RU2196618C1 - Method for treating patients for onychocryptosis - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves removing inflamed tissues of nail wall and built-in edge of the nail plate by applying longitudinal evaporation by means of focused laser beam. Nail bed is excised under the nail plate by means of focused laser beam propagating in parallel to nail phalanx. Periosteum is acted upon with defocused laser beam. Perforating openings are produced in the nail plate using laser beam. 2-5 sessions of magnetic impulse therapy are administered before and after surgical operation. The therapy involves using antiseptic napkins produced from dialdehyde cellulose wetted with physiological salt solution having immobilized trypsin, Mexidol, or Mexidol and copper. The napkins are applied to the onychocryptosis area. Magnetic impulse field of 0.5-1.0 Tesla units is applied. EFFECT: enhanced effectiveness of treatment.

Description

 The invention relates to medicine, specifically to surgery, and in particular to a method for radical surgery of an ingrown nail.

 A known method for the radical treatment of ingrown nails, consisting in the fact that under local anesthesia a longitudinal dissection of the ingrown nail is performed, retreating 2-3 mm from the ingrown edge. The dissected nail plate is twisted, the incision is deepened through the nail bed to the periosteum. A second arched incision through the lateral roller to the periosteum connecting the top and bottom of the longitudinal section excise a lunate flap. The edges of the wound are brought together by a bandage or sutures passing through the edge of the nail ("Big Medical Encyclopedia", M .: G N And "Soviet Encyclopedia", 1961, v. 21, p. 62).

 The disadvantage of this method is the frequent cleavage of the nail platinum after surgery, as well as infectious complications leading to an increase in the healing time of the wound.

 Known for the radical treatment of ingrown nails with preservation of the nail plate, including the removal of inflamed tissues of the nail roll and the impact on the nail plate, excision of the nail bed under the nail plate, subsequent exposure of the periosteum, the application of perforated holes in the nail plate, suturing the wound with the edge of the soft tissues under the nail plate and the application of an antiseptic dressing (EA Gorokhova et al. "Surgical treatment of ingrown nails. Plastic surgery in traumatology and orthopedics." St. Petersburg, 1995, pp. 93-94).

 The disadvantages of this method include the possibility of delamination of the nail platinum during the puncture of its surgical needle and postoperative complications.

 Known closest to the claimed method of radical treatment of ingrown nail, including the removal of inflamed tissues of the nail roll, the impact on the nail plate, excision of the bed of the nail under the nail plate, the subsequent impact on the periosteum, the application of perforated holes in the nail plate, applying sutures to the wound with the soft edges tissue under the nail plate and the application of an antiseptic dressing, according to which the inflamed tissue of the nail roller and the growing edge of the nail plate remove the longitudinal After evaporation by a focused laser beam, excision of the nail bed under the nail plate is carried out by a focused laser beam, the matrix bed and matrix are evaporated by a focused laser beam parallel to the nail phalanx, the periosteum is exposed to a defocused laser beam, the perforated holes in the nail plate are applied by the laser beam as an antiseptic dressing use dialdehyde cellulose napkins containing copper and the Tykveol plant-derived antioxidant (RU 2155013 C1, 08.27.2000).

 The disadvantages of the method include morbidity during treatment - in the preoperative and postoperative periods, significant swelling and exudation from the nail bed.

 The invention solves the problem of relieving pain, reducing edema and reducing exudation from the nail bed.

 The problem is solved due to the fact that in the method of treating an ingrown nail, including the removal of inflamed tissues of the nail roller and the growing edge of the nail plate by longitudinal evaporation of the focused laser beam, excision of the nail bed under the nail plate by the focused laser beam, evaporation of the matrix bed and matrix by a focused laser beam, running parallel to the nail phalanx, exposure to the periosteum with a defocused laser beam, applying perforations in the nail plate with a laser beam with after by applying an antiseptic dressing, as an antiseptic dressing use dialdehyde cellulose napkins with immobilized trypsin containing mexidol or mexidol and copper, and in the preoperative and postoperative periods, 2-5 sessions of magnetopulse therapy are applied, including the application of an antiseptic dressing moistened with physiological solution moistened with physiological the nail and the impact of a pulsed magnetic field induction of 0.5-1.0 T.

Obtaining napkins with immobilized trypsin containing mexidol is carried out according to the patent of Russian Federation 2149648, MKI A 61 L 15/00, according to which medical gauze is oxidized to dialdehyde cellulose, trypsin is immobilized, washed with distilled water and treated with 0.4-0.6% an aqueous solution of Mexidol to the content of Mexidol 1.8-2.2 mg per 1 cm ² material.

 Napkins made of dialdehyde cellulose with immobilized trypsin containing mexidol and copper are obtained by treating napkins with immobilized trypsin containing mexidol, a 2% aqueous solution of a complex of copper (II) with trioxymethylaminomethane, with a carrier to solution mass ratio of 1: 4 over 24 hours at room temperature.

 The method is as follows.

 An antiseptic napkin of dialdehyde cellulose with immobilized trypsin containing mexidol or mexidol and copper pre-moistened with saline is applied to the nail ingrowth area. Then, the area of nail ingrowth is exposed to a pulsed magnetic field for 5 minutes using the Seta-1 apparatus by induction of a magnetic field of 0.5-1.0 T. Depending on the condition of the patient in the preoperative period, 2-3 sessions of magnetic pulse therapy are carried out.

 The operation is performed under local anesthesia (4-6 ml of a 2% solution of novocaine according to A. I. Lukashevich). Using the laser beam, the growing edge of the nail plate is longitudinally evaporated, as well as the hypergranulation of the lateral nail roller to restore its original size. The nail bed of the growing edge of the nail plate, the matrix bed and the matrix are evaporated by a beam parallel to the nail phalanx, with the beam pointing under the posterior nail roller while preserving the latter. A soft strip evaporates the soft tissues involved in the inflammatory process, which are to the periosteum, without damage to this place of the matrix. The periosteum in the area of the preserved nail plate and on the lateral side of the ingrowth is treated with a defocused laser beam. Apply 2-3 perforated holes with a laser beam in the nail plate at a distance of 2-3 mm from the edge of the resection, suture the wound with silk on an atraumatic needle from the side of the nail plate with the soft tissues under the nail plate. The operation is completed by applying a dialdehyde cellulose wipe with immobilized trypsin containing mexidol or mexidol and copper onto the postoperative wound.

 In the postoperative period, depending on the patient’s condition, 3-5 sessions of pulsed magnetotherapy are performed as described above. Primary healing. Sutures are removed on the 5-7th day.

 The invention is illustrated by examples.

 Example 1

 Patient S., 19 years old, was admitted to the surgical department of the hospital with a diagnosis of ingrown nail of the first toe of the right foot. Complaints of pain in the first toe of the right foot, swelling, purulent discharge from under the nail plate.

 Examination of organs and systems revealed no pathological changes, the local nail nail of the first toe of the right foot is swollen, hyperemic, painful on palpation, there is ingrowth of the nail plate on the inside, a slight serous-purulent discharge from under it.

Diagnosis: ingrown toenail of the first toe of the right foot
In the preoperative period, the patient began physiotherapy sessions using dialdehyde cellulose wipes with immobilized trypsin containing mexidol and copper, and the Seta-1 apparatus.

A napkin of dialdehyde cellulose with immobilized trypsin containing mexidol moistened with saline is applied to the area of the ingrown nail. Then, an impact on the area of the ingrown nail is carried out with a pulsed magnetic field using the Seta-1 apparatus. Inductors are located on the medial and lateral sides of the nail phalanx contact, exposure parameters:
- the repetition rate of a series of pulses per minute is 45,
- the interval between pulses in the series is 10 ms,
- INT magnetic field induction - 0.5 Tl the first two procedures, 1.0 Tl - the third procedure.

 - exposure time - 5 minutes. The total number of procedures in the course of treatment is 3. After the 2nd session, the pain syndrome disappeared, after the 3rd - the edema subsided, there was no serous-purulent discharge.

 The operation is performed under local anesthesia (5 ml of a 2% solution of novocaine according to A.I. Lukashevich). Using the laser beam, the growing edge of the nail plate is longitudinally evaporated, as well as the hypergranulation of the lateral nail roller to restore its original size. The nail bed of the growing edge of the nail plate, the matrix bed and the matrix are evaporated by a beam parallel to the nail phalanx, with the beam pointing under the posterior nail roller while preserving the latter. A soft strip evaporates the soft tissues involved in the inflammatory process, which are to the periosteum, without damage to this place of the matrix. The periosteum in the area of the preserved nail plate and on the lateral side of the ingrowth is treated with a defocused laser beam. Apply 2 perforation holes with a laser beam in the nail plate at a distance of 2 mm from the edge of the resection, suture the wound with silk on an atraumatic needle from the side of the nail plate with the soft tissues under the nail plate. The operation is completed by applying a dialdehyde cellulose napkin with immobilized trypsin containing Mexidol onto the postoperative wound.

 In the postoperative period, 5 sessions of pulsed induction therapy are carried out using a dialdehyde cellulose wipe with immobilized trypsin containing mexidol. The parameters of the first two sessions are similar to those described above, from the third to fifth sessions, the induction of a magnetic field of 1 T. The postoperative period was uneventful, healing by primary intention. No postoperative complications were observed. Sutures were removed after 5 days.

 Example 2

 Patient Zh, age 22, was admitted to the surgical department with a diagnosis of ingrown nail of the first toe of the right foot.

 Complaints upon receipt of pain in the first toe of the right foot, swelling.

 When examining organs and systems, pathological changes were not detected, the local nail nail of the first toe of the right foot is swollen, hyperemic, painful on palpation, there is ingrowth of the nail plate on the outside.

 The physiotherapy sessions were started using dialdehyde cellulose wipes with immobilized trypsin containing Mexidol and the Seta-1 apparatus.

A napkin of dialdehyde cellulose with immobilized trypsin containing mexidol moistened with saline is applied to the area of nail ingrowth. Then carry out the impact on the ingrown nail with a pulsed magnetic field using the Seta-1 apparatus. Inductors are located on the medial and lateral sides of the nail phalanx contact, exposure parameters:
- the repetition rate of a series of pulses per minute is 45,
- the interval between pulses in the series is 10 ms,
- magnetic field induction - 0.5 T. the first two procedures,
- exposure time - 5 minutes. The total number of procedures in the course of treatment is 2.

After the second session, the pain syndrome disappeared, swelling subsided, no discharge
The operation is carried out as in example 1.

 In the postoperative period, 3 sessions of pulsed induction therapy are carried out using a dialdehyde cellulose wipe with immobilized trypsin containing mexidol. The parameters of the first two sessions are similar to those described above, the third session is carried out at a magnetic field intensity "INT" of 1.0 T. The preoperative and postoperative period is painless, the sutures were removed on the 5th day.

Claims (1)

 A method of radical treatment of an ingrown nail, including the removal of inflamed tissues of the nail roller and the growing edge of the nail plate by longitudinal evaporation of the focused laser beam, excising the nail bed under the nail plate with a focused laser beam, excising the matrix bed and matrix with a focused laser beam running parallel to the nail phalanx, defocused laser beam, applying perforated holes in the nail plate with a laser beam, followed by the application of an antiseptic mating, characterized in that as an antiseptic dressing use dialdehyde cellulose napkins with immobilized trypsin containing mexidol or mexidol and copper, and in the preoperative and postoperative periods, 2-5 sessions of magnetic pulse therapy, including the application of an antiseptic dressing, are performed. moistened with saline, on the area of nail ingrowth and exposure to a pulsed magnetic field with an intensity of 0.5-1.0 T.