Clinical and morphological features of reparative processes in patients with the diabetic foot syndrome

The purpose of the study was to examine structural abnormalities in the skin and granulation tissue, which explain long-term heal­ing and recurrent trophic ulcers in patients with the neuropathic diabetic foot syndrome who received adequate treatment. Biopsy specimens were taken from the granulation tissue and skin of the edge of a trophic ulcer in 12 patients (mean age 48.4+6.6 years) with types 1 and 2 diabetes mellitus (its duration was 14.0+4. 7 years). All the patients were treated for the neuropathic diabetic foot syndrome according to the generally accepted recommenda­tions. According to the duration of trophic ulcer, the patients were divided into 2 groups: 1) 4 patients with a history of under 3 months and 2) 8 patients with a history of above 3 months. Ac­cording to the presence or absence of trophic ulcers in the history, all the patients were again divided into Groups A (recurrent ul­cers, n = 5) and В (primary ulcers, n = 7). Patients with slowly healing ulcers were found to have an abnormal foot pressure more frequently, as evidenced by computerized pedography (the peak load in the ulcer area being in 63% of them versus 25% in Group 1) and some specific features of granulation tissue (excess of active fibroblasts, immaturity of the extracellular matrix, at­rophy and sclerosis of nerve fibers). Patients with recurrent ulcers were older, demonstrated lower vibration perception scores, mor­phological features, such as abundant active polymorphonuclear leukocytes, mast cells with signs of degranulation and T-helper cells, immature extracellular matrix, fibrinoid necrosis and young capillary vessels with microthrombi. Thus, the detection of the above granulation tissue and wound edge changes (especially with an abnormal foot pressure pattern, significantly low vibra­tion perception scale, and old age) makes it possible to suggest slow healing or recurrence of ulcer.