RU2158112C1 - Method for performing skin plastic operations - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves applying free split dermal flap and covering postoperative donor and operation wounds using antiseptic bandages. Dialdehyde cellulose napkins containing copper and some antioxidant of vegetable origin as antiseptic bandages are applied. EFFECT: enhanced effectiveness in reducing skin insemination with microbes; napkin sterility during the whole observation period. 1 tbl

Description

 The invention relates to medicine, specifically to surgery, to a method of skin grafting for the treatment of non-healing wounds and trophic ulcers.

 Skin plastic surgery is the operation of replacing skin defects using a skin flap taken from a healthy area of the skin. Dermatomic skin plastic with split calibrated, i.e. pre-determined thickness, graft.

 With dermatomic skin grafting, thin skin grafts are placed on a previously prepared wound surface and covered with a pressure bandage. On the second day, a dressing must be carefully changed to avoid displacement of the graft with a dried dressing.

The donor skin used for plastic surgery is covered with a sterile dressing. The dressing is impregnated with a solution of potassium permanganate, and after drying, the dressing is not removed, and again impregnated with the same solution in places where it gets wet. In this state, she is on the wound until it independently "falls off" on the 18-21 day after the operation. (Big Medical Encyclopedia. - M.: Publishing House. Soviet Encyclopedia, 1979, v. 11, p. 50)
A disadvantage of the traditional method of treating wounds after skin surgery is the easy trauma of the wounds and secondary infection.

A known method of skin grafting for the treatment of non-healing wounds and trophic ulcers with a free transversely split dermal flap. Graft epithelization occurs on the 10th day. Wound closure is done with traditional materials. (USSR author's certificate N 1000023, MKI A 61 B 17/322, 1981)
The disadvantages of this method include the easy secondary infection of wounds and the possibility of injury during dressings.

 The invention solves the problem of preventing injury and secondary infection of wounds after surgery of skin plastics, reducing treatment time.

 The problem is solved due to the fact that in the method of skin plastics for the treatment of non-healing wounds and trophic ulcers with a free split dermal flap followed by closing of the operating and donor wounds with antiseptic dressings, dialdehyde cellulose wipes containing copper and an antioxidant of plant origin are used as antiseptic dressings "Pumpkin".

 "Tykveol" is a herbal preparation, is produced from pumpkin, contains a complex of biologically active substances, is approved for use and industrial production of the M3 of the Russian Federation on 12/30/1994, registration number N 94/302/9.

Copper dialdehyde cellulose wipes are dressings obtained by treating a cellulose matrix containing 1 to 5% aldehyde groups with a 1.5 to 2.5% aqueous solution of a complex of copper (II) with tris (oxymethyl) aminomethane in bulk the ratio of cellulose matrix and complex equal to 1: 0.05 - 0.15. (Application N 94028220/14 of 07.26.94, MKI A 61 L 15/44, published. 10.27.96, BI N 30)
The method is as follows
An operation of skin plasty is performed with a free split Tishu flap. Antiseptic dialdehyde cellulose dressings containing copper previously impregnated with Tykveol are placed on the operating and donor wounds. After 4 to 5 days, ligation is performed. Dressings are easily removed, transplanted flaps are not injured, 100% engraftment is noted, donor wounds are epithelized by 50%. No signs of inflammation.

 The invention is distinguished by the fact that the joint use of components known in medicine in medicine is not known and leads to a result that does not follow with obviousness from the known properties of these components, i.e. there is a significant (over-total) increase in the antimicrobial properties of the material used.

To confirm the above effect of the proposed dressing material - dialdehyde cellulose wipes (DAC) containing copper, impregnated with the drug Tykveol, their effect on the change in microbial contamination of the skin surface was studied. The following dressings were investigated: DAC (control), DAC + Cu (Tris) ₂ SO ₄ , DAC + Tykveol, DAC + Cu (Tris) ₂ SO ₄ + Tykveol. Comparative data are given in the table.

 To obtain the presented data, a bacterial suspension was applied with a swab to the surface of the skin disinfected with alcohol and the test napkins were applied. At certain intervals, washings were made from the areas of skin in contact with the wipes that were seeded into the culture medium. At the same time, microbial contamination of tissues was determined. Clinical strains of E. coli, Staphylococcus aureus, and Pseudomonas aeruginosa served as test cultures.

As can be seen from the table, in the control experiment, the microbial contamination of the skin during the 3 hours of observation practically did not change, there was only a slight decrease in the concentration of staphylococci and E. coli due to the bactericidal activity of the skin. Application of napkins based on DAC + Cu (Tris) ₂ SO ₄ or DAC + Tykveol leads to a decrease in the number of staphylococci, the level of skin contamination with gram-negative bacteria corresponds to the control. Infection of DAC, DAC + Cu (Tris) ₂ SO ₄ and DAC + Tykveol wipes with bacteria applied to the skin is observed, except for staphylococci that were not found on the DAC + Cu (Tris) ₂ SO ₄ and DAC + Tykveol wipes.

The application of DAC + Cu (Tris) ₂ SO ₄ + Tykveol wipes on infected skin leads to a significant reduction in the number of all studied species, while the wipes remain sterile throughout the observation period.

 Thus, the above data allow us to conclude that the combination of the proposed known means leads to a new, non-obvious result.

 The invention is illustrated by examples.

 Example 1

 Big N. was admitted to the hospital with a diagnosis of carbuncle of the back of the neck.

 Bala performed the operation of excision of the neck carbuncle. The next day, a revision of the wound, necrectomy.

 Localis status - a wound on the back of the neck, size 8.0 x 6.0 x 0.5 cm, without necrotic tissue with flaccid granulations. A dressing of medical gauze (or dialdehyde cellulose with copper), impregnated with Tykveol, was applied for 2 days.

 After 2 days, the dressing was performed, the wound was clean, granulation, the dressing with the drug "Tykveol" was applied for 5 days. Then a dressing was performed. The wound is clean, the granulation is juicy, lively, marginal epithelization, the dressing with the drug "Tykveol" is applied for 2 days.

 The patient was discharged under outpatient observation by a surgeon of the clinic on the 8th day after autodermoplasty.

 On day 14, the wound is completely epithelized, there are no complaints.

 Example 2

 Patient P. was admitted to the hospital with a diagnosis of carbuncle of the back.

 An operation was performed to excise the carbuncle of the back.

 Localis status - a wound in the interscapular region, size 6.0 x 5.0 x 0.8 cm, the edges of the wound are swollen, in the wound moist necrosis. A dressing of medical gauze (or dialdehyde cellulose with copper), impregnated with Tykveol, was applied for 2 days.

 After 2 days, the dressing was performed, the wound was cleaned, sluggish granulation in the wound, the dressing with Tykveol was applied for 2 days. Then a dressing was performed. The wound is clean, the granulations are juicy, lively, bright red, marginal epithelization, a bandage with chlorhexidine is applied, preparation for autodermoplasty with a free split graft according to Tiersch has been carried out.

 The next day, autodermoplasty was performed according to Tirsch, free split flaps from the hip were transplanted, the size of the flaps was 2.0 x 1.0 cm, a dressing made of dialdehyde cellulose containing copper soaked with Tykveol was applied to the wound. The same dressing is applied to the donor site.

 4 days after the transplantation, the dressing was performed, the dressing is painless, the dressings are easily removed, 100% engraftment of grafts was noted, the appearance of marginal epithelization of skin flaps, the wound in the donor site was epithelized by 50%.

 Antiseptic dressings of dialdehyde cellulose containing copper impregnated with Tykveol are applied to wounds.

 On the 9th day after the operation, the condition of the wound and flaps is stable, epithelization of the flaps, bright live granulations in unepithelial interglottal areas, there are no signs of inflammation.

 The patient was discharged under outpatient observation by a surgeon of the clinic on the 9th day after autodermoplasty.

 On the 12th day the wound is completely epithelized, there are no complaints.

 Example 3

 Patient H.

She entered the surgical department after being treated in the clinic with traditional metadas for 3 months. The state of moderate severity, hyperthermia up to 38 ^o C, the right lower leg is swollen, hyperemic, trophic ulcers are circular in size from 1.0 to 3.0 cm in diameter, with purulent necrotic plaque. Conducted infusion detoxification therapy, antibiotic therapy, therapy with drugs that improve microcirculation.

 Locally conducted therapy with solutions of iodopyrone and water-soluble ointments "Levomikol", "Diksikol".

 On the 5th day, the wound cleansed, the exudation of the wound surface was significantly reduced, granulation appeared, there were single dry necrosis at the edges of ulcerative defects.

 A necrectomy operation was performed, dry necrosis in the wounds was excised. The ulcer surfaces are clean, granulation in the wound.

 On the 9th day, the wound is clean, the granulation is juicy, lively, edge epithelization is observed. A dressing of dialdehyde cellulose soaked with Tykveol was applied for 2 days.

 On the 10th day, the wound is clean, the granulation is juicy, lively, bright red. A bandage with chlorhexidine was applied, preparations were made for autodermoplasty with a free split transplant according to Tirsch.

 On the 11th day, an autodermoplasty operation according to Tirsch was performed, free split flaps from the hip were transplanted, the size of the flaps was 2.0 x 1.0 cm, a dressing of dialdehyde cellulum soaked with Tykveol was applied to the wound. After taking the transplants, the donor site was covered with a dialdehyde cellulose napkin containing copper impregnated with Tykveol.

 5 days after transplantation, dressing was performed, 100% engraftment of grafts, and the appearance of regional epithelization of skin flaps were noted. The bandage on the donor site is easily removed, the wounds at the site of grafting are epithelized by 50%.

 On the 10th day after the operation, the condition of the wound and flaps is stable, flap epithelization is noted, bright live granulations in unepithelial interglottal areas. Donor wound without signs of inflammation.

 The patient was discharged under outpatient observation by a surgeon of the clinic on the 10th day after autodermoplasty.

 On day 18, the wound is completely epithelized. The bandage was removed from the donor site for 12 days, the wound was completely epithelized.

Claims (1)

 A skin plasty method for treating non-healing wounds and trophic ulcers with a free split dermal flap, followed by closing the operating and donor wounds with antiseptic dressings, characterized in that dialdehyde cellulose wipes containing copper obtained by processing a cellulose matrix containing 1 - are used as antiseptic dressings 5% aldehyde groups, a 1.5 - 2.5% aqueous solution of a complex of copper (II) with tris (oxymethyl) aminomethane at a weight ratio of cellulose matrix to complex, Mr 1: 0.03 - 0.15, and impregnated with a drug of plant origin "Tykveol".

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