RU2008005C1 - Method for treatment of wounds - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: Silica powder is laid on wound preliminary 2-4 hours before surgical treatment; then borders of viable tissues are estimated visual. After that necrotic tissues are removed and wound is treated with water suspension of silica. EFFECT: simplification of definition of viability of soft tissues in wound and fulfillment of prophylaxis of wound complications.

Description

 The invention relates to medicine, namely to surgery, in particular to methods of treating wounds.

 A known method for the treatment of purulent wounds, including a preliminary diagnosis of the boundaries of viable tissues by its dehydration, computed tomography followed by surgical treatment.

 The aim of the invention is to simplify the method and prevention of wound complications.

 The goal is achieved in that in a method of treating wounds, including surgical treatment after determining the boundaries of viable soft tissues by preliminary application of a sorbent to the wound, highly dispersed silica is used as the sorbent, which is applied to the wound in the form of powder 2-4 hours before treatment, followed by visual assessment of the boundaries, after which non-viable tissues are removed and the wound is irrigated with an aqueous suspension of silica.

 Methodology

 After being injured in first aid, the wound is treated with dry silica powder, for which it is applied to the wound surface about a half-centimeter layer of powder, depending on the state of the wound.

 After treatment, an aseptic dressing is applied and the patient is transported to the clinic.

 After 2-3 hours, the wound is revised, scraps of clothing, foreign bodies, blood clots, loose pieces of tissue are removed, then silica is washed out of the wound with a stream of antiseptic. Sites of non-viable tissues are easily detected, they are dull, dense, a clear line is visible that delimits viable and non-viable tissues. Tissue excision is performed within the zone limited by this line. After excision of non-viable tissue, the wound is washed with a 3% suspension of silica, further treatment is carried out according to the generally accepted technique.

 PRI me R 1. Patient A., 36 years old. Bruised left hip wound.

At the scene, the wound was treated with silica and covered with an aseptic dressing. General condition is satisfactory. The body temperature of 36.8 ^{° C,} pulse 92 beats per minute, rhythmical, blood pressure 110/80 mm Hg. Art. From the internal organs of the pathology is not detected. In the region of the upper third of the outer surface of the left thigh, a bruised wound measuring 7x1.8 in depth to 3 cm.

 Blood and urine tests without features. X-ray of the left hip - no pathology detected.

 Upon receipt, 0.5 ml of tetanus toxoid and 3000 AE of tetanus tetanus toxoid were introduced.

 2 hours after the initial treatment of the wound with silica, the dressing was removed. A wound toilet was carried out, silica was washed out of the wound cavity with a jet of 1: 5000 furatsilin solution. The skin in the area of the edges of the wound at a distance of about 4 mm became dry, dull, dense. The subcutaneous tissue has dried up in the area up to 6 mm, does not bleed when touched. The compaction and drying of muscle fibers to a depth of 2 mm is also noted. Muscle fibers do not contract when irritated. Within the area of compaction and drying of tissues, excision was made. After excision, bleeding of tissues is noted. The muscles are pink, contracting with irritation. The subcutaneous tissue is yellow, shiny and elastic. The skin is pink, elastic, with moving edges. The wound was washed with a suspension of silica in a solution of furatsilina 1: 5000. Primary sutures were laid.

 There was no discharge from the wound in the postoperative period. The patient received methyluracil and multivitamins. Sutures were removed on the 8th day. The wound healed by primary intention. In the area of the outer surface of the upper third of the left thigh, only a smooth linear scar with dimensions of 7x0.3 cm was preserved.

 PRI me R 2. Patient F., 28 years old. A bruised right hip wound.

 At the scene, the wound was treated with silica powder and covered with an aseptic dressing.

General condition is satisfactory. Body temperature 36.9 ^o C. The pulse of 92 beats per minute, rhythmic. Blood pressure 115/70. From the internal organs of the pathology is not detected.

 3 hours after the initial treatment, the dressing was removed, the wound toilet was made. The skin in the area of the edges of the wound at a distance of 3 mm became dry, dense, dull. Subcutaneous tissue also became dry in the area up to 5 mm, does not bleed when touched. Compaction and mummification of muscles in the zone up to 3 mm are also noted, muscle fibers do not contract with irritation. Tissue excision was performed within the compaction and mummification zone.

 After excision, the tissues bleed, shiny, elastic muscles contract with irritation. The wound was washed with a suspension of silica in an aqueous solution of furatsilina 1: 5000. Primary sutures were laid.

 There was no discharge from the wound in the postoperative period. The patient received methyluracil and multivitamins. Sutures were removed on the 9th day. The wound healed by primary intention. In the area of the posterior surface of the upper third of the right thigh, a smooth linear scar 5x0.2 cm in size was preserved.

 PRI me R 3 (negative). Patient S., 27 years old. Bruised right shoulder wound.

 At the scene, the ambulance paramedic treated the wound with dry silica powder and applied an aseptic dressing.

Upon admission to the clinic, the victim's general condition is satisfactory, body temperature 36.9 ^o C, pulse 92 beats per minute, blood pressure 110/70 mm RT. Art. From the internal organs of the pathology is not detected. Blood and urine tests - without features.

 X-ray of the right shoulder: no pathology detected.

 Clinical diagnosis: bruised wound in the middle third of the right shoulder. In the area of the posterior-outer surface of the middle third of the right shoulder, an oblique wound measuring 6x1.5 cm deep up to 1.5 cm. The wound walls were formed by subcutaneous tissue, the bottom by muscles. In the wound cavity - scraps of clothing, blood clots, silica. In the region in the upper pole of the wound there is a pocket up to 1.5 cm deep, in the region of the lower pole there is a skin site with subcutaneous tissue on the leg. The edges of the wound are crushed, sedimented, cyanotic, infiltrated for up to 3 mm. Subcutaneous tissue is dull, inhibited by blood, edematous, there are bluish areas.

 Upon admission, 3000 AE of tetanus toxoid serum and 0.5 ml of tetanus toxoid were administered. An hour after silica treatment, the dressing was removed and the wound was revised. Scraps of clothes, blood clots and silica were removed from the wound.

 Reliable visual determination of the boundary between viable and non-viable tissues is difficult, tissue excision is made on the basis of subjective criteria (type of tissue, bleeding, contraction of muscle fibers in response to irritation, the presence of visible destruction, tissue impregnation with exudate). The skin edges are dissected at a distance of 3 mm, that is, within the boundaries of visually unchanged tissues. The subcutaneous tissue is also excised within the visually unchanged tissues in an area up to 4 mm. A pocket is disclosed in the region of the upper pole of the wound. The flap on the pedicle in the region of the lower pole of the wound is highlighted.

 Dissected visually non-viable muscles in the area up to 3 mm. The wound was washed with a suspension of silica in a solution of furatsilina 1: 5000. Primary sutures were laid. The patient was prescribed ampicillin 0.5x4 times a day intramuscularly, ascorutin 0.5x3 times a day, methyluracil 0.5x3 times a day.

 However, despite the treatment, on the third day the pain intensified in the wound area, skin hyperemia, swelling appeared. On the fourth day, a mucopurulent discharge appeared from the lower corner of the wound. The sutures were removed, the wound was revised, and necrotic areas in the subcutaneous tissue were removed. The wound is drained with a single-lumen polyvinyl chloride tube with side openings. Further wound management - under a dressing with the use of antiseptics, enzymes. The patient received gentamicin 0.1 x 2 times a day intramuscularly, oxacillin 0.5 x 4 times a day intramuscularly, methyluracil 0.5 x 3 times a day, ascorutin 0.5 x 3 times a day.

 The wound cleansed of pus and detritus on the 10th day, granulation appeared on the 11th day, epithelization began on the 13th day. The patient was discharged from the hospital on the 18th day.

 In the area of the posterior-lateral surface of the middle third of the right shoulder, a 8x2 cm scar formed slightly above the skin surface.

 Therefore, it turned out that the one-hour interval in which the silica was in the wound was insufficient for sufficient visualization of the wound zone, which leads to errors in excision of the tissues and, in essence, to complications in the treatment of wounds, lengthening the healing time, and the cost of drugs needed to deal with complications.

 Cured 22 patients. The results of treatment in comparison with the results of treatment according to the traditional method are presented in the table.

 As can be seen from the table, the treatment of wounds with the use of silica made it possible not only to reduce the length of hospital stay, but also the number and severity of complications during treatment.

 In all cases of treatment using silica, side effects were practically not observed. The percentage of suppuration in the treatment of wounds by a known method reaches 22%.

 The use of silica in the initial treatment of wounds helps to accelerate the time of blood coagulation and stop bleeding. When using silica, the time to achieve a hemostatic effect was 1-3 minutes.

 Silica has a pronounced osmotic activity. When studying it by diffusion through a semipermeable membrane, it was found that the hourly osmotic activity is 100-200%, the three-hour one is 170-280%. (56) Copyright certificate of the USSR N 1666070, cl. A 61 B, 6/00, 1989.

Claims (1)

 METHOD OF TREATMENT OF THE RAS, including surgical treatment after determining the boundaries of viable soft tissues by preliminary application of a sorbent to the wound, characterized in that, in order to simplify the method and prevent wound complications, silica is used as the sorbent, which in the form of powder 2 to 4 hours before treatments are applied to the wound, followed by a visual assessment of the boundaries, after which non-viable tissues are removed and the wound is irrigated with an aqueous suspension of silica.

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