RU2153907C2 - Method of treating ulcerous and wound defects with low-frequency ultrasound - Google Patents

Abstract

FIELD: surgery; applicable in sanitation of wound defects. SUBSTANCE: method includes preliminary formation of temporary artificial walls in the form of well from silicyl-zinc paste over perimeter of defect. Walls are hermetically connected with skin and impermeable for liquids; placing into well of medicinal solution which is exposed to effect of sonic waves. Upon completion, paste is uniformly distributed over treated surface. Method provides for full-value ultrasound treatment of defects located on convex surfaces various in size and shapes. EFFECT: higher efficiency of treatment. 5 cl, 1 ex

Description

 The invention relates to medicine, namely to methods of ultrasonic debridement of ulcers and wounds.

 A known method of treating ulcerative and wound defects with low-frequency ultrasound, performed on a domestic ultrasonic device URSK-7N-22 (Bulletin of Surgery named after II Grekov, N 10, Medicine, 1984, S. 110-113). Ultrasonic treatment of the wound cavity was carried out through a solution of antiseptics, for example, a 0.5% solution of chlorhexidine, which was supplied into the wound cavity with a syringe, washing the end of the emitter. The distance between the waveguide from the ultrasound unit and the wound surface was 3-5 mm, and the direction of the tool should be perpendicular to the surface being treated. During the RCD, the entire wound surface is exposed, from the bottom to the skin around the wound. In this case, the emitter's moving speed should be at least 1 cm / s, and the solution flow should be constant.

 The disadvantage of this method is the difficulty in organizing an uninterrupted supply of a drug solution to the zone of the end part of the waveguide when voicing surface ulcers and wounds with a shallow bottom, as well as defects with a convex surface. At the same time, a significant part of the drug solution is poured out of the wound defect, thereby consuming a large number of expensive drugs. Difficulties are created in the treatment of wounds, the resolution of which requires at least two medical personnel. In addition, the duration of the RCD is much longer.

 SUMMARY OF THE INVENTION

 The objective of the invention is to simplify the ultrasonic debridement of superficial ulcers and skin wounds, as well as defects in soft tissues with a convex surface, while saving drugs and increasing the efficiency of ultrasound treatment.

 This object is achieved by the fact that in the method of treating ulcerative and wound defects with low-frequency ultrasound, including supplying the drug solution to the wound area and then treating it with ultrasound, according to the invention, salicylic-zinc paste is applied to the skin around the defect before the solution is supplied to the area of ulcer and wound defects in the form of a continuous tape, forming an enclosed space with the subsequent building-up of walls from the paste, turn by turn, to the required height, the drug is poured into the "well" vennyj solution, after scoring the treated surface is removed waste liquid and salitsilovo- zinc paste spread evenly over the treated surface ultrasound.

 Moreover, before applying salicylic-zinc paste, the skin around the wound is treated with 70% ethanol.

It is advisable to apply the salicylic-zinc paste around the wound with a syringe, into which the paste is poured at a temperature of 60-65 ^o C, followed by cooling to 20-25 ^o C.

 The drug solution should be poured into the formed "well", while the liquid level in it should be 4-6 mm above the highest point of the treated surface.

 At the end of ultrasonic sanitation and the distribution of salicylic-zinc paste on the surface of the defect, a sterile gauze dressing is applied from above.

 The best option for implementing the method.

Before voicing superficial ulcers and wounds, as well as defects in soft tissues with a convex surface, the skin around the ulcer (wound) was treated with 70% ethanol and dried. A salicylic-zinc paste preheated to a fluid state (60 ^{° C.} ) was poured into a sterile syringe. After lowering the temperature of the paste to room temperature (20-25 ^° C) and, consequently, increasing its viscosity to normal, a salicylic-zinc paste in the form of a “tape” was applied under pressure with a syringe under the perimeter of the defect along the perimeter of the defect so that the first The “turn” of the tape was glued to the skin, and the subsequent ones located above the previous ones were fixed among themselves due to the adhesive properties of the paste. This allows you to build up temporary artificial walls along the perimeter of the defect, hermetically connected to the skin and impervious to liquids. The height of the “well” made from the medical paste should be sufficient so that after pouring the medicinal solution into it, the liquid level should be at least 0.5 cm higher than the highest part of the bottom of the defect. In the “well”, the bottom of which is ulcerative or wound defect, the required amount of the drug solution (antiseptic, antibiotic or other drug) was poured and then the ulcer (wound) surface was voiced. At the same time, RCDs were carried out on the domestic apparatus URSK-7N-22. The operating frequency was 26.5 kHz + 7.5%. During operation, the direction of the tool was perpendicular to the surface being machined. After the ultrasonic sanitation was completed, the contaminated liquid was completely removed by an electric suction pump, and the salicylic-zinc paste, from which temporary artificial walls were made, was evenly distributed with a spatula over the surface of the defect. At the end of the procedure, a sterile gauze dressing was applied to the defect area.

 Industrial applicability.

 The proposed method for treating ulcerative and wound defects with low-frequency ultrasound compares favorably with the previously known one in that it quickly, easily, reliably, efficiently and with minimal cost of drugs allows one operator to perform ultrasonic sanitation of superficial ulcers and skin wounds, as well as soft tissue defects with a convex surface . This method of treating ulcerative and wound defects was tested in clinics of the city of Tver and showed good results in the healing of defects.

 Clinical example.

 Patient Sizova Zinaida Dmitrievna, 75 years old, was treated in the surgical department of the 4th mountain. Tver hospital (medical history N 908) from 02/04/99 to 03/02/99 with a diagnosis of Postthrombotic disease of the right lower limb. Extensive trophic ulcer of the right lower leg.

Upon receipt, the right lower leg and foot are swollen, the skin of the lower leg in the lower third is pigmented, subcutaneous tissue is induced. Against this background, in the lower third of the leg with the transition to the middle third on the anteroposterior rounded surface there was an extensive surface trophic ulcer of irregular shape measuring 6.5 x 4.0 x 0.3 cm (defect area - 20.4 cm ² ). Granulation of the bottom of the ulcer is dirty gray.

 During bacteriological examination of granulation tissue of the ulcer bottom, E. coli and Staph.aureus were isolated, and 1 g of tissue contained 7.3 x 10 microorganisms of the 8th degree (methodology of the A.V. Vishnevsky Institute of Surgery).

 02/08/99 performed ultrasonic treatment of the ulcer surface with low-frequency ultrasound according to our developed technique, which lasted 5 minutes and was not accompanied by any painful sensations. As a result, the bottom of the ulcer was cleansed of necrotic tissue, the granulation began to have a pink-red color. The number of microbial bodies in 1 g of the tissue of the bottom of the defect decreased to 5.4 x 10 to the 6th degree.

 Subsequently, two additional sessions of voicing the trophic ulcer were taken at an interval of 3 days (12.02.99 and 02.16.99), while the number of microbial bodies in 1 g of ulcer tissue consistently decreased to 4.6 x 10 in the 4th degree and 3, 1 x 10 to the 3rd degree, that is, it was below the "critical level". The exudation of the wound discharge was significantly reduced, granulations throughout became clear and pink, the area of the defect decreased by more than 1/2 from the original due to marginal and islet epithelization, which is significantly higher than the healing rate of similar trophic ulcers with traditional methods of treatment.

 After complete epithelization of the defect on February 24, 1999, resulting from the subsequent local application of salicylic-zinc paste, the patient was discharged. A year after the treatment, the patient's condition is satisfactory, there is no recurrence of a trophic ulcer of the right lower leg.

Claims (5)

 1. A method for treating ulcerative and wound defects with low-frequency ultrasound, comprising supplying a drug solution to the defect area with subsequent sonication, characterized in that temporary artificial walls are formed around the defect perimeter, tightly connected to the skin and impervious to liquids, in the form of a "well "from salicylic-zinc paste, in which the medicinal solution is placed, and after voicing the solution, the paste is evenly distributed over the treated surface.  2. The method according to claim 1, characterized in that before applying salicyclic-zinc paste, the skin around the defect is treated with 70% ethanol.  3. The method according to claim 1, characterized in that the salicylic-zinc paste is applied around the defect with a syringe. 4. The method according to claim 1, characterized in that the paste is poured into the syringe at a temperature of 60 - 65 ^o C, followed by cooling to 20 - 25 ^o C.  5. The method according to p. 1, characterized in that the liquid level should be 4-6 mm above the highest point of the treated surface.