RU2027432C1 - Ointment for long-term nonhealing wound treatment - Google Patents

Abstract

FIELD: medicine, surgery. SUBSTANCE: ointment has, wt.-%: streptokinase 250000-750000 IU, carboxymethylcellulose 2-2.5; dimethylsulfide 8, and distilled water - the rest. EFFECT: enhanced pharmacological activity.

Description

 The invention relates to medicine, namely to surgery. It can be used in the treatment of postoperative complications.

 One of the urgent problems of general surgery is the treatment of patients with long-term non-healing wounds - wounds that do not heal within 1 month. [1] . Such patients are treated for months and years on an outpatient basis, periodically in the hospital, but the results of treatment are not always satisfactory [1]. The average duration of conservative treatment of such wounds can reach 125 days. The relevance of treatment of long-term non-healing wounds increases due to their ability to malignant degeneration [2].

 These circumstances dictate the need to develop drugs for the treatment of long-term non-healing wounds. As such agents, the use of ointments is preferable, since they are convenient in use, are stored for a long time (in comparison with solutions), and are convenient in transportation.

 Ointments for the treatment of nonhealing wounds are known [3-5].

According to [3], the ointment for the treatment of nonhealing wounds contains birch tar, xeroform, castor oil (Balsamic liniment according to Wisniewski) in the following ratio, g: Tar birch 3 Xeroform 3 Castor oil 100
However, this ointment is not effective enough. Even with prolonged use in the treatment of these wounds does not provide extraction.

 Known ointment for the treatment of long non-healing wounds "Solcoseryl" [4], which contains a standard deproteinized extract from the blood of calves with high activity of RES. This ointment is ineffective and not available for widespread use. So, ointment "Solcoseryl" even with a long period of treatment (3-4 months) of long non-healing wounds in some cases does not provide recovery. This ointment can also be used only on wounds cleansed of necrotic tissue and purulent discharge, which requires surgical excision of necrotic tissue and complicates its use. For large wounds, autodermoplasty is required. In addition, this ointment is scarce, an imported patented product manufactured by Alkaloid-Skopje (SFRY) in cooperation with Solco Basel AG (Switzerland). This limits the scope of the ointment in surgical practice.

Closest to the proposed is an ointment for the treatment of long-term non-healing wounds "Iruksol" [5], including the microbial enzyme clostridiopeptidase A, chloramphenicol and a lipophilic base with the content of components in 1 g of ointment: Clostridiopeptidase A 0.6 U Chloramphenicol 10 mg Lipophilic base The rest
Ointment "Iruksol" is ineffective: in the treatment of long-term non-healing wounds, even when used for 3-4 months, healing does not occur. In addition, with large wounds, mandatory autodermoplasty is required. Prior to the use of Iruxol ointment, necrotic tissue should be excised. All this complicates the treatment with Iruxol ointment. In addition, this ointment is not available for use in wide surgical practice, since it is a scarce imported patented product, manufactured by PLIVA (Yugoslavia) in cooperation with KNOLL AS (Germany).

 The purpose of the invention is to increase the pharmacological activity of the ointment.

This goal is achieved in that the ointment for the treatment of nonhealing wounds contains the enzyme streptokinase, dimethyl sulfoxide, carboxycellulose and water in the following ratio of components, wt.%: Streptokinase 250-750 thousand IU Carboxymethyl cellulose 2.0-2.5 Dimethyl sulfoxide 8-12 Distilled water rest
The use of the proposed ointment made it possible to sharply accelerate the processes of tissue regeneration and achieve recovery in cases where all other drugs are ineffective.

 The invention is illustrated by the following examples.

PRI me R 1. An ointment for the treatment of long non-healing wounds contains the following components, wt. %: Streptokinase 250 thousand IU Carboxymethyl cellulose 2.0 Dimethyl sulfoxide 8 Distilled water
Ointment is prepared as follows. Take 2g of carboxymethylcellulose are dissolved in 80 ml of distilled water heated to 80-90 ^C. Cool to room temperature and added with stirring 8 ml of dimethylsulfoxide, 250 thousand. IU streptokinase (e.g., drug "celiase") previously dissolved in 2 ml of distilled water. Then the volume was adjusted with distilled water to 100 ml. The ointment is stored in a glass or porcelain dish at a temperature of +4 - +8 ^o C.

Patient Fumanova N.F. Born in 1948, she was admitted to the clinic of the Belarusian Research Institute of Traumatology and Orthopedics 05/12/86 with a diagnosis of "Open comminuted fracture of the II-III metatarsal bones of the right foot with a defect of the III metatarsal bone" (case history No. 163/32). On the rear of the right foot, the wound is 1x0.5 cm, granulating sluggishly, with scanty serous-purulent discharge and scarring. The duration of the disease is 8 months. Previous wound treatment on an outpatient basis and in the hospital (01/14/86 - 04/18/86) did not lead to its healing. During the period from 05/15/86 to 06/30/86, the wound was treated by washing with a mixture of hydrogen peroxide, potassium permanganate and lactic acid, as well as Iruxol ointment. The treatment did not give an effect. 06/30/86 the wound was washed with a solution of hydrogen peroxide, after which the proposed ointment of 0.5 cm ^{3 was} applied daily. No necrotic tissue was excised. Starting from the 2nd day, revitalization and growth of granulations, softening of scarred edges, contraction of the wound, 10 days before the size of 0.4x0.1 cm, were noted. After 25 days (25.07.86), complete healing began. Examination 6 months after discharge showed no relapse.

PRI me R 2. Ointment for the treatment of long non-healing wounds contains the following components, wt. %: Streptokinase 500 thousand IU Carboxymethyl cellulose 2.2 Dimethyl sulfoxide 10 Distilled water
The ointment is prepared analogously to example 1.

Patient Kochergo G.V. Born in 1932, she was operated on at the clinic of the Belarusian Research Institute of Traumatology and Orthopedics on 05/28/86 about the pseudoarthrosis of the upper third of the left tibia (medical history N 955/159). A history of -K diabetes. In the postoperative period - a non-healing wound measuring 2x1.8 cm with flaccid granulations and scanty serous-purulent discharge. Within 4 weeks (from 16.06. To 10.07.86) I carried out the treatment of hydrogen peroxide, potassium permanganate and lactic acid, as well as Iruxol ointment. The treatment did not give an effect. 07.07.86 the wound was washed with a solution of hydrogen peroxide, after which the proposed ointment of 0.5 cm ^{3 was} daily applied to the wound. No necrotic tissue was excised. After 3-4 days, a decrease in necrotic plaque, revitalization and growth of granulations, a decrease in discharge from the wound was noted, after 10 days the size of the wound decreased from 2x1.8 cm to 1.5x0.9 cm, after 20 days - to 1.2x0.5 cm , after 30 (i.e. 10.08.86), healing began. Examination 3 months after discharge showed no relapse.

 Sick Parkhanovich V.I. Born in 1954, he was operated on in the clinic of the Belarusian Research Institute of Traumatology and Orthopedics on 08.28.86 for a traumatic injury to his own ligament of the right patella with a defect (6x6 cm) in the skin of the right knee joint and replacing them with scar tissue (case history No. 2122/356). In the postoperative period - necrosis of a part of an auto-transplant, a non-healing wound measuring 4.5x2.5 cm, granularly limp with necrotic plaque, scarred edges and bottom, scanty serous-purulent discharge.

For 3 weeks, treatment was carried out by washing with solutions of furatsillina, hydrogen peroxide, the use of ointment "Iruksol". The treatment did not give an effect. The significant size of the defect did not give any hope of closing the defect except by repeated autodermoplasty. However, on September 15, 86 the wound was washed with hydrogen peroxide, after which treatment with the help of the proposed ointment was started. Tissue excision was not performed. Daily, an even layer of 0.5 cm ³ ointment was applied to the wound. After 3 days, revitalization and growth of granulations was noted, detachable and necrotic plaque disappeared. After 10 days, the size of the wound decreased from 4.5x2.5 cm to 4x2 cm, by the 20th day - to 3.2x1.2 cm. 30 days after the start of treatment with the proposed ointment (i.e., 10.21.86), the wound was completely closed. Repeated autodermoplasty was not performed. When viewed after 3 months, no relapse was detected.

PRI me R 3. An ointment for the treatment of long-term non-healing wounds contains the following components, wt.%: Streptokinase 750 thousand IU Carboxymethyl cellulose 2.5 Dimethyl sulfoxide 12 Distilled water Else
The ointment is prepared analogously to example 1.

Patient Pakhamovich E.F. Born in 1963, he was operated on at the clinic of the Belarusian Research Institute of Traumatology and Orthopedics for rheumatoid arthritis of the knee joint (medical history No. 429). In the postoperative period - the formation of a keloid scar with a non-healing wound of 1x0.5 cm in size, languidly granulating with necrotic plaque, scarred edges and scanty serous discharge. The wound was washed with a solution of hydrogen peroxide and treatment with the proposed ointment was started, applying 0.5 cm ^{3 of} ointment daily to the wound. After 3 days, revitalization and growth of granulations, the disappearance of necrotic plaque, detachable were observed. After 10 days from the start of treatment, the wound closed. No surgical excision of necrotic tissue was performed. There was no relapse.

 The proposed ointment had a pronounced therapeutic effect even in cases where other therapeutic measures were ineffective. The ointment allows you to heal long-term non-healing wounds in 2-6 weeks, the treatment is simple because it does not require surgical excision of necrotic tissue. In addition, even with large wounds, the use of the proposed ointment eliminates autodermoplasty, which cannot be dispensed with when treating with ointments of known formulations. When using the proposed ointment, the length of stay of patients in specialized hospitals can be reduced compared with the time of stay of patients in the case of using known ointments. The proposed ointment is available, contains components only of domestic production, which eliminates the use of imported patented agents and makes it possible to widely use the ointment for the treatment of long-healing wounds in surgical practice.

 The invention can be widely used in medicine in the treatment of postoperative complications and long-term non-healing wounds of another etiology.

Claims (1)

OINTMENT FOR TREATING LONGLY HEALING RAS, containing an enzyme and a base, characterized in that, in order to increase pharmacological activity, it additionally contains dimethyl sulfoxide, streptokinase as an enzyme, and carboxymethyl cellulose as a base in the following ratio of components, wt. %:
Streptokinase - 250-750 thousand ME Carboxymethyl cellulose - 2.0-2.5
Dimethyl sulfoxide - 8-12
Distilled Water - Else