RU2195930C2 - Method for treating prolonged trophic ulcers - Google Patents

Abstract

FIELD: medicine, surgery. SUBSTANCE: a napkin is used with immobilized trypsin and decametoxin. A napkin is impregnated with the solution of "photosens" photosensitizer at concentration of 125-5000 mcg/ml to be kept on an ulcer for 24 h. Ulcer is treated with NO- containing air-plasmatic flows at impact duration of 10-15 sec for 1cm². Irradiation of wound is carried out with light at 670 nm wave length followed by daily impact of NO-containing air- plasmatic flows upon a wound at the same impact duration values. The method enables to accelerate ulcerous purification against necrotic tissues, pathogenic microflora and stimulate tissue regeneration. EFFECT: higher efficiency of therapy. 2 ex, 1 tbl

Description

 The invention relates to medicine, specifically to surgical methods for the treatment of long-existing trophic ulcers of the lower leg of venous etiology.

 A surgical method is known for the treatment of purulent diseases of soft tissues, including trophic ulcers, consisting in opening the purulent foci and wound toilet, then applying a bandage with antiseptic solutions or ointments, followed by daily dressings. At the same time, ulcers are carried out using antiseptic solutions (Big Medical Encyclopedia, M .: Soviet Encyclopedia, 1985, v. 1, p. 20-21).

 Treatment using traditional dressings is long, lingering, dressings are painful due to the drying of the dressing to the wound and is not applicable in the treatment of long-existing trophic ulcers.

 The problem of healing trophic ulcers, characterized by varying degrees of severity of deviations from the stereotypical dynamics of the inflammatory-reparative process, remains one of the most important in surgery. Despite the large number of methods for the prevention and treatment of trophic ulcers of venous etiology, they suffer from at least 2% of the adult population, and the treatment of trophic ulcers remains one of the most difficult and far from unresolved problems of our time. Trophic ulcers of venous etiology can be divided into trophic ulcers, existing up to 3-5 months, and long-existing trophic ulcers - existing over 6 months. Long-existing trophic ulcers differ in the depth and nature of tissue damage, they are characterized by the presence of secondary necrosis and inflammation (G.N. Berchenko. Morphological aspects of healing of complicated wounds, abstract for the degree of doctor of medical sciences, M., 1997, pp. . 22-23).

 The closest to the claimed method of treating purulent lesions of soft tissues and trophic ulcers is known, which consists in placing a napkin with immobilized trypsin - Dalcex-trypsin through which a semiconductor low-energy laser is irradiated daily (Khusvinov R.Z. Complex treatment of trophic ulcers of the lower limbs using immobilized trypsin on gauze and low-energy helium-neon and gallium arsenide laser radiation. Author. Cand. diss., M., 1989, 19s.).

 Epithelization during treatment in a known manner was observed on days 9-12.

 However, this method is ineffective in the treatment of long-existing trophic ulcers, since the phenomena of secondary necrosis are removed with great difficulty and the treatment is delayed.

 The invention solves the problem of accelerating and increasing the effectiveness of the treatment of secondary necrosis of long-existing trophic ulcers.

The problem is solved due to the fact that in the method of treating long-existing trophic ulcers, consisting in the fact that a napkin based on dialdehyde cellulose with immobilized trypsin followed by irradiation is applied to the ulcer, a napkin with immobilized trypsin, additionally containing decamethoxin, soaked in an aqueous solution of photosensitizer Photosens "with a concentration of 125-500 μg / ml, incubated napkin on the ulcer for 24 hours and treat the ulcer with NO-containing air-plasma flows for a long time exposure for 1 cm ² 10-15 s, and irradiation of the wound is carried out with light with a wavelength of 670 nm, followed by daily exposure to the wound with NO-containing air-plasma flows with the same duration of exposure. The number of sessions is determined individually according to indications and usually does not exceed 10.

 A dressing based on dialdehyde cellulose containing immobilized trypsin and decamethoxin is obtained by oxidizing medical gauze to dialdehyde cellulose, followed by immobilization of trypsin, washing with distilled water, drying and treating with a 0.9-1.2% aqueous solution of decamethoxin with a module of 4-6 followed by pressing the material up to 100-120% (Pat. RF 2143923, class A 61 L 15/00, publ. 2000).

 "Photosens" is a sulfonated aluminum phthalocyanine and is a domestic photosensitizer developed at the State Scientific Center "NIOPIK". Permission for clinical trials was given by the Pharmacological Committee of the Russian Federation in 1994 ("Photodynamic therapy of malignant neoplasms." Second All-Russian Symposium with international participation, M., 1997, p.21).

 The method is as follows.

After the patient is admitted to the hospital, the ulcer toilet is carried out by treating it with a solution of hydrogen peroxide and chlorhexidine, then a napkin of dialdehyde cellulose containing immobilized trypsin and decamethoxin (DAC-trypsin-decamethoxin) impregnated with an aqueous solution of photosensitizer 125 Fotosens00 with a concentration of 125 μg / ml, incubated for 24 hours and initially exposed to the ulcer with NO-containing air-plasma flows using the PLAZON air-plasma apparatus with an air duration of action per 1 cm ² 10-15 s, the total time, respectively, the area of the wound, then the ulcer is irradiated with red light with a wavelength of 670 nm, emitted by a non-laser light source of a wide emission band of 600-700 nm. Next, daily exposure of the ulcer to NO-containing air-plasma flows is carried out using the PLAZON air-plasma apparatus with an exposure time of 1 cm ^{2 of the} ulcer surface of 10-15 s and the total exposure time, respectively, of the wound area.

 The number of sessions is determined depending on the severity of the inflammatory process and wound exudation and usually does not exceed 10.

 When treating the proposed method for long-existing trophic ulcers, it is possible to solve the problem of secondary necrosis that impedes the healing of these ulcers. The terms of treatment compared with the prototype method are reduced by 1.5-2 times compared with the traditional method of treatment by 2-3 times.

 Comparative data on the treatment of long-existing trophic ulcers by the proposed and known methods are presented in the table.

 The proposed method reduces the treatment time of long-existing trophic ulcers by accelerating the cleaning of ulcerative defects from pathogenic microflora and necrotic tissues, improves microcirculation (arrests intravascular, vascular and extravascular microcirculation disorders), stimulates reparative processes, and prevents the formation of inferior granulation and fibrous tissue and secondary necrotic tissue.

 The invention is illustrated by examples.

 Example 1

 Patient T., 75 years old, was admitted to the surgical department of the hospital with a diagnosis of Trophic ulcers of the left and right legs. Postthrombophlebitis syndrome. Chronic venous insufficiency. The duration of trophic ulcers is 1.5 years.

Both legs are edematous, hyperemic, the pulsation on the vessels is weakened, on the front surface of the right lower leg a trophic ulcer 100 cm ² , on the left lower leg 150 cm ² , at the bottom of the ulcer necrosis and purulent discharge.

 A day later, a necrectomy operation was performed - necrosis was excised, a bandage with iodopyrone was applied. Next, dressings are carried out every other day with water-soluble ointments. A weak therapeutic effect is observed, the ulcer surface is covered with purulent discharge, patches of sluggish, pale granulations.

 Due to the ineffectiveness of traditional therapy, an application of DAC-trypsin-decamethoxin wipes, impregnated with an aqueous solution of the Photosens drug with a concentration of 500 μg / ml for 24 hours, was performed on the ulcer.

After maintaining the wipes, the ulcers were exposed to NO-containing air-plasma flows using the Plazon air-plasma apparatus. The exposure time per 1 cm ² 10 s, the total exposure time, respectively, of the ulcer area of 1000 s and 1500 s. Then, ulcers are irradiated with red light with a wavelength of 670 nm, emitted by a non-laser source of red color of a wide emission band. The exposure time of 20 minutes per 1 cm ² surface at a distance from the working end of the fiber to the wound surface 3-5 mm

Next, daily exposure of ulcers to NO-containing air-plasma flows is carried out using the Plazon air-plasma apparatus with an exposure duration of 1 cm ² 10 s and a total exposure time of the ulcer area of 1000 s and 1500 s, respectively. After therapy with NO-containing air-plasma flows, ligation is performed using dac-trypsin-decamethoxin wipes.

 On the second day after the first session of NO-therapy, the surface of ulcerative defects was cleaned, separated slightly, areas of live, bright red granulations appeared, and edge epithelization was observed. On the 4th day - the ulcer surfaces are clean, the granulation is juicy, alive, there is edge epithelization.

 A total of 5 sessions of NO-therapy.

 Preparation for autodermoplasty with a free split graft according to Tirsch was carried out.

 The next day, an operation was performed - autodermoplasty according to Tirsch, free split flaps from the hip were transplanted, the size of the flaps was 2.0 by 1.0 cm, on the wound surface of ulcerative defects of both legs.

 5 days after transplantation, ligation was performed, 100% engraftment of the transplants, and the appearance of marginal epithelization of skin flaps were noted.

 On the 7th day after the surgery, the condition of the wounds and grafts is stable, epithelization of the grafts, bright, vivid granulations in the unepithelized interglottes are observed. A bandage on the donor site without signs of inflammation.

 The patient was discharged under outpatient observation by a surgeon of the clinic on the 7th day after autodermoplasty. On the 19th day, the ulcers are completely epithelized.

 Example 2

 Patient S., 73 years old, was admitted to the surgical department of the hospital with a diagnosis of Trophic ulcer of the left leg. Chronic venous insufficiency. Prescription trophic ulcer 1 year.

The lower leg is edematous, hyperemic, on the front surface of the left lower leg a trophic ulcer of 80 cm ² , at the bottom of the ulcer of necrosis and purulent discharge.

 A necrectomy operation was performed - necrosis was excised, a bandage with chlorhexidine was applied. Next, dressings are carried out every other day with water-soluble ointments and antiseptics. A weak therapeutic effect is observed, the ulcer surface is covered with purulent discharge, patches of sluggish, pale granulations.

 Due to the ineffectiveness of traditional therapy, an application of DAC-trypsin-decamethoxin wipes, impregnated with an aqueous solution of the Photosens drug with a concentration of 125 μg / ml for 24 hours, was performed on the ulcer.

After maintaining the wipes, the ulcer was exposed to NO-containing air-plasma flows using the Plazon air-plasma apparatus. The exposure time per 1 cm ² 10 s, the total exposure time, respectively, of the ulcer area 800 s. Then the ulcer is irradiated with red light with a wavelength of 670 nm emitted by a non-laser source of red color of a wide emission band in the conditions of example 1.

Next, daily exposure of the ulcer to NO-containing air-plasma flows is carried out using the Plazon air-plasma apparatus with an exposure duration of 1 cm ² 10 s and a total exposure time, respectively, of the ulcer area of 800 s, for a total of 5 sessions. After therapy with NO-containing air-plasma flows, ligation is performed using dac-trypsin-decamethoxin wipes.

 On the second day after the first session of NO-therapy, the surface of ulcerative defects was cleaned, separated slightly, areas of live, bright red granulations appeared, and edge epithelization was observed. On the 4th day - the ulcer surfaces are clean, the granulation is juicy, alive, there is edge epithelization. Preparation for autodermoplasty with a free split graft according to Tirsch was carried out.

 The next day, an operation was performed - autodermoplasty according to Tirsch, free split flaps from the hip were transplanted, the size of the flaps was 2.0 by 1.0 cm, on the wound surface of the leg ulcer.

 5 days after the transplantation, ligation was performed, 100% engraftment of the grafts, and the appearance of marginal epithelization of skin flaps were noted.

 On the 10th day after the operation on the dressing, the condition of the wounds and flaps is stable, epithelization of the flaps is observed, bright, vivid granulations in the unepithelized interglottes. A bandage on the donor site without signs of inflammation.

 The patient was discharged under outpatient observation by a surgeon of the clinic on the 10th day after autodermoplasty. On the 20th day, the ulcer is completely epithelized.

Claims (1)

A method of treating long-existing trophic ulcers, consisting in the fact that a ulcer based on dialdehyde cellulose with immobilized trypsin followed by irradiation is applied to the ulcer, characterized in that a napkin with immobilized trypsin is used, additionally containing decamethoxin impregnated with an aqueous solution of photosensitizer “Photosens” concentration 125 -500 ug / ml, incubated on tissue ulcer for 24 hours and treated with NO-containing air plasma flows under exposure of 1 cm ² ulcer 10-15 And wound irradiation is carried out with light of wavelength 670 nm, followed by daily exposure to the wound NO-containing air plasma flows with the same exposure duration.

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