RU164776U1 - METHOD FOR TREATMENT OF PROBLEM-BURSITS - Google Patents

Abstract

A method for the treatment of pressure sores-bursitis, including primary surgical treatment of pressure sores, excision of necrotic tissue, partial excision of the infected infected bag, characterized in that they form a bursostomy and lower its mouth as close as possible to the mid-axillary line and anteriorly.

Description

The utility model relates to medicine, namely to surgery, and can be used to treat bedsores of the sciatic area.

As a prototype, a method for the treatment of pressure ulcers-bursitis was selected (Method for the surgical treatment of deep bedsore-bursitis of the sciatic tuberous region in patients with combined spinal injury) / I.A. Lurin, V.N. Gerasimenko, A.E. Paray, K.V. Pendrakovsky // Hipurgy

Ukraine. - 2009. - No. 1. - S. 69-72), which consists in the fact that by plasty of a wound defect with a subcutaneous fat flap, a skin defect is replaced with a primary excision of a pressure sore bag.

The reasons that impede the achievement of the expected technical result (increasing the efficiency of the treatment of pressure sores) are the impossibility of completely excising the synovial bag and completely closing the soft tissue defect with some types of pressure sores.

Signs that coincide with the essential features of the proposed method are: performing the replacement of a skin defect with primary excision of the pressure sore bag by plasty of the wound defect with a subcutaneous fat flap.

The utility model is based on the task of improving the method of treating pressure ulcers-bursitis by additionally forming a bursostomy in the form of a lip-shaped fistula with the reduction of the mouth of the fistula as anteriorly and laterally as possible.

The problem is solved in that in the method of treating pressure ulcers, bursitis, including primary surgical treatment of pressure ulcers, excision of necrotic tissue, partial excision of the infected infected bag, according to the utility model, form a bursostomy and lower its mouth as close as possible to the mid axillary line and anteriorly.

Between the set of essential features of the proposed method and the technical result that can be achieved, the following causal relationship is manifested: the formation of a bursostomy with the reduction of its mouth reduces the area of purulent lesion, and hence intoxication, reduces the cavity of the bag, improves drainage, which leads to speedy preparation patient for radical surgery.

The method is as follows.

Partial resection of the bag is performed under anesthesia or without anesthesia after opening the bag and excising non-viable tissue,

they sew it to the skin in the form of an artificial lip-shaped fistula and lower the mouth of the bag as close to the middle axillary line as possible. Example 1

Patient R., 39 years old, was admitted with complaints of pressure sores in the right buttock, lack of movement and decreased sensitivity in the lower extremities, urinary incontinence, stool with a laxative, 3 times a week. While on duty crushed in a career. The legs were taken away immediately. After 12 hours, spinal surgery - decompression laminectomy. After operations, positive neurological symptoms were not observed. Six years later, a pressure sore appeared in the region of the right buttock, was treated on an outpatient basis at home, in connection with the deterioration of the general condition, he went to the surgeon, after which he was hospitalized in the surgical department. Moves in a wheelchair.

Location: On examination, in the area of the right buttock there is a round ulcer up to 3.0 cm in diameter with a serous-purulent discharge, pockets in different directions are determined up to a depth of 4.0-6.0 cm, spilled hyperemia and edema around, the bottom of the wound is tubercle of the ischium. Diagnosis: deep bedsore-bursitis in the region of the right buttock in the inflammatory-regenerative stage, late recovery period of TBSM after compression fracture d12-l1 in the form of lower flaccid paraparesis, pelvic organ dysfunction.

Operation: Surgical treatment of a pressure sore of the right gluteal region.

Without anesthesia, given the characteristics of post-traumatic innervation.

After processing the surgical field with a solution of C-4, the skin and subcutaneous tissue were dissected three times over the cavity. The cavity of the pressure sore bag extends to the trochanter of the right thigh, envelops them and extends to the front surface of the latter. Bag sores in the gluteal region is partially excised. The remainder of the pressure sore capsule is fixed to the skin with edges to ensure adequate drainage. Pressure ulcer cavity treated

Volkman's spoon. The ischium is not involved in the process. Hemostasis. The wound cavity is washed with antiseptics, tamponized with hydrogen peroxide. Ace. bandage.

Operation: Excision of a pressure sore of the right gluteal region with resection of the sciatic tuber on the left and plastic surgery with a skin-fat flap on the proximal leg.

Without anesthesia, taking into account the post-traumatic innervation, the bedsore of the right gluteal region was excised. Hemostasis is dry. Subtotal resection of the sciatic tuber on the right within viable tissues. The soft tissue defect was plasticized with local tissues, with layer-by-layer suturing of the wound, leaving active tubular drainage and rubber graduates. Aseptic dressing.

The postoperative wound healed by primary intention. The patient was discharged under the supervision of a surgeon and a neurosurgeon at the place of residence.

Example 2

Patient Sh., 41 years old. Received a gunshot wound to the spine at the level of Th ₁₀ -Th ₁₁ with damage to the chest organs. Immediately after the wound, lower spastic paraplegia developed with impaired function of the pelvic organs. On the first day, he was operated on for injuring his chest organs. A month later, spinal surgery: decompressive laminectomy, embryo tissue replanting. After surgery, positive neurological dynamics were not observed. A pressure sore appeared 2 years after the injury. Repeatedly treated in surgical hospitals for bedsores of the right buttock and phlegmon of the right thigh.

Upon admission to the hospital, a moderate state. Severe intoxication. Lower spastic paraplegia with a violation of all types of sensitivity according to the conductor type from the level of the aphid segment of the spinal cord. Pressure ulcer with a diameter of 5.0 cm, the edges are infiltrated, with areas of necrotic tissue. Extensive streaks under the gluteal muscles capture almost the entire gluteal region.

After massive antibiotic therapy, partial excision of the bursa-bedsore was performed with the formation of a bursostomy and the reduction of its mouth to the level of the middle axillary line. After cleansing and physiological contraction of the wound, the second stage of treatment was performed - total excision of the sore bursa in the region of the right buttock with total resection of the tubercle of the sciatic bone and plasty with local tissues. Active aspiration drainage of the wound for 5-6 days. The postoperative period was uneventful. Sutures were removed on the 11th day.

Using this method allows to increase the effectiveness of surgical treatment of patients with bedsores-bursitis with combined spinal trauma and to achieve a positive result in 75% of cases.

Claims (1)

A method for the treatment of pressure sores-bursitis, including primary surgical treatment of pressure sores, excision of necrotic tissue, partial excision of the infected infected bag, characterized in that they form a bursostomy and lower its mouth as close as possible to the mid-axillary line and anteriorly.