RU2220741C2 - Method for treatment and prophylaxis of development of hypertrophic and keloid scars - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves carrying out the general therapy, transdermal administration of collagenase with simultaneous administration of lydazum by intradermal route in therapeutic doses. Treatment course is 10-15 every day procedures. Method provides the enhancement of permeability of intercellular matrix for collagenase that results to reducing treatment time. Invention can be used for treatment and prophylaxis of development of hypertrophic and keloid scars. EFFECT: enhanced effectiveness of treatment and prophylaxis.

Description

 The present invention relates to medicine, namely to combustiology and traumatology, and can be used to treat patients with scars after burn and traumatic skin injuries.

 A known method of treating keloid scars by introducing lidase into the affected area [2, 3].

 The prototype is a method of treating post-burn scars by topical application of collagenase [1, 3].

 However, the disadvantages of these methods is the duration and low effectiveness of treatment due to the isolated effects on the elements of scar tissue, frequent relapses and functional inferiority of the tissue.

 The technical result is a reduction in treatment time and improved functional results.

 Collagenase is known to cause selective destruction of connective tissue and dermal collagen; however, viable muscles, granulation tissue and epithelium are not damaged by the enzyme. Collagenase is applied externally immediately after the staged removal of necrotic tissue and preparation of the wound for surgical closure or self-epithelization.

 Hyaluronidase (lidase) promotes partial lysis of the main substance of connective tissue. The main indications for its use are joint contractures, scars after burns and operations, ankylosing spondylitis, hematomas, and others. A lidase solution is administered near the site of the lesion under the skin or under scarred tissues. The therapeutic effect is manifested by softening of scars, the appearance of mobility in the joints, and a decrease in contractures.

 In the sources of scientific, technical and patent information, the authors did not find a method of treatment by the combined use of these drugs. Thus, the claimed method meets the criterion of "Novelty."

 The authors found that with the combined use of these agents, a potentiation effect is observed: the permeability of the intercellular matrix increased under the influence of hyaluronidase (lidase) facilitates the access of collagenase to the fibers, and the partial destruction of the latter loosens the tissue, increases its elasticity and promotes early normalization of blood circulation and functional properties of the skin.

 Thus, the claimed method meets the criterion of "Inventive step".

 The proposed method of treatment is as follows: at the same time, the patient is administered lidase into the thickness of the scar or scar tissue in a therapeutic dose, depending on the size, depth and prescription of the lesion and collagenase by electrophoretic (phono) phoresis on the scar area in an average therapeutic dose. The course of treatment is 10-15 daily procedures.

 In 2000-2001 In the Republican Burn Center of the Republic of Belarus, conservative treatment of patients with hypertrophic and keloid post-burn scars of various localization and area was carried out. The first group consisted of 12 patients who underwent complex treatment with the simultaneous administration of lidase (64-256 units) into a scar or scar tissue and collagenase electrophoresis (250 units, 15 min) daily. The course of treatment included 10-15 procedures, the drugs were released GUP "Immunopreparat", Ufa. The second group of patients consisted of 15 patients who were treated only with lidase in the specified dose.

 The results of the treatment with the combined use of collagenase and lidase indicate a more pronounced therapeutic effect: scar involution is much faster (50-70%), itching in the scars and their hyperemia are significantly reduced, the epithelization of superficial trophic wounds in the scar area is accelerated (within 5 -7 days instead of 20-30 days), the range of motion in the joints increases, a faster normalization of the general condition is observed. Specified is illustrated by the following clinical examples.

 1. Patient I., 30 years old, was treated at the Republican Burn Center of the Republic of Belarus in 2001. In 2000, he received a burn with a flame covering up to 40% of the body surface, of which 35% - a deep burn. 6 months after the initial treatment, which ended with complete epithelization of the wounds, he was re-hospitalized with a diagnosis of Post-burn hypertrophic scars of the face, neck, trunk, upper and lower extremities. Adjuvant cicatricial contracture of the neck of the II degree. Adductive and flexion contracture of the joints of the upper extremities II - III degree "Burn disease, stage of convalescence. Deep vein thrombophlebitis of the lower extremities." Upon admission, he complained of itching in the scars, restriction of movement of the neck, upper limbs, fatigue, poor sleep, swelling of the legs. Objectively: the general condition is relatively satisfactory, on the face, neck, front and back surfaces of the trunk, circularly on the upper extremities - dense burns of red color with a cyanotic hue, fused with underlying tissues, the thickness of the scar tissue is from 0.2 to 2.0 cm On the surface of scars - injected small vessels, traces of scratching; localized hyperthermia is noted. Cicatricial cords in the projection of the joints of the upper limbs and the front surface of the neck sharply limit the range of movements. Conducted a comprehensive treatment: pyrogenal 50 MTD daily intramuscularly N 20, vitamin therapy, troxevasin 1 capsule 2 times a day, anavenol 20 drops. 3 times a day, electrosleep N 10, the introduction of 128 units of lidase in the areas of maximum itching and severe cicatricial stitches in the thickness of the scar or scar tissue in combination with phonophoresis of collagenase at a dose of 250 units for 15 minutes After the treatment, improvement is noted, a significant decrease in itching, an increase in the range of motion in the joints, epithelization of the surface of trophic wounds, blanching and softening of scars. Discharged after 20 days in satisfactory condition.

 2. Patient M., 41, was undergoing treatment in the Republican Burn Center for post-burn hypertrophic scars of the calcaneal region of both feet. Injured by contact with a hot object; primary treatment was excision of necrotic tissue and autodermoplasty. She was re-hospitalized six months after discharge with complaints of gross itchy scars on the back surface of both feet in the heel area, limiting foot mobility. Objectively: in the calcaneal regions of both feet at the border with the dorsal plantar surface - coarse dense scars with severe hyperkeratosis, cracks and flaky epidermis, local edema, hyperemia and local hyperthermia. Complex treatment was carried out: daily administration of lidase under the scar tissue of each foot in 64 units, collagenase electrophoresis in a dose of 250 units for 15 minutes per scar area (10 procedures each). After treatment, the edema of the feet decreased, the severity of hyperkeratosis decreased significantly, the scars turned pale and softened. The patient notes a significant improvement in condition and the possibility of a long walk without rest.

 The proposed method of treatment is easily reproducible, gives a pronounced clinical effect, can be used in any medical institution, and, thus, meets the criterion of "Industrial applicability".

Sources of information
1. Markovich N.A., Omigov V.V., Balakhnin S.M. et al. Morphological assessment of the impact of collagenase of king crab Paralithodes camtschatica on thermal burn in an experiment // Bull. an experiment. biol. honey. - 1996. - 7. - S. 97-102.

 2. Pakhomov S.P. Surgery for burns in children. - N. Novgorod: NNIIITO, 1997 .-- S. 168-169.

 3. Yudenich V.V., Grishkevich V.M. Guidelines for the rehabilitation of burned. - M .: Medicine, 1986. - S. 22.

Claims (1)

A method for the treatment and prevention of the development of hypertrophic and keloid scars by transdermal administration of collagenase against the background of conventional therapy, characterized in that lidase is additionally administered intradermally at therapeutic doses, and the course of treatment is 10-15 daily procedures.