RU2254876C2 - Method for prophylaxis of post-operative wound complications and formation of pathological scars - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to a method for prophylaxis of post-operative complication of wounds and formation of pathological scars using the medicinal therapy. Method involves applying a napkin comprising the following components, mg/cm²: sodium alginate, 6.25; hydrocortisone acetate, 0.4; dimexide, 11.25; mexidol, 0.8; gentamycin, 0.15. Before applying the napkin is wetted and remained on wound for 1-3 days with periodical wetting 2-3 times per 24 h and control of wound region by ultrasonic method at least 3 times in a day and regions with structural damages are detected. Then napkins are applied on these regions with exceeding the surface area by 1-2 cm and with change in 2-3 days for 2-3 weeks. The proposed invention provides enhancing the prophylaxis effectiveness, reducing treatment time and prevents arising complications and pathological scars. Invention can be used for treatment of firearm wounds.

EFFECT: improved method for prophylaxis and treatment of wounds.

1 ex

Description

The invention relates to medicine and can be used to treat gunshot wounds.

Gunshot injuries are characterized by a number of histomorphological features both at the initial stages of the wound healing process and during the regenerative histogenesis of epithelial skin, connective dermis, adipose hypodermis, skeletal muscle and bone tissue. After a gunshot wound, expressed heteromorphy, leukocyte infiltration with paranecrotic changes, diffusion of connective tissue elements, newly formed capillaries and revascular cells, which indicates a protracted wound process compared with a non-gunshot injury, and inhibition of reparative regeneration, persist in tissues for 14-16 days due to the extensive damage and primary infection. The resulting scar tissue is prone to hypertrophy with a predominance of connective tissue elements over the epithelium and in the refocal tissues.

After eliminating the phenomenon of inflammation, primary-delayed, early or late secondary sutures are applied to the wound. Given the presence of primary infection, tissue ischemia in the early postoperative period, there is a high risk of purulent complications, a violation of epithelialization processes with the formation of hypertrophic or keloid scars. Prevention of these unwanted complications and consequences in wounded with gunshot injuries is given great attention. In the postoperative period, wound drainage, their local treatment are performed, preventive courses of antibacterial and restorative therapy are carried out.

A known method for the prevention of postoperative complications of wounds and the formation of pathological scars, including drug therapy (“The use of a new treatment complex for purulent-necrotic complications of military gunshot wounds”, Abstracts of the II International Conference “Modern approaches to the development of effective dressings, suture materials and polymer implants” , M., - 1995, S. 149-151, prototype).

This method includes the use of physical and chemical asepsis - ultrasonic cavitation (ultrasonic testing) with an antiseptic mixture: gentamicin, dioxidine, solcoseryl and terrilithin (“GDST”)

The disadvantage of this method is that for its use requires special equipment and the availability of trained personnel. When carrying out prevention in a known manner, the formation of side effects is possible, which in themselves can cause complications. So, for example, the ionization of water under the influence of ultrasound occurs not only in microbial cells, but also in human wound cells with possible subsequent death, which is especially dangerous for gunshot wounds.

In addition, the installation of an intraranial dialysis tube can exacerbate the purulent process, contribute to the formation of fistulas. After UZK with “GDST”, subsequent closure of the wound by one of the types of dressings is necessary, which lengthens the dressing time, increases the cost of treatment.

The objective of the present invention is to remedy these disadvantages, increase efficiency and reduce the time of prevention due to local non-invasive summing up of a complex of drugs (LP) and prevention of complications.

To solve this problem, in a method for the prevention of postoperative complications of wounds and the formation of pathological scars, including drug therapy, it is proposed to use a therapeutic napkin containing 6.25 mg / cm ² sodium alginate, 0.4 mg / cm ² hydrocortisone acetate, dimexide as a drug therapy 11.25 mg / cm ² , mexidol 0.8 mg / cm ² , gentamicin 0.15 mg / cm ² , and moisturize the tissue before application, leave it on the wound for 1-3 days, periodically moisturizing 2-3 times a day, and control the wound area with an ultrasound scan of at least 3 p after a day, identify areas of structural disturbances, after which wipes are applied to these areas with an excess of area of 1-2 cm with a change in 2-3 days for 2-3 weeks.

The significance of these signs is confirmed by the fact that the local supply of necessary drugs to the wound reduces the risk of undesirable consequences and complications (in the form of allergies, possible toxic effects, etc.) that can develop with the systemic use of these medications. The creation of the necessary concentration of anti-exudative, antihistamines, antimicrobials and antioxidants in the lesion site (gunshot wound) through the use of an appropriate treatment wipe helps to normalize the course of the wound process, creates conditions for wound healing in optimal terms with the formation of normotrophic scars.

The proposed anti-inflammatory napkin for treating wounds at the stage of scar formation consists of an atraumatic hydrophilic base with a mixture of drugs applied on it: sodium alginate gel 6.25 mg / cm ² , hydrocortisone acetate 0.4 mg / cm ² , dimexide 11.25 mg / cm ² , gentamicin 0.15 mg / cm ² .

The proposed combination of medications improves microcirculation, stimulates regenerative processes in the wound area. The combination of all the above qualities provides the napkin with wide indications for use in the treatment of gunshot wounds and their consequences as a prophylactic in the postoperative period after secondary suturing, for the care of hypertrophic scars during their maturation, as well as for the treatment of wounds when there is a risk of formation keloid. Monitoring the wound area using ultrasound allows you to determine its condition in a timely manner and apply napkins to the required places.

The method is as follows.

At secondary seams stitched wound or pathological scar tissue defined by visible and inflammatory degenerative changes, for 24-72 hours impose anti-inflammatory therapeutic napkin, sodium alginate gel comprising 6.25 mg / cm ^2, hydrocortisone acetate 0.4 mg / cm ² , dimexide 11.25 mg / cm ² , gentamicin 0.15 mg / cm ² . The technology for producing napkins is similar to that used for the production of Koleteks napkins (Oltarzhevskaya ND “Theoretical Foundations and Technology for the Production of Textile Medical Materials with Preset Properties”. Author. Thesis, Doctor of Technical Sciences, St. Petersburg, 1996 ., p.3-44), and consists in printing on a knitted basis compositions containing a biocompatible polymer - sodium alginate in the form of a gel and the above drugs dispersed in it. Moreover, the peculiarity of the process of manufacturing napkins is such that it is possible to introduce essentially any medications into the composition according to one technological scheme. After applying a viscous composition to a textile base, drying and sterilizing, a therapeutic napkin with a prolonged (up to 2-3 days) anti-inflammatory effect is obtained. Moreover, before applying, the napkin is moistened, which ensures the penetration of drugs, and left on the wound for 1-3 days, periodically moisturizing 2-3 times a day, constantly maintaining uniform penetration of drugs.

Then, the wound area at least 3 times in a day (2, 4, 6 days), depending on the features of the course of the wound process and the formation of scar tissue, ultrasound is monitored and the areas of structural disorders, edema, the presence and prevalence of destructive degenerative changes, are excessively determined accumulation of fluid and its density. After that, the napkin is applied to the region of interest so that it overlaps the wound and the entire area of pathological changes in the refocal tissues with a capture of at least 1-2 cm, which is associated with the depth of penetration of drugs and napkins into the underlying soft tissues. In this case, the napkin is changed 2-3 days before the restoration of tissue structure in the wound area and around it with the formation of normotrophic scar in the area of damage, regression, signs of lymphoid edema and destruction. The course of treatment is 2-3 weeks.

Example 1

Patient K., 29 years old with the consequences of a mine-explosive wound of the lower extremities. Atophic pseudarthrosis, chronic osteomyelitis of the right femur, fistulous form, exacerbation. Post-traumatic neuropathy of the right sciatic nerve. Extensive ulcerative hypertrophic scars of the area of the knee joints and the posterior surface of the right thigh, the area of the right ankle joint and the right calcaneal region. The patient underwent necrosecvestrectomy. False joint resection, osteosynthesis of the right femur with the rod apparatus of external fixation. After excision of pathological granulations, removal of sequestration, treatment of a wound on the outer surface of the right thigh, secondary sutures were applied to it after 14 days. After the operation, the wound with sutures is closed with the moistened wipes offered, overlapping it by at least 2 cm on both sides. Subsequently, the change of wipes was performed once every 2 days, monitoring the course of the wound process clinically, visually and with the help of ultrasound, carried out on the 2nd, 4th, 6th day after the operation. In the area of the posterior-outer thigh surface at a distance of 5 cm from the surgical wound, excessive accumulation of fluid, swelling of the soft tissues with a violation of their structure were diagnosed. A puncture of the focus of fluid accumulation was performed, 15 ml of serous contents were obtained. The wound and the area of destructive changes with lymphoid edema are closed by the proposed napkins with an excess of its area by 2 cm. At the same time, the napkins were moistened 2 times a day, changing after 2 days for 10 days. On the 8th day after the operation, the phenomena of inflammation were stopped, the wound healed with the formation of a soft elastic scar, the sutures were removed on the 15th day after the secondary surgical treatment. To care for the hypertrophic scars of both knee joints, the right ankle joint and the right calcaneal region, to stop the inflammation in this zone, anti-inflammatory wipes were used according to the above scheme. The phenomena of inflammation regressed after 2 weeks from the start of treatment and prophylactic measures.

The use of this invention will increase the effectiveness of prevention, reduce treatment time, prevent the occurrence of complications and pathological scars.

Claims (1)

A method for the prevention of postoperative complications of wounds and the formation of pathological scars, including drug therapy, characterized in that as a drug therapy, a medical tissue is used containing 6.25 mg / cm ² sodium alginate, 0.4 mg / cm ² hydrocortisone acetate, 11 dimexidum, 25 mg / cm ² , mexidol 0.8 mg / cm ² , gentamicin 0.15 mg / cm ² , moreover, before application, the napkin is moistened, left on the wound for 1-3 days, periodically moistened 2-3 times a day, and controlled while the wound area using ultrasound at least 3 times in a day, you are areas of structural disturbances, after which wipes are applied to these areas with an excess of area of 1-2 cm with a change after 2-3 days for 2-3 weeks.