RU2597767C2 - Method of bite wounds treatment - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, in particular to traumatology, and can be used in treating bite wounds. Method involves arrangement of outlining element above wound to form sealed cavity and wound jet washing with water with detergent. Then disinfectant liquid through inflow tube is added to wound and simultaneously flushing fluid is discharged outside through outflow tube. At that, limiting element is placed to form cavity above all wounds, wounds and skin are washed in cavity with silver water with concentration of silver ions in it of 21-25 mg/l. After wounds washing, they are covered with therapeutic external agent and tissue. External therapeutic agent used is emulsion containing: lidocaine hydrochloride 0.25-0.5 %, thrombolysin 25-29 %, metronidazole 0.2-0.24 %, clindamycin 0.25-0.29 %, rifampicin 0.35-0.4 %, olive oil 5.0-9.0 %, sea-buckthorn oil 1.0-1.4 %, starch 4.5-5.0 % and silver water 50.57-63.45 % with concentration of silver ions in it of 30-36 mg/l. Tissue with emulsion is changed on daily basis until disappearance of evident hyperemia and tissues edema around wounds.

EFFECT: invention usage allows to accelerate treatment of bite wounds and prevent infectious complications.

3 cl, 1 ex

Description

The invention relates to medicine, namely to surgery and traumatology, and is intended for the treatment of patients with wounds obtained from bites by mammals.

In recent years, the urban population of Russia has increasingly begun to keep dogs, cats and other small animals in apartments, and along with this, injuries to people from being bitten by mammals are increasing [Starykh BC, Potkina TN, Golovina LN, Agafonov A. N., 2000, 2003; Yashina T.N., Bad A.A., 2002]. Bite wounds that penetrate the body cavity, which are extensive in area and damage large vessels and nerves, tendons and bones, require patients to be referred to the hospital for surgical treatment. When bites are inflicted by small mammals, often there are multiple, but not extensive and not deep wounds, which are not an indication for surgical intervention and treat injured patients on an outpatient basis. However, a bite wound, even in the form of a puncture, scratch or abrasion, is usually contaminated with pathogenic microflora contained in the saliva and on the teeth of the bite [Kollontai Yu.Yu., Panchenko MK, Andruson MV Open brush damage. Kiev, "Health". 1983, p. 88]. It is known that in the oral cavity of even a healthy person, 1 mm ^{3 of} plaque contains 100-200 million colonies of saprophytes and pathogenic microorganisms, gram-positive and gram-negative cocci, spirochetes, vibrios, actinomycetes, protozoa, fungi, etc. [N.F. Danilevsky, E.A. Magid, N.A. Mukhin, V.Yu. Milikevich. Periodontal disease. Atlas. Ed. Prof. ON. Danilevsky. - M .: “Medicine”. 1993. S. 41, 51, 64]. Streptococci, staphylococci, bacteroids and other anaerobes, anaerobic bacteria, gram-negative bacillus [Managing bites from humans and other mammals are often found in bite wounds inflicted by even domestic animals. DTB 2004; 42 (9): 67-70; Treatment of bitten wounds. Published: Wednesday May 25, 2005 at 8:55 am]. Bite wounds sometimes contain dirt in the wound and on the skin and are often contaminated in a wide range by pathogenic microflora, therefore they are classified as bacterially contaminated, and if they show local signs of bacterial inflammation, they are considered infected. Even with minor damage that does not seem dangerous, the developing infectious process can lead to complications: panaritium, abscess, osteomyelitis, meningitis, sepsis and even rabies [Kollontai Yu.Yu., Panchenko MK, Andruson MV, there same. 1983]. The high frequency of infectious complications of bitten wounds has prompted us to develop a new, more effective way to treat patients who seek medical help, mainly with small, multiple bitten wounds that do not require surgical intervention.

A known method of treating small wounds in the form of punctures or abrasions, including cleansing them several times with cotton swabs or gauze balls moistened with hydrogen peroxide. The surrounding skin is treated with gasoline or ether, iodonate or a solution of iodine and a bandage with syntomycin emulsion is applied. In order to prevent purulent process during first aid, especially with puncture wounds, a solution of antibiotics is injected into the wound and surrounding tissue [Wound treatment. Treatment of bitten wounds. http://www.pro-medicine.com/hirurgiya/hirurgiya-1035.html].

The disadvantage of this treatment is, as the authors note, there remains the possibility of developing an infectious complication in the form of a purulent process: abscess, phlegmon, panaritium, etc. The alcohol tincture of iodine used in this method, once in a wound, can be irritating and cause reflex changes in the body [The Internet. The use of iodine in medicine. M. Veldanova, A. Skalny; http://juxtra.info/bites/rabies_animals.php]. One of the antibiotics synthomycin does not suppress the whole variety of pathological microflora in a bitten wound. In this method, there are no signs of increasing the effectiveness of the prevention of infectious complications by means of more accelerated, reliable, harmless to tissues and the whole organism suppression of a variety of pathogenic microflora at the same time in multiple bite wounds. It should be noted that for a long time in medical institutions they were guided by such an attitude of the authorities of domestic surgery: “Any washing of wounds is prohibited” [B.M. Khromov. Surgical care in outpatient facilities. State publishing house of medical literature. - M .: 1963. S. 89].

Known is the treatment of bitten wounds inflicted by mammals on the basis of the “Instructions on the operating procedures of medical institutions and centers of the state sanitary epidemiological surveillance for the prevention of rabies in humans”, approved by Order of the Ministry of Health of the Russian Federation No. 297 of October 7, 1997. It includes abundant washing of the wound, scratches, abrasions, places of salivation with a jet of water with soap (or any detergent), treating the wound edge with 70-degree alcohol or tincture of iodine, and applying a sterile dressing. The instruction prohibits excising the edges of the wound inflicted by the animals during the first three days and suturing it, excluding injuries that require special surgical interventions for health reasons.

The disadvantage of this method can be considered the possibility of 70% alcohol or iodine getting into the wound when processing its edges, which can cause sharp local pain, as well as the absence of signs in it of increasing the effectiveness of preventing infectious complications by means of more accelerated, reliable and harmless suppression for tissues and the whole organism diverse pathogenic microflora simultaneously in several bitten wounds.

Known from the order of the Moscow Health Committee No. 459/139/235 of 08/11/1998 "On the organization of a package of measures for the prevention of rabies" is a method of treating bitten wounds. It includes profuse washing of the wound, scratches, abrasions, places of saliva under a running stream of water with soap or any detergent for 20 minutes, treating the edges of the wound with 70 ° alcohol or 5% tincture of iodine, applying a sterile dressing with an antiseptic, such as an aqueous solution, to the wound chlorhexidine. The order prohibits the excision of damaged tissue and suturing wounds in the first three days after injury, with the exception of wounds to the hands and face, requiring special surgical interventions. Subsequent treatment is carried out with a periodic change of dressings with antiseptics.

The disadvantage of this method is the possibility of developing an allergic reaction of the patient to chlorhexidine. When processing the edges of the wound, the ingress of 70% alcohol or iodine into the wound with the occurrence of pain is not excluded. From the instructions for use of chlorhexidine, it follows that it acts on bacterial spores only at elevated temperatures. It is useless to combine it with soap, since then it will not have any effect [http://www.tiensmed.ru/news/hrolgeksidin-wkti†. You can not combine chlorhexidine with iodine [http://www.tiensmed.ru/news/ hrolgeksidin-wkti]. In this method, there are no signs of increasing the effectiveness of the prevention of infectious complications by means of a more accelerated, reliable harmless to tissues and the whole organism suppression of a variety of pathogenic microflora simultaneously in multiple bitten wounds.

A known method of washing a bitten wound from the patent of the Russian Federation 2493886 on our "Device for the treatment of contaminated wounds" containing a multi-chamber container for different liquids. Each chamber is connected by its own supply pipe to the collector. From it, a fluid supply hose is led to the wound in the cavity of the wound sealing element, and from it the free end of the wash liquid outlet pipe from the wound is placed in the container to collect it. Before using the claimed method, containers are placed above bitten wounds. Close the collector. Remove the lid of the container and pour water into one of its chambers with soap or other washing-up liquid diluted in it. The second tank is filled with healing fluid. The handle of the collector opens the message of the fluid supply tube from the chamber with the cavity formed above the wound. Pumping air with the help of a discharge element under the control of a pressure gauge, regulate the pressure in the container and jet wash the wound with water and soap diluted in it. Further, to treat the wound and skin with the treatment fluid, the collector’s handle switches the direction of fluid flow from another tank. If necessary, changes in the speed of washing the wounds change the lumen of the fluid supply hose and the lumen of the flush pipe.

The disadvantage of this method is the lack of signs in it of increasing the effectiveness of the prevention of infectious complications by more quickly, reliably and harmless to tissues and the whole organism by removing various pathogenic microflora from several bitten wounds simultaneously.

The closest in technical essence and the achieved result is the method of washing a bitten wound from RF patent 2493886, which we take as a prototype, and its disadvantages are described above.

The technical result of the invention is to increase the effectiveness of the prevention of infectious complications by means of more accelerated, reliable and harmless to tissues and the whole organism suppression of a variety of pathogenic microflora simultaneously in several bitten wounds.

The technical result of the invention is achieved in that the method of treating bitten wounds includes placing a delimiting element above the wound with the formation of a sealed cavity above the wound, jet washing the wound with water and detergent, then pouring disinfectant liquid into the wound through the inflow tube and simultaneously removing the washing liquid through the outflow tube characterized in that the delimiting element is placed with the formation of one cavity over all wounds, after washing all the wounds in the cavity simultaneously Doi with detergent, the wound was washed with water and a silver concentration of silver ions therein 21-25 mg / l, then, after removal of the delimiting element wound cloth coated with an outer therapeutic and prophylactic agent.

In a preferred embodiment of the method, as an external therapeutic agent, an emulsion is used containing: lidocaine hydrochloride 0.25-0.5%, thrombolysin 25-29%, metronidazole 0.2-0.24%, clindamycin 0.25-0.29 %, rifampicin 0.35-0.4%, olive oil 5.0-9.0%, sea buckthorn oil 1.0-1.4%, starch 4.5-5.0% and silver water 50.57- 63.45% with a concentration of silver ions in it of 30-36 mg / l.

In another preferred embodiment of the method, an emulsion wipe is replaced daily until severe hyperemia and tissue edema around the wounds disappear.

A specific example of the method in a patient with five bite wounds of the anterior abdominal wall inflicted by a dog. For the treatment of wounds, we used our device for the treatment of contaminated wounds according to the patent of the Russian Federation No. 2493886. Its delimiting element of large size is placed simultaneously over all wounds, forming one cavity 10-20 mm above the skin, isolating the washing area from the environment. One chamber under water with soap diluted in it, which is a detergent, is connected with its own supply pipe to the collector. From it, the fluid supply hose is communicated with a cavity above the wounds. The second chamber of the tank is filled with silver water with a concentration of silver ions of 21-25 mg / L. Install the device’s capacity chambers above the level of bitten wounds. The handle of the collector opens the message of the water supply tube with soap diluted in it with the cavity of the delimiting element above the wounds. Under the control of the pressure gauge, air is pumped into the tank chamber using the discharge element. Under increased pressure, the washing liquid is poured into the formed cavity to the wounds and the wounds and the skin around them are washed. At the same time, washing liquid is withdrawn through the drain pipe into the dishes to collect the flowing liquid. Then, with the handle of the collector, the communication tube with another chamber is opened and the disinfectant and healing silver water with a silver ion concentration of 25 mg / l is sent to the wounds. If it is necessary to determine the washing intensity, the area of skin with wounds under the boundary element is preliminarily determined and silver water is consumed at the rate of 0.5-2 ml per 1 cm of the washed area per minute. The degree of filling of the cavity above the wounds and the rate of outflow of fluid from the wound is controlled by changing the lumen of the fluid supply hose into the cavity above the wounds and the lumen of the wash liquid drain pipe. At the end of the procedure, the delimiting element of the device is removed from the patient’s body. A wipe with a treatment-and-prophylactic emulsion is applied to the wounds and the skin around them, containing: lidocaine hydrochloride 0.5%, thrombolysin 25%, metronidazole 0.24%, clindamycin 0.29% rifampicin 0.4%, olive oil 9%, sea buckthorn oil 1.4%, starch 5.0% and silver water 58.17% with a concentration of silver ions 36 - mg / l. A tissue with a therapeutic emulsion is changed daily until severe hyperemia and tissue edema around the wounds disappear.

The significance of the differences of the developed method for treating bitten wounds is as follows. Placing a delimiting element with the formation of one thin cavity over multiple wounds, accelerates the washing with soapy water at the same time of all wounds and the skin around them. Then washing with medical silver disinfectant water with a silver ion concentration of 21-25 mg / l in it provides reliable suppression of pathogenic microflora in wounds and skin. Subsequent application of wipes with a therapeutic and prophylactic emulsion to the wounds and skin around them increases the effectiveness of the treatment and prevention of infectious complications. It has been established that different types of mammalian animals may have different pathogenic microflora, and it is believed that no antibacterial drug destroys all the various pathogens in a bite wound [Managing bites from humuns and other mammals [DTB .. Vol. 42 No. 9, September 2004]. Therefore, in the treatment and prophylactic emulsion, which according to the claimed method cover bitten wounds, use a combination of various active agents. Hydrochloride, which is a part of a special treatment and prophylactic emulsion, acts as an anesthetic in comparison with novocaine faster, stronger and longer [Mashkovsky MD Medicines Manual for doctors. Volume 1. 14th edition. M LLC "New Wave". Ed. S.B. Duvov. 2002. S. 294], which improves the quality of medical care for the patient. The active substance in the treatment and prophylactic emulsion for bitten wounds is metronidazole, an antibacterial drug with a wide spectrum of action. Metronidazole interacts with the deoxyribonucleic acid of microorganism cells, inhibiting the synthesis of their nucleic acids, which leads to the death of bacteria [http://www.reanimatolog.ru/fs_instr.php?id=254] It has a high penetration into the skin. It has high activity against anaerobic microorganisms, obligate anaerobic bacteria and some gram-positive bacteria [ru.wikipedia.org/wiki/metronidazole]. However, aerobic microorganisms and facultative anaerobes are insensitive to metronidazole [http://amt.allergist.ru/metronidazol_l.html], and therefore clindamycin is added to the emulsion, which, by inhibiting the synthesis of bacterial protein in the microbial wound, has both bacteriostatic and bactericidal effect. It is active against aerobic gram-positive and anaerobic microorganisms. But clindamycin is not effective against the causative agent of rabies [http://ru.wikipedia.org/wiki/clindamycin]. To compensate for this deficiency, rifampicin, a semi-synthetic antibiotic with a broad antibacterial spectrum of activity, which is active against intracellular and extracellular microorganisms, was introduced into the emulsion. Rifampicin has a virucidal effect on rabies virus, inhibits the development of rabies encephalitis [http: // woman winsov ru / medicints / m1470 html]. Moreover, it is highly active against gram-positive and gram-negative microorganisms [http://amt.allergist.ru/309_b.html], spore-forming anaerobes, microaerophilic gram-positive cocci. To accelerate the passage of active substances into the depths of tissues and their faster and deeper effects on pathogenic microflora, the emulsion includes thrombolysin, obtained from the umbilical cord of a newborn. It increases the permeability of tissues and facilitates the movement of fluids in interstitial spaces [Milinevsky I.V., Milinevskaya N.A., Nikitina V.P., Baturina N.P. Parametric administration of the drug thrombolysin in the treatment of exudative otitis media. Bulletin of the Kuzbass Scientific Center. Issue No. 9 "Modern approaches to the prevention, diagnosis, treatment of cerebrovascular diseases." "Actual health issues." Kemerovo. 2009]. Thrombolysin is also offered as a biogenic stimulant (RF patent No. 2154477). The presence of ointment-like olive and sea-buckthorn oils in the emulsion is due to their ability to retain drugs and prolong their therapeutic effect. Oils have antimicrobial, antioxidant and cytoprotective effects, and protect cell and subcellular membranes from damage due to the presence of fat-soluble bioantioxidants, stimulate reparative processes in the skin, accelerate the healing of damaged tissues and have a general strengthening effect [www.webapteka.ru/drugbast/name3939 html. Potato starch was used due to the content of many useful substances in it, it has anti-inflammatory, hemostatic properties and can contribute to wound healing, preventing the formation of skin scars in their place [Posted on 05.24.2014 by annapetrovna]. Potato starch is involved in maintaining the level of human immunity. The use of silver water in the claimed method for washing bitten wounds is based on the destructive effect of silver ions on pathogenic microorganisms even at a low concentration of 0.1 mg per liter of water [http akwa-servis.ru/news/ltjstvie ionjv serebra na vodu na mikrobnju kletku / 2011 -0209-15]. The antimicrobial effect of silver ions is associated with the nitrogenous bases of deoxyribonucleic acid, which violate the stability of DNA and the viability of bacteria, fungi and viruses. The rapid penetration of silver ions into the cytoplasmic membrane of the cell leads to disruption of the membrane functions and the blockade of bacterial enzymes, leading to the death of microorganisms. The concentration of silver ion emulsion in water of 30-36 mg / l, provides suppression of almost any pathogenic microflora of wounds. It is reported that the antibacterial effect of the use of silver water is 1750 times stronger than the action of carbolic acid and 90 times higher than the effectiveness of penicillin. At the same time, silver ions practically do not negatively affect human tissues and organs, and a person can use silver water for many years without any harm to the body [http://silverwater.clan.su/publ/1-1-0- four]. The book “Silver Water” shows the design of apparatus for producing water with silver ions and contains information that “By changing the current strength or the time the water passes through the apparatus, you can get silver solutions of any concentration” [L.A. Kulsky. "Silver water." The ninth edition, revised and supplemented. Kiev. Naukova Dumka. 1987, p. 84] Daily change of wipes with a therapeutic and prophylactic emulsion of a wide range of therapeutic effects until the disappearance of severe hyperemia and swelling of tissues around the wounds, increases the effectiveness of preventing the development of infection.

Thus, the claimed method, in the aggregate of its features, including after washing several bite wounds at the same time and washing them with highly effective bactericidal water with silver ions, which is harmless to tissues and the whole body, followed by the use of therapeutic and prophylactic emulsion, is aimed at eliminating pathogenic microflora in bite wounds. The claimed method speeds up the processing and treatment time of bitten wounds and helps to prevent the occurrence of infectious complications and lead to a social and economic effect.

The use of the invention is possible in veterinary medicine.

Claims (3)

1. A method of treating bitten wounds, including placing a device boundary element with the formation of a sealed cavity above the wound, jet washing the wound with water and detergent, then pouring disinfectant liquid into the wound through the inflow tube and simultaneously removing the washing liquid through the outflow tube by the arc, characterized in that the delimiting element is placed with the formation of one cavity over all wounds, after washing all the wounds in the cavity simultaneously with water and detergent, the wounds are washed with silver water with a concentration of silver ions in it of 21-25 mg / l, then, after removing the delimiting element, the wounds are covered with a napkin with a therapeutic and prophylactic external agent. 2. The method according to p. 1, characterized in that as a therapeutic and prophylactic external agent, an emulsion is used containing: lidocaine hydrochloride - 0.25-0.5%, thrombolysin - 25-29%, metronidazole - 0.2-0 , 24%, clindamycin - 0.25-0.29%, rifampicin - 0.35-0.4%, olive oil - 5.9-9.0%, sea buckthorn oil - 1.0-1.4%, starch - 4.5-5.0% and silver water - 50.57-63.45% with a concentration of silver ions in it of 30-36 mg / l. 3. The method according to PP. 1 and 2, characterized in that the tissue with the emulsion is replaced daily until severe hyperemia and edema of the tissues around the wounds disappear.