RU2230554C2 - Method for treating normo-atrophic scars with mechanic dermabrasion by applying combined collagen covering with antimicrobial preparation - Google Patents

Abstract

FIELD: medicine, laboratory diagnostics.

SUBSTANCE: one should carry out the complex of preoperational measures and dermabrasion, moreover, under out-patient sterile conditions of small operation room one should open operational area, skin surface should be twice treated with butol per 10 ml with the help of a gauze napkin, by capturing more than 2-3 cm operational area , as for anesthesia it should be performed locally with lidocaine, then with the help of rotation apparatus one carries dermabrasion and treat skin surface by applying a gauze napkin preimpregnated with butol, operational wound should be treated with butol twice 10-15 ml out of plastic needle-free syringe, and 3-5 min later after no signs of burning one should remove gauze napkin, after dermabrasion one should apply collagen covering that exceeds operational area for 1-2 cm and operational wound should be twice constantly treated with butol per 10-15 ml out of plastic needle-free syringe and operational surface should be irradiated with infrared radiation of low power 5-8 times/d, and in postoperational period - for 7-10 d butol-syringing of napkins should be conducted for several times daily till complete healing of epidermis and spontaneous removal of scab.

EFFECT: higher efficiency of therapy.

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Description

The invention relates to medicine, namely to cosmetology.

Normo-atrophic scars are a cosmetic defect of the skin (not violating the functions of organs and skin tissues). Cicatricial formations older than six months form formed structures that are no longer subject to therapeutic treatment methods due to poor performance. In the treatment of normo-atrophic scars, combined surgical and therapeutic methods are considered the most effective. Chemical peels allow you to smooth the upper layers of the epidermis, but do not affect the scar structure, so their use is impractical. Traditionally, mechanical dermabrasion is used to treat normo-atrophic scars. Healing has a protracted nature. Lack of alignment is associated with a lack of local collagen. This circumstance in 47% of cases leads to the need to repeat the operation and in 15% to the subsequent dermabrasion. This led to the rapid development of the Green method, which accelerates the healing of vast skin surfaces through the use of in vitro grown keratinocytes. A pioneering method of scar correction is a combination of Green and dermabrasion methods (Ozerskaya O. Application for invention. Priority reference number 99111224 of 05.24.1999). This method is adopted as a prototype.

During surgery, a culture of autogenous keratinocytes, previously grown on porous films, is planted on a polished surface. This culture is obtained by isolating keratinocytes using polycollagenase from hydrobionts of the patient’s skin. Then the culture is grown to a certain thickness of the keratinocyte layer on the POLIPOR film in F12 medium with added 10% calf serum, cholera toxin and isoprotefenol at the appropriate humidity and temperature. After the scar is aligned with the surrounding tissue and hemostasis, the operative surface is washed with saline and dried. The presence of a positive charge on the film allows reliable contact on the operated skin and does not use additional fixatives. Under the film, the processes of aseptic inflammation, metabolism and repair of skin structures begin. The processes of repair and the creation of new structures in the skin occur throughout the year, which does not differ from the usual course of events with dermabrasion. After 5-12 days (individually), spontaneous rejection of the film occurs. It should be noted that the porosity of the film does not interfere with gas exchange. The effect of smoothing the microrelief of the skin is significantly higher than with traditional dermabrasion, and this fact becomes noticeable after a month. Erythema lasts for 3 months, and very significantly (as with ordinary dermabrasion) during the first month.

Therefore, the disadvantage of the prototype is that this method retains a high level of risk of infectious complications in the postoperative period for a very long time. Traditionally used antiseptic agents (5% potassium permanganate solutions, tetracycline ointments) do not provide 100% antimicrobial protection. The following example, also taken as a prototype, was taken according to Udotov O., Kovalkova E. Erbium laser as a tool for cosmetic surgery // Cosmetics and Medicine, 2000. - No. 2. - S. 55-62. After laser dermabrasion with an erbium laser, the Panthenol spray and a collagen film with methyluracil ointment or with an ointment containing gentamicin or erythromycin are applied. But already on the next day after the operation and on the following days, this bandage is changed to a new one every day, since there is a significant outflow of lymph with an admixture of sucrose and there is a threat of infection of the operating area. Typically, Macropen antibiotics are prescribed by mouth and Bactroban topically. However, with such massive attacks on infection, the process of scarring of cords (hypertrophic scars) in the resection area is observed in 13% of patients, and the formation of atrophic scars in 8% of patients. Similar results are noted with dermabrasion of wrinkles with a CO ₂ laser (B. Yeremeyev, K. Kalajdzhyan. Anti-wrinkle lasers // Cosmetics and Medicine, 2000. - No. 2. - P. 5-17). Therefore, the problem of combating wound infection continues to remain relevant and is objectively determined by the following circumstances. On the one hand, wound infection has a pronounced polymicrobial nature, i.e. can be caused by many aerobic and anaerobic bacteria with different sensitivity to chemotherapeutic agents. On the other hand, any chemotherapeutic agent inevitably has a relatively narrow spectrum of antimicrobial action, since in the interests of harmlessness to somatic cells of the body it (as an antimetobolite) is focused on selective interaction mainly only with individual biochemical structures of the microbe. In this situation, the high efficacy of chemoprophylaxis and chemotherapy of wound infection can be ensured only if a truly etiotropic treatment is provided. In other words, chemoprophylaxis will be effective if the choice of the used antimicrobial agent is made taking into account the preliminary microbiological decoding of the etiological structure of microbial contamination or infectious inflammation, as well as determining the sensitivity of microflora to it. But a complete microbiological analysis of this kind is very long in time, and the effectiveness of suppressing wound infections depends on the start date of the use of antimicrobial agents. In such a situation, it is possible to increase the efficacy and effectiveness of chemoprophylaxis and chemotherapy of polymicrobial wound infection after dermabrasion by using combined antimicrobial agents that have a wide spectrum of action and contain several chemically and physically compatible antiseptics that can mutually enhance activity and expand the spectrum of antimicrobial action. Such a preparation was obtained by Tolstov A.V. (RF patent No. 2154148 dated 01/23/98, "Combined chemotherapeutic agent BUTOL for the treatment of local wound infections and inflammatory diseases"). Given its high antibacterial activity, the “Method for the prevention and treatment of infectious complications during mechanical dermabrasion surgery using an antiseptic agent” was invented (IB Glubokova, AV Tolstov, NI Fayzullin. Application for invention of the Russian Federation. Priority reference number No. 2001114571/14 (015296) dated 06/18/2001). This method is also taken as a prototype. However, in this prototype there is no way to use collagen coatings for dermabrasion of normo-atrophic scars.

The essence of the proposed method lies in the fact that used in mechanical dermabrasion according to a specific method, a combined collagen coating with an antimicrobial agent BUTOL. The coating is used on a polyethylene oxide basis. As an antiseptic, the drug BUTOL is used. After applying the collagen coating, the patient independently irrigates the area of operation with 10-15 ml of BUTOL solution several times a day to prolong the antimicrobial effect for the first 10-15 days, up to spontaneous healing of the epidermis. To increase the effectiveness of BUTOL, the operating surface is irradiated with low-power infrared radiation (infrared lamp) several times a day.

The method is as follows.

A complex of preoperative measures is carried out, including psychological preparation and traditional cosmetic preparation of the patient’s skin. The operation is performed by a cosmetologist on an outpatient basis, under sterile conditions of a small operating room. The area of operation is exposed. The skin surface is treated twice with BUTOL (10 ml each) with a gauze cloth, capturing more than 2-3 cm of the area of the operating area. Anesthesia is produced locally by lidocaine. Using a rotary apparatus produce dermabrasion. During the operation, skin surface treatment and hemostasis are provided by BUTOL. Alcohol and metal-containing drugs are not used. Impose a gauze napkin moistened previously with BUTOL. The surgical wound is treated twice with BUTOL (10-15 ml) from a plastic syringe without a needle. 3-5 minutes after the patient disappears, burning sensations remove a gauze napkin with a hook. After dermabrasion, a collagen coating is applied to the surgical surface. This coating does not require additional fixation. The size of the collagen coating should exceed the surgical area by 1-2 cm. The surgical wound is treated twice without a break with BUTOL (10-15 ml each) from a plastic syringe without a needle. The patient is provided with BUTOL in an amount of at least 200 ml and instructions for its use. In the postoperative period, for 7-10 days, the patient will independently drape gauze dressings several times a day at home, right up to the healing of the epidermis - spontaneous scab removal. To increase the effectiveness of BUTOL, the operating surface is irradiated with low-power infrared radiation 5-8 times a day. Next, carry out traditional skin care.

The effectiveness of the method with therapeutic effect is shown in the following example.

Patient A., female, 36 years old, on both cheeks and zygomatic areas multiple infected pustular elements and acne scars. The skin was prepared with a course of acne treatment and the corresponding psychological preparation for surgery. Dermabrasion was performed as described above on January 31, 2002. Further treatment of the patient included daily two-time douching of applied collagen coatings with BUTOL and the use of an infrared emitter. On the 8th day - complete rejection of the scab. Erythema was observed for 1 month. In the future - without complications and the traditional management of patient skin care.

The considered example allows you to visually see the affirming fact of the benefits of using a collagen coating with BUTOL. In no case was there a relapse of suppuration of the skin in the postoperative period. Observations of 27 patients revealed the following patterns. Temperature reactions did not exceed subfebrile numbers. Edema in the area of the operation was small (not more than 1 point), which is 3-4 times less than traditional dermabrasion. Erythema, determined by the method of Utz S.R. (Utz S.R. New optical diagnostic methods and laser therapy in dermatology // Abstract of thesis, MD, M., 1998. - 36 pp.), In intensity and duration was less than 2.4 and 3 , 1 time, respectively. Skin microrelief smoothing occurred 2-3 weeks after surgery. The integrated indicators of the state of the body and skin reaction in the postoperative period with this method have a lesser bias of 47.3% compared with traditional dermabrasion, and the risk of infectious complications is reduced by 2.3 times.

Thus, clinical observations confirm the high efficiency of the proposed method. The method developed by the authors, claimed as an invention, can be recommended for implementation in modern cosmetology.

Claims (1)

A method of treating normo-atrophic skin scars by carrying out a complex of preoperative measures and dermabrasion, characterized in that the surgical area is exposed on an outpatient basis under sterile conditions in the small operating room, the skin surface is treated twice with 10 ml butyl using a gauze cloth, capturing more than 2-3 cm areas of the operating zone, and anesthesia is performed locally with lidocaine, then using a rotary apparatus, dermabrasion is performed and the skin surfaces are treated by applying a gauze towel moistened with With butol, the operating wound is treated with butol twice 10-15 ml from a plastic syringe without a needle, and 3-5 minutes after the patient has a burning sensation, a gauze cloth is removed with a forceps, after dermabrasion, a collagen coating is applied to the surgical surface, which exceeds the operating area by 1 -2 cm and the surgical wound is treated twice without interruption with 10-15 ml butol from a plastic syringe without a needle and the surgical surface is irradiated with low-power infrared radiation 5-8 times a day, and in the postoperative for 7-10 days, gauze dressings with butol will be douched several times a day until the epidermis heals and spontaneous scab removal.