RU2185781C2 - Method for treating purulent wounds - Google Patents

Abstract

FIELD: medicine, surgery. SUBSTANCE: during the first phase of wound process before and after operation it is necessary to apply a multilayer bandage upon a wound surface. Its first layer is treated with proteolytic enzyme dissolved in 30%-aqueous urea solution, the second layer is treated with a multi-component ointment upon a water-soluble foundation of antibacterial and dehydration properties, the third layer is hydrophobized with a naphthalane ointment. During the second phase of wound process one should perform a free cutaneous plasty or secondary sutures are applied with irrigation drainage of residual cavity by using 30%-aqueous urea solution. The method enables to conduct dehydrative, necrolytic, antimicrobial, trophic, antiadhesive, anesthetic impact upon purulent wounds by taking into account all phase peculiarities of the wound process. EFFECT: higher efficiency of therapy. 1 ex

Description

 The invention relates to medicine, namely to methods for treating purulent wounds.

 In accordance with the modern concept of the essence of the wound healing process, drugs for the local treatment of purulent wounds should have dehydration, antimicrobial, necrolytic, analgesic, trophic and anti-adhesive properties.

 There are many ways to treat purulent wounds, for example, by treating them with trypsin according to A.S. 1121005, IPC: A 61 K 37/48, by applying to the wound a proteolytic enzyme in the form of trypsellin or proteazim according to A. with. 936919, IPC: A 61 K 37/48. However, in these methods, only a necrolytic effect is achieved.

 It is known to wash a wound with a 30% urea solution and a solution of a proteolytic enzyme in 30% urea by as 1163863, IPC: A 61 K 37/48. This method provides a good effect only with active drainage. In addition, with severe injuries, for example, mine explosive injuries, it has insufficient dehydration effect.

 Closest to the proposed technical solution is a method for the treatment of purulent wounds described by B.M. Datsenko et al., In Art. "Local treatment of purulent wounds", Surgery, 1984, 1. S. 136-141.

 This method is carried out by surgical treatment of a wound with excision of purulent-necrotic tissue and subsequent application of a single-layer dressing of several gauze napkins impregnated with a multicomponent ointment on a water-soluble basis of the type "levonorsin" or "levomekol" that affects the main etiopathogenetic mechanisms of the inflammatory process. The ointment, if necessary, in a heated state is injected into the purulent cavity in a liquid form.

 However, a significant part of the hydrophilic ointment applied to the wound evaporates, being absorbed by the surface layers of gauze napkins and bandages with a diphilic structure. In this case, the pharmacological activity of the drug is reduced. And the layers of gauze adjacent to the wound, due to its developed porous fibrous structure and significant specific surface, adsorb and bind the organic components of purulent wound exudate (also having a diphilic structure), after 4-6 hours losing their drainage function, they turn into a cork. In the treatment of wounds with extensive areas of non-viable tissue using water-soluble ointments (levonorsin, levomikol, levosin, mafenide acetate), the necrolytic effect is insufficient. In addition, polyethylene glycol, which is the water-soluble base of the ointments used, in the second phase of the wound process has an undesirable pronounced dehydrating effect on granulation tissue.

 The objective of the invention is the implementation of dehydration, necrolytic, antimicrobial, trophic, anti-adhesive and analgesic effects on the purulent wound, taking into account the nature of the wound and the phase of the wound process available in the production and available drugs.

 This problem is solved by the fact that in the first phase of the wound healing process before and after the operation, a multilayer medical gauze dressing with combined drugs is applied on the wound surface, where the 1st layer is impregnated with a proteolytic enzyme dissolved in a 30% aqueous solution of urea, II the layer - with a multicomponent ointment on a water-soluble basis, the 3rd layer is completely hydrophysed with a naphthalan ointment, and in the second phase, free skin plasty is performed or secondary sutures with drainage of the residual cavity using 30% aqueous urea solution.

 The proposed method is as follows. In the first phase of the wound process, before and after the secondary surgical treatment of the purulent wound, when it is not possible to close it in one stage or there are contraindications, a multicomponent three-layer medical gauze dressing with a combination of drugs is applied to the wound surface. The first layer consists of gauze napkins moistened with a proteolytic enzyme, in particular terrilithin, dissolved in a 30% aqueous solution of urea (in a concentration, according to the instructions, 200 IE of terrilithin per 10 ml of a 30% aqueous solution of urea). The second layer of the dressing from gauze napkins is impregnated with a water-soluble multicomponent ointment heated to a liquid state (levonorsin, levomekol, levosin, mafenide acetate, etc.) and applied to the first layer of the dressing. Outdoor i.e. the third layer of gauze napkins is pre-hydrophobized with naphthallic ointment or some other hydrophobic ointment based on oil, for example Vishnevsky ointment. Treatment is continued until the wound surface is completely cleansed of necrotic tissue, relief of the phenomena of the acute inflammatory process. In the second phase of the wound healing process, skin grafting is performed or secondary sutures are applied to the granulating wound, followed by irrigation drainage of the residual wound cavity with a 30% aqueous urea solution.

 The theoretical justification and clinical testing of the developed method was carried out at the Central Exhibition Center of the Ministry of Defense of the Republic of Azerbaijan and the Nizhny Novgorod Research Institute of the Russian Federation. Clinical and laboratory studies have found that the first layer of the dressing has a pronounced necrolytic property, is a fast-acting and effective tool against gram-positive and gram-negative, including anaerobic microbes. Microflora isolated from pathological foci of patients in 100% of cases was highly sensitive to a 30% aqueous solution of urea. Due to the effect of denaturation of not only the protein structures of microbial cells, but also of purulent exudate, a 30% solution of urea dilutes the pus, increases its dispersion, thereby preventing a violation of the capillary-transport function of gauze and its adhesion to the wound surface. The second layer of the dressing with a water-soluble ointment, along with the antibacterial and analgesic properties, exceeds the 10% solution of sodium chloride by 10-30 times the dehydration effect. Studies have shown that without a third, hydrophobic layer, hydrophilic drug solutions of the first two layers of the dressing, absorbed by the surface layers of hydrophilic gauze and bandages, evaporate within 3-4 hours, which leads to a decrease in pharmacological activity and an increase in the consumption of therapeutic drugs used. In addition, the balsamic liniment according to A.V. Vishnevsky has a positive effect due to the weak irritating effect on tissue receptors, and naphthalan oil and its preparations, when exposed to the skin, have a softening, absorbable, disinfecting and some analgesic effect. In the second phase of the wound process, there is no need to use all the drugs used in the first phase. In this phase, it is sufficient to use only one urea in a 30% concentration, which has a dehydrating, antibacterial, trophic effect and, while diluting the wound exudate with blood clots, allows adequate active drainage of the wound cavity and thereby ensures a smooth flow of the wound process.

 Clinical example. Patient A., born in 1951, and b / w 4765, was treated from 10/03/1992 to 12/25/1992 with a diagnosis of reactive toxic period of mine-explosive injury, condition after amputation of the left thigh at the level of the upper third, bruise and hematoma of the right lower leg and foot, closed fracture of the tuberosity of the right calcaneus and 11-111 metatarsal bones, multiple fragmentation wounds of the left forearm, traumatic shock of 11 tbsp.

 02.10.1992, as a result of a mine-explosive injury, he received a detachment of the left lower limb at the level of the upper third of the leg with destruction of the tissues of the left knee joint and lower third of the left thigh. 3 hours after the injury, with the provision of qualified medical care, primary surgical treatment of wounds and high amputation of the left thigh were performed.

 From 03.10.92 to 12.10.92, there was a general and local treatment of wounds using known methods. Due to the secondary devitalization of tissues and the attachment of a hospital infection, an extensive purulent-necrotic wound formed on the cult. The wounds on the forearm were with purulent discharge and with dull granulations covered with gray fibrin coating. Reamputation of the hip stump was not possible due to its short length. Expectant tactics have been undertaken to try to avoid exarticulation. On 12.10.92, the treatment of purulent wounds was started using the developed method.

 After the toilet of wounds with a 3% solution of hydrogen peroxide, multilayer dressings with combined medicines were applied to the wound surfaces. The first layer consisted of gauze napkins impregnated with a proteolytic enzyme terrilithin dissolved in a 30% aqueous solution of urea (in a concentration, according to the instructions, 200 IU of terrilithin per 10 ml of a 30% aqueous solution of urea). The second layer was gauze napkins impregnated with a heated multicomponent water-soluble ointment “levomekol”. In order to prevent evaporation and absorption of the ointment by the surface layers of the dressing and rounds of bandages, a third layer of gauze dressing was applied, hydrophobized with naphthalan ointment. Toilet wounds and changing dressings in the first two weeks were carried out daily. After stopping the acute phenomena of a purulent-inflammatory process, the dressings changed every other day. From the first days of treatment, the inflammatory process subsided, a decrease in tissue edema and hyperemia of the skin, active cleansing of the wound from necrotic tissue, thinning of purulent discharge, and reduction of pain in the wound area. No adhesion of the dressing to the wound was noted, its drainage property was not broken, the wound was filled with pink juicy granulations. Thus, a pronounced dehydration, antimicrobial, necrolytic, anti-adhesive and trophic effect was noted. Moreover, during dressings, 1.5-2 times less amount of drugs was used compared with the use of known treatment methods. The wounds on the forearm were cleaned and completely healed within 19 days, and the wound on the femoral stump was completely cleansed of purulent-necrotic tissue within 21 days, i.e. already by this time the second phase of the wound healing process had begun. Under intravenous anesthesia on November 3, 1992, the granulating wound of the femoral stump was closed with plastic by local tissues with drainage of the residual wound cavity through contrapertures with perforated tubes. In the postoperative period, closed irrigation drainage was performed using a 30% aqueous solution of urea.

 The course of the wound process without complications (and without the use of antibiotics), 11/14/92, the sutures were removed, wound healing by the type of primary tension. The thigh stump is functionally fit. The patient is directed to prosthetics.

 The developed method has been successfully applied in the treatment of 121 patients with severe purulent wounds (post-traumatic and gunshot osteomyelitis, purulent osteoarthritis, extensive purulent bone-soft tissue wounds due to mine-blasting wounds, panaritiums, abscesses, phlegmons, etc.). When using the method, the first phase of the wound healing process is reduced in time by 1.5-1.7 times, in the second phase, wound healing by the type of primary tension and full graft engraftment are noted. The consumption of medicines and dressings is reduced by 1.5-2 times compared with the use of known methods of treatment. To apply the method does not require the development and creation of new drugs and drugs. The method is universal, simple enough and can be used in the treatment of any purulent-necrotic wounds.

Claims (1)

 A method of treating purulent wounds by surgical treatment and subsequent application of a dressing with drugs, characterized in that in the first phase of the wound process, before and after surgery, a multilayer dressing is applied to the wound surface, the first layer of which is impregnated with a proteolytic enzyme dissolved in a 30% urea aqueous solution, the second layer is a multicomponent ointment on a water-soluble basis, which has antibacterial and dehydration properties, the third layer is hydrophobized with naphthalan ointment, and in the second phase, free skin grafting is performed or secondary sutures are applied with irrigation drainage of the residual cavity using a 30% urea aqueous solution.