, Izmailov SG, Beschastnov VV, Kletskin AE, Vasyain AN. Analysis of the reasons for the return of trophic ulcers of venous etiology. Q: How to improve outcomes in patients with vascular disease. XXIII international conference Krasnodar, June 16-18, 2008 Krasnodar; 2008.185 - 7. Russian.

Hoods IM. Current issues in the treatment of venous ulcers. Clinical phlebology. 2015; 8(1): 15–6. Ukrainian.

Wittens C, Davies AH, Bækgaard N, Broholm R, Cavezzi A, Chastanet S, et al. Editor's Choice - Management of Chronic Venous Disease: Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2015 Jun;49(6):678-737. doi: 10.1016/j.ejvs.2015.02.007. Epub 2015 Apr 25. Erratum in: Eur J Vasc Endovasc Surg. 2020 Mar;59(3):495. PMID: 25920631.

Rabe E, Pannier F. Epidemiology of chronic venous disease. In: 16 World congress of the Union Internationale de Phlebology. e-abstract book. Monaco; 2009:72.

Chernukha LM. Vein disease is a problem that needs to be addressed. Health of Ukraine. 2011;(6):2–3. Russian.

Chernukha LM. Modern approaches to the treatment of chronic venous diseases: news from the European Venous Forum. Health of Ukraine. 2012;(4):10-3. Russian.

Chernukha LM, Gooch AA, Vlaikov GG. Pathogenetic substantiation of active surgical tactics and the main concept of conservative rehabilitation treatment in patients with severe forms of chronic venous insufficiency of the lower extremities. Clinical phlebology. 2009;(1). С. 105–9. Russian.

Scotton MF, Miot HA, Abbade LP. Factors that influence healing of chronic venous leg ulcers: a retrospective cohort. An Bras Dermatol. 2014 May-Jun;89(3):414-22. doi: 10.1590/abd1806-4841.20142687. PMID: 24937814; PMCID: PMC4056698.

Bilyaeva OO, Rogovsky VM, Yatsun VV. Autodermoplasty in the complex treatment of chronic venous insufficiency of the lower extremities in the stage of trophic disorders. Tauride Medical and Biological Bulletin. 2011;14(4):20–3. Ukrainian.

Wenger IC, Bedenyuk AD, Romanyuk TV. Trophic ulcers of venous origin - tactics of surgical treatment. Hospital Surgery. 2011;(10):57–60. Ukrainian.

Tolstykh PI, Tamrazova OB, Pavlenko VV, Kuleshov IYu, Tolstykh MP. Long-term non-healing wounds and ulcers (pathogenesis, clinic, treatment). Moscow: Deepak; 2009. 168 p. Russian. ISBN: 978-5-98580-046-3.

Leaper DJ, Schultz G, Carville K, Fletcher J, Swanson T, Drake R. Extending the TIME concept: what have we learned in the past 10 years?. Int Wound J. 2012 Dec;9 Suppl 2(Suppl 2):1-19. doi: 10.1111/j.1742-481X.2012.01097.x. PMID: 23145905; PMCID: PMC7950760.

Huch AA, Chernukha LM, Smorzhevsky VI. Trophic disorders of lower extremity tissues in patients with morbid obesity. Clinical phlebology. 2013;6(1):144–5. Russian.

Rusyn VI, Korsak VV, Mitrovka BA. Complex treatment of patients with trophic ulcers of venous origin. Clinical phlebology. 2013;6(1):170. Ukrainian.

Villavicencio JL. Leg ulcers of venous origin: From ancient to modern times. J Vasc Surg Venous Lymphat Disord. 2013 Jan;1(1):96-9. doi: 10.1016/j.jvsv.2012.08.003. Epub 2012 Dec 8. PMID: 26993903.

Frykberg RG, Banks J. Challenges in the Treatment of Chronic Wounds. Adv Wound Care (New Rochelle). 2015 Sep 1;4(9):560-82. doi: 10.1089/wound.2015.0635. PMID: 26339534; PMCID: PMC4528992.

Gethin G, Cowman S, Kolbach DN. Debridement for venous leg ulcers. Cochrane Database Syst Rev. 2015 Sep 14;2015(9):CD008599. doi: 10.1002/14651858.CD008599.pub2. PMID: 26368002; PMCID: PMC6486053.

Brothers KM, Stella NA, Hunt KM, Romanowski EG, Liu X, Klarlund JK, Shanks RM. Putting on the brakes: Bacterial impediment of wound healing. Sci Rep. 2015 Sep 14;5:14003. doi: 10.1038/srep14003. PMID: 26365869; PMCID: PMC4650533.

Swanson T, Grothier L, Schultz G. Wound Infection Made Easy. Wounds International 2014. Available from: www.woundsinternational.com.

Snyder RJ, Bohn G, Hanft J, Harkless L, Kim P, Lavery L, et al. Wound Biofilm: Current Perspectives and Strategies on Biofilm Disruption and Treatments. Wounds. 2017 Jun;29(6):S1-S17. PMID: 28682297.

Gilchrest BA. Biochemical and molecular changes in photodamaged skin. In: Gilchrest BA, editor. Photodamage. Cambridge: Blackwell Science Ltd; 1995. 168-84.

Karrer S, Bosserhoff AK, Weiderer P, Landthaler M, Szeimies RM. Influence of 5-aminolevulinic acid and red light on collagen metabolism of human dermal fibroblasts. J Invest Dermatol. 2003 Feb;120(2):325-31. doi: 10.1046/j.1523-1747.2003.12037.x. PMID: 12542540.

Szeimies RM, Landthaler M, Karrer S. Non-oncologic indications for ALA-PDT. J Dermatolog Treat. 2002;13 Suppl 1:S13-8. doi: 10.1080/095466302317414654. PMID: 12060512.

Orringer JS, Hammerberg C, Hamilton T, Johnson TM, Kang S, Sachs DL, et al. Molecular effects of photodynamic therapy for photoaging. Arch Dermatol. 2008 Oct;144(10):1296-302. doi: 10.1001/archderm.144.10.1296. PMID: 18936392.

Chu ES, Wong TK, Yow CM. Photodynamic effect in medulloblastoma: downregulation of matrix metalloproteinases and human telomerase reverse transcriptase expressions. Photochem Photobiol Sci. 2008 Jan;7(1):76-83. doi: 10.1039/b703417b. Epub 2007 Nov 2. PMID: 18167600.

Boyko VV, Ivanova YuV, Mushenko EV, Korobov AM. Combined therapy of complicated surgical infections caused by multi-drug resistant microflora in patients with diabetic foot. Photobiology and Photomedicine. 2016;(1-2):51-9. Russian.

Massagué J. The transforming growth factor-beta family. Annu Rev Cell Biol. 1990;6:597-641. doi: 10.1146/annurev.cb.06.110190.003121. PMID: 2177343.

Hase T, Shinta K, Murase T, Tokimitsu I, Hattori M, Takimoto R, et al. Histological increase in inflammatory infiltrate in sun-exposed skin of female subjects: the possible involvement of matrix metalloproteinase-1 produced by inflammatory infiltrate on collagen degradation. Br J Dermatol. 2000 Feb;142(2):267-73. doi: 10.1046/j.1365-2133.2000.03296.x. Erratum in: Br J Dermatol 2000 Aug;143(2):470. PMID: 10730759.

Sternlicht MD, Werb Z. How matrix metalloproteinases regulate cell behavior. Annu Rev Cell Dev Biol. 2001;17:463-516. doi: 10.1146/annurev.cellbio.17.1.463. PMID: 11687497; PMCID: PMC2792593.

Published
2021-11-28
How to Cite
ІvanovaY. V., Gramatyuk, S. M., KryvoruchkoІ. A., Zarudnyi, O. O., & Miasoiedov, K. V. (2021). Photodynamic therapy in treatment of trophic ulcers in patients, suffering chronic venous insufficiency. Klinicheskaia Khirurgiia, 88(7-8), 32-38. https://doi.org/10.26779/2522-1396.2021.7-8.32
Section
General Problems of Surgery