RU2745712C1 - Method of a wound surgical preparation for autodermoplasty - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention relates to medicine, namely to surgery. A vacuum bandage is applied to the wound and connected to a vacuum therapy apparatus. Variable negative pressure on the wound is provided for 5 days. In the meantime, a negative pressure in the mode of -70 mm Hg. is created for 3 minutes. Next, a switch is made to the -110 mm Hg mode for 3 minutes. After that, the cycle is repeated. At the same time, 500 ml of 1.5% solution for Reamberin infusions is administered daily intravenously for 5 days.EFFECT: method makes it possible to improve therapy effectiveness, reduce treatment time, reduce or completely eliminate pain, reduce the risk of infection and reduce the cost of treatment.1 cl, 2 ex

Description

The invention relates to medicine, namely to surgery, and can be used to prepare a wound for autodermoplasty.

There is a known method of local conservative treatment of wounds at the stages of rendering assistance to victims of burns (Alekseev A.A., Bobrovnikov A.E., Krutikov M.G., Tyurnikov Yu.I., Bogdanov S.B. "Conservative technique using modern wound coatings: clinical guidelines ", All-Russian public organization" Association of combustiologists "World without burns", 2014), including multiple dressings with wound dressings that create a moist environment in the wound and promote the growth of granulation tissue and the preparation of the wound for autodermoplasty.

The disadvantages of this method are its lack of effectiveness, the duration of treatment up to 44 days, as well as high economic and labor costs for dressings.

A known method of treating infected burn wounds using vacuum therapy (Bogdanov V.V., Cherdakov A.V., Lagvilava M.G., Krutikov M.G., "Complex treatment of burn wounds using a moist environment and vacuum therapy" International Practical Conference "Vacuum therapy of wounds in children and adults", April 16-17, 2013, Moscow), taken as a prototype, including the use of negative pressure in the wound area, preferably from -50 to -250 mm Hg ... together with wound dressings, films and drains.

The known method is not highly effective. When using the known method, as indicated in the article, at negative pressures below -80 mm Hg. the patients had severe pain, it was also indicated that the described method did not provide a reduction in the timing of wound epithelialization.

The objective of the claimed invention is to improve the efficiency of the method, reduce the duration of treatment and reduce pain.

The problem is solved by the fact that according to the method of surgical preparation of the wound for autodermoplasty, including the application of a vacuum dressing and connection to the vacuum therapy apparatus, a variable negative pressure on the wound is provided for 5 days, while a negative pressure is created in the mode of -70 mm Hg. ... within 3 minutes, then switch to -110 mm Hg mode. for 3 minutes, after which the cycle is repeated, while 500 ml of a 1.5% solution for diffusion of Reamberin is injected daily intravenously daily for 5 days.

The claimed invention is highly effective. Variable evacuation of the wound surface and simultaneous intravenous administration of the antihypoxant "Reamberin" promotes the formation of blood vessels, restoring the epithelium and improving survival. In addition, the claimed method makes it possible to reduce the duration of treatment, as well as to weaken or completely eliminate pain, to reduce the risk of infections and to reduce the cost of treatment.

The claimed method is carried out as follows. To conduct vacuum therapy, a negative alternating pressure apparatus is used, for example, a Hartmann Vivano Tes apparatus containing a device (compressor) for creating a vacuum and a VivanoMed sponge dressing (wound filler).

It is necessary to cleanse the wound from necrosis, scab and solid particles of exudate, using the necessary tools (scissors, tweezers, scalpel, Volkmann spoon and others). Perform thorough hemostasis. Rinse the wound surface with saline. Next, you need to apply a vacuum bandage. To do this, use sterile scissors to cut the VivanoMed sponge to the size and shape of the wound. Place the sponge into the wound cavity and close hermetically with Hydrofilm. Straighten the film well so that the surfaces do not stick together. Pulling the film slightly, cut a hole with a diameter of 2-4 cm in it. At the same time, try not to pierce the sponge. The cut hole must line up with the holes in the base of the connection port. If it matches, glue the base of the connection port to the hole cut with scissors in the Hydrofilm. Connect the drainage tubing of the sterile exudate container to the port.

Next, a negative variable pressure is provided on the wound for a period of 5 days (the Vivano Tes apparatus from Hartmann creates a negative pressure in the -70 mm Hg mode for 3 minutes, then it switches to the -110 mm Hg mode, also to 3 minutes, after which the cycle repeats). Simultaneously with the provision of negative alternating pressure on the wound, 500 ml of Reamberin 1.5% solution for diffusion is injected daily for 5 days intravenously at a rate of 40-60 drops / min. The apparatus, which creates an alternating negative pressure, is removed immediately before the autodermoplasty.

In the combustiology department of BUZ UR "1RKB MZ UR" in the period from 2014 to 2019. the analysis of the results of treatment of 100 patients with chronic wounds and ulcers with an area of 1-5% of various etiology, who were in hospital

The patients were divided into two groups: the main group I (n = 47 people) and the comparison group II (n = 53 people). The main group I (n = 47) was divided into two subgroups: IA (n = 30) and IB (n = 17). In patients of the first subgroup IA (n = 30), NPWT (Vacuum) therapy was used in the preparation of wounds for autodermoplasty for 5 days. In patients in the second subgroup IB (n = 17), NPWT (Vacuum) therapy was used in the preparation complex for 5 days and the introduction of 500 ml of Reamberin 1.5% solution for diffusion intravenously, drip, with speed 40-60 drops / min. In comparison group II (n = 53), preparation was carried out using traditional methods with the use of antibiotic therapy and local use of various types of dressings and ointments. As a result, the survival rate of the skin flap after NPWT therapy when included in the complex of treatment with Reamberin infusions in the second subgroup IB (n = 17) increased 1.3 times compared with the comparison group II (n = 53) (the average survival rate of the skin flap was 90, 29 ± 2.33% versus 71.23 ± 4.17%, respectively, and 1.08 times compared with the first subgroup IA (n = 30) (90.29 ± 2.33% versus 83.17 ± 4, 21%, respectively). A comparison of the postoperative bed-day was carried out in the groups who received various variants of wound preparation before autodermoplasty. The difference in mean indicators was revealed: in the group receiving "Reamberin" and vacuum therapy, the average indicator of postoperative treatment was 8.0 ± 0 , 65 bed-days This is less than the same indicator in the group receiving vacuum therapy without "Reamberin" by 1.5 times (12 ± 1.76) and in the comparison group by 2.25 times (18 ± 1.68).

Example 1.

Patient Ch., 56 years old. Infected burn with boiling water 3AB degree of the left lower limb 5%. Was admitted to the burn department on the 7th day from the onset of the disease with infected burns. The wound surface is cleared of necrosis. On the 6th day after the start of treatment, a vacuum bandage was applied, an apparatus was applied, and a negative alternating pressure on the wound was set for 5 days, at which a negative pressure was created in the mode of -70 mm Hg. within 3 minutes, then the switch was made to the mode -110 mm Hg. for 3 minutes, after which the cycle was repeated. At the same time, the administration of 500 ml of the antihypoxant Reamberin 1.5% solution for diffusion intravenously 1 time a day for 5 days was prescribed. On the 5th day, autodermoplasty was performed after dismantling the negative pressure apparatus. She was discharged 1 day after autodermoplasty in a satisfactory condition with engraftment of skin flaps 80-85% and a tendency to self-healing of residual wounds. In total, she was treated in the burn department for 19 days.

Example 2.

Patient F., 79 years old. Extensive trophic ulcer of the left leg with an area of 4% of the body surface. Transferred from the department of purulent surgery, where she was treated for 44 days with a diagnosis of chronic venous insufficiency, trophic ulcer of the left leg 4%. The ulcer has existed for about 7 months; 2-stage necrectomy was performed. Transferred to the burn department to close the wound defect. On the day of admission, necrectomy was performed in the department. The next day, a negative pressure apparatus was imposed on the wound for five days and a mode was set in which negative pressure was created in the mode of -70 mm Hg. within 3 minutes, then switching to -110 mmHg mode is performed. for 3 minutes, after which the cycle repeats. At the same time, 500 ml of Reamberin was administered once a day for 5 days. On the 5th day, the device was removed, Reamberin was canceled, and autodermoplasty was performed. She was discharged from the burn department on the 24th day of treatment in satisfactory condition with completely healed wounds. A year later, the result is excellent; there is young scar tissue at the site of the wound. The function of the lower limb is in full, there is no lameness.

Claims (1)

A method of surgical preparation of a wound for autodermoplasty, including applying a vacuum bandage and connecting to a vacuum therapy apparatus, characterized in that it provides a variable negative pressure on the wound for 5 days, while creating a negative pressure in the mode of -70 mm Hg. within 3 minutes, then switch to -110 mm Hg mode. for 3 minutes, after which the cycle is repeated, while 500 ml of a 1.5% solution for diffusion of Reamberin is injected daily intravenously daily for 5 days.