RU2261699C2 - Method and device for treating purulent wounds and cavities - Google Patents

Abstract

FIELD: medicine; medical engineering.

SUBSTANCE: method involves locally administering 30-50% hypertonic solution of xymedon hydrochloride, combined smoothly corrugated draining device, introducing gauze drain into upper part of wound cavity and intra-drain ultrasonic cavitation.

EFFECT: enhanced effectiveness of treatment; reduced risk of complications.

5 cl, 4 dwg

Description

The invention relates to medicine and can be used in the treatment of purulent wounds and cavities.

Modern surgery is characterized by the search for new pathogenetically substantiated methods and original surgical solutions in the treatment of wounds and wound infections. Despite the successes achieved in the treatment of wounds, this problem continues to be one of the central ones in medicine.

Known methods of physical antiseptics based on the use of the laws of capillarity, hygroscopicity, diffusion, osmosis, the principle of siphon, etc.

Drainage of wounds, purulent foci (abscesses, empyema, phlegmon, etc.) provides for the creation of conditions for the outflow of wound discharge into the external environment (into a bandage, special dishes with antiseptic solutions). Fat-free gauze swab, the physical properties and capillarity of which were well studied and described in 1894 by M.Ya. Preobrazhensky, is used as drainage in the treatment of wounds. He introduced a new concept of "physical antiseptics." The method was first applied by the English surgeon Wright (1915) in a clinic in the form of the introduction of tampons moistened with 5-10% NaCl solution into the wound. Such "suction" dressings for the purpose of "lymphatic" drainage are widespread in surgery. Gauze drainage for the purpose of lavage of a wound or cavity is recommended to be installed at their lower point, as if this enhances the drainage properties of gauze. Tampons of various sizes are prepared from a strip of bleached gauze and loosely introduced into the wound; due to its hygroscopicity, the swab absorbs blood, exudate, pus. Its draining properties are manifested within no more than 8 hours, after which it can turn into a “plug” that clogs the wound and disrupts the outflow of exudate from it. To increase the drainage properties of the dressing, tampons are moistened with hypertonic solutions: NaCl (5-10%), MgSO ₄ (25%), grape or beet sugar (20-40%), urea (30%), boric acid (3-4% ) This contributes to the creation of high osmotic pressure, which leads to an increase in the outflow of fluid from the wound into the dressing.

In addition to the usual swab, Mikulich's swab is used. A large gauze napkin with a thread sewn to its middle is introduced into the wound. The napkin is laid on the bottom and walls of the wound, forming a "bag", which is filled with gauze swabs. When the tampons are impregnated with the wound, they are removed, the gauze napkin is left and the formed cavity is filled with new tampons. A change of tampons is carried out several times until the outflow of purulent discharge ceases, after which the napkin is removed by pulling on the thread.

It turned out that hypertonic solutions are not indifferent to tissues and cause the death of young connective tissue and inhibit the processes of physiological regeneration and repair. Therefore, it was proposed to replace them with powders (Zhitnyuk R.I., Chukhman B.D. Treatment of infected wounds with a powder mixture // Vestn.khir. - 1978. - 8. - P.84-86; Kamaev MF. Infected wound and its treatment.- M .: Medicine, 1970), hydrophilic globules - debrisan, which have the same drawbacks as previous analogues (Jackobson S., Rothman U., Arturson A. et al. A new pzinciple for the cleansing of infected wounds // Scand. J. plast. reconstr. Surg. - 1976. - Vol. 10. - P.64-72).

Proteolytic enzymes (terrilithin, etc.) and their ointment compositions, which have necrolytic, anti-inflammatory and anti-edematous effects, contribute to a quick and relatively painless wound cleansing.

Known enzyme preparations of animal origin - trypsin, chymotrypsin, chymopsin, ribonuclease, collagenase; bacterial - terrilitin, streptoliasis (streptokinase), asperase, iruxol (an ointment for enzymatic wound cleansing contains clostridyl peptidase, a proteolytic enzyme isolated from Clostridium histolyticum, and chloramphenicol); vegetable - papain, bromelain. Enzymatic preparations of proteolytic action are applied topically in the treatment of purulent wounds, trophic ulcers in the form of a solution or powder. After treatment with a solution of hydrogen peroxide or furatsilina, wipes impregnated with an enzyme solution are applied to the wound or ulcer. Some enzymes are used in ointments (Iruxol, Asperase). Drugs are used until the wounds or ulcers are completely cleansed of necrotic tissue and pus. Doses of drugs are different and are indicated in the instructions for their use.

Enzyme solutions are used for intracavitary administration: into the pleural cavity with purulent pleurisy, into the joint cavity with purulent arthritis, into the abscess cavity. Drugs are administered by puncture of cavities or through drainage tubes after preliminary removal of pus by aspiration.

The principle of dehydrating effect on the wound was used in the creation of ointment preparations based on water-soluble polyethylene glycol (PEG) with the inclusion of antibiotics and other drugs (Levosin, Levomekol, Sulfamekol, 10% mafenide acetate ointment, 5% dioxid ointment, iodopyrone ointment, "Quinifurin" and others). So, the Dioxol ointment is known, which includes the antiseptic dioxidine, methyluracil and trimecain, which we took as a prototype (Datsenko B.M., Tamm T.I. Study of a multicomponent ointment on a water-soluble basis with dioxidine // Klin.khir. - 1981. - N 1. - S. 43-45).

However, both analogues and prototype have significant disadvantages:

- their osmotic activity rapidly decreases as a result of the short duration of deposition, dilution with wound or dressing to dry until the dehydration action is completely stopped after 8 hours (Struchkov V.I. Purulent surgery. - M.: Medgiz, 1962; S. Kurbangaleev; Purulent infection in Surgery. - M .: Medicine, 1985);

- to constantly ensure a high hydration effect, repeated frequent dressings are required every 3-5 hours (Kostyuchenok B.M., Svetukhin A.M., Gelfenbeyn A.S. et al. Active surgical treatment of purulent mastitis // Sov. honey. - 1979. - N3. - P.23-29; Isakov Yu.F., Nemsadze V.P., Kuznechikhin E.P., Ginodman G.A. Treatment of wounds in children.- M .: Medicine, 1990; Petrov S .V. General Surgery. - St. Petersburg, 1999);

- Frequent change of dressing is traumatic for the patient and leads to blood loss;

- high risk of introducing a secondary hospital infection;

- high consumption of dressings and loss of working time;

- have a depressing effect on the viable elements of tissues and inhibit the regeneration processes;

- a quick loss of the physical properties of the gauze dressing, usually after 6 hours there is a loss of its capillarity, since the pores are clogged with purulent-fibrinous exudate and the tampon becomes only an obstacle to the outflow of wound contents to the outside;

- the optimal effectiveness of the used proteolytic enzymes is limited to a narrow range of pH values in the wound and is 7.0 (Gostishchev V.K. Operative purulent surgery. - M .: Medicine, 1996);

- the danger of prolonged abandonment of enzymes in the purulent cavity due to the possible destruction of their protective biological barrier;

- the inability of enzymes to decompose intact collagen fibers (Sharma X., 1978; Halbchevake J., 1978;

Wounds and wound infection / Ed. M.I. Kuzina and B.M. Kostyuchenok. - M .: Medicine, 1981);

- low solubility (0.8%) of methyluracil does not allow to impart osmotic activity to the medicinal composition;

- methyluracil does not have an antibacterial property, has an extremely low (equivalent to placebo) regenerative effect, as evidenced by many years of own observations and literature data (Gorbunov S.M. Anabolic drugs / In: Autoallodermoplasty in clinical practice. - Kazan: Polygraph Publishing House. - 1980. - S.46-51);

- do not possess a desensitizing effect and often themselves cause or enhance a local allergic reaction;

- the installation of gauze drainage at the lower point of the purulent wound or cavity contradicts the scientific physicochemical principles of capillarity ("wick"), since it is known that gravity (in the specific case of wound toxicoinfective exudate) cannot play a decisive role here. Moreover, it is well known that the wetting liquid can rise in narrow tubes (along capillaries), i.e. move in the opposite direction to the action of gravity (Adam N.K. Physics and chemistry of surfaces. - L.: Gostekhizdat, 1947; Deryagin B.V. The nature of molecular forces and their importance in science and practice. - M.: Knowledge, 1956 ; Goryunov Yu.V., Sum BD Wetting. - M.: Knowledge, 1972). Therefore, such a location of gauze drainage is not only not useful, but also harmful due to the rapid clogging of its pores with purulent-fibrinous masses and capillarity disturbance.

Clinical observations show that a violation of the capillarity of the drainage occurs primarily due to the mucus of the part of the gauze swab that is inside the cavity. Therefore, methods of physical and chemical exposure should be directed to the intracavitary segment of drainage.

Drainage can be performed using rubber, vinyl chloride and other tubes of different diameters, which are inserted into the wound, the cavity of the abscess, the joint (with purulent arthritis), pleura (with purulent pleurisy), the abdominal cavity (with purulent peritonitis). The resulting pus, tissue breakdown products, and with them microorganisms, are released into the bandage through one or more drains. Drainage can be connected by a tube to a vessel into which any antiseptic solution is poured; then the wound discharge will be released into the vessel, thereby reducing contamination of the dressing. Through drainage, chemical antiseptics, antibiotics, proteolytic enzymes are introduced into the wound or purulent cavity. Passive drainage is based on the gravitational principle.

For more effective washing of wounds and purulent cavities, another tube is inserted in them (except for drainage for the outflow of wound discharge), through which a solution of an antibacterial drug is introduced, along with which tissue breakdown products, pus, blood and fibrin are removed from the wound through a drainage tube. Thus, combining the methods of physical and chemical antiseptics, create a method of flow dialysis. This method is also used in the treatment of purulent pleurisy and peritonitis. To increase its effectiveness, proteolytic enzymes are used as a washing solution, which contribute to a more rapid melting of non-viable tissues, pus, fibrin (flow-through enzymatic dialysis method).

In cases where the drained cavity is tight (a wound stitched with blind sutures, pleural empyema, purulent arthritis, abscess cavity), active aspiration (vacuum drainage) is used. Depression in the system can be created using a Janet syringe, which removes air from a sealed can with drainage connected to it, or using a water-jet suction or a three-can system. This is the most effective method of drainage, it also helps to reduce the wound cavity, its faster closure and elimination of inflammation, and with pleural empyema - the expansion of the lung compressed by exudate.

Known drainage devices (A.S. USSR 1591994, 1990; A.S. USSR 1595530, 1990; A.S. USSR 1593664, 1990) are complex in design and do not make it possible to fully rehabilitate cavities.

Tubular drainages are also described (Burykh MG, General principles of the technology of surgical operations. M: Phoenix, 1999. - 544 p .; USSR AS N 1591994, class A 61 M 31/00), which 6-8 hours cease their functions.

The closest in design is the drainage device, taken as a prototype, made in the form of a polymer tube, a textile cover with immobilized lysozyme located on both sides of the tube (AS USSR N1595530, class A 61 M 27/00). The cover on the side of the inner surface of the tube is made of highly extensible threads, and on the outside of the low stretch and has a layer of enzyme. However, the prototype has significant disadvantages:

- the rigidity of the structure does not allow to change the shape of the device when it is in the wound cavity;

- the lack of mobility of the walls leads to stagnation of wound exudate, slowing down its evacuation, which is the main cause of fibrin loss with subsequent blockage of drainage;

- removal of drainage is accompanied by significant injury to the walls of the channel;

- the device does not have universality and cannot be used in moving areas (joints, etc.);

- the necrolytic and diluting effect of lysozyme under the influence of wound contents undergoes inactivation after 6-8 hours;

- lysozyme is hardly soluble in water, which makes it impossible to create its solutions with a high osmotic effect;

- lysozyme inhibits the growth of only gram-positive microbes and does not have a noticeable effect on the growth of gram-negative pathogenic microflora, for example, Pseudomonas aeruginosa, which is a frequent representative of hospital infection;

- the drug does not have a stimulating effect on tissue regeneration processes (Mashkovsky M.D. Medicines. M: Medicine, 2001);

- clinical experience indicates that a case of filaments of fibrin, blood clots, tissue detritus is formed near the drainage tube in 6-8 hours, which leads to delimitation, isolation of drainage, blockage of perforations with the cessation of the outflow of wound exudate and tissue detritus;

- drainage functions only with increased pressure in the wound or in the purulent cavity, when the contents flow out along the path of least resistance due to gravitational forces (Tolstykh P.I., Yunus Yu.M., Makushkin RZ, etc. Surgical drainage in the treatment of purulent postoperative wounds and cavities // Surgery. - 1989. - N5. - S. 133-139);

- the location of drainage can lead to pressure sores due to its mechanical pressure on nearby tissues and vital anatomical structures due to the mismatch of the shape of the drainage device and the configuration of the wound cavity;

- clogging of the drainage leads to a violation of its function and the creation of favorable conditions for the development of microorganisms and the generalization of inflammation (Polyakov N.G. Drainage in surgery. Kiev: - Health, 1978).

- Active drains, although they can avoid a number of drawbacks, but they require sophisticated technical equipment, are expensive, bulky, complicate care (the possibility of getting a bed wet) and are often practically impossible. Often cause maceration and skin irritation around the wound, skin protection with oilcloth, plastic wrap is unreliable.

In addition to the above, a significant drawback is the low solubility in the wound content of a number of drugs used, for example, sulfonamides (streptocid, etc.), nitrofurans (furadonin, etc.), pyrimidine derivatives such as methyluracil. Locally applied these pharmacological agents in dosage form - the powder leads to the introduction of its constituent crystals, grains into the surface tissue, wound cavity, granulation. This happens spontaneously, as well as under the influence of pressure and rubbing the bandage with the inner layers, especially with its mobility in cases of insufficient fixation or when applying excessively tight rounds. Therefore, one of the main requirements for pharmacological agents for local treatment of wounds is their quick, easy and high solubility in wound exudate and the lack of ability to precipitate when mixed.

These requirements are met by a new pyrimidine derivative - coimedone hydrochloride [N- (β-hydroxyethyl) -4,6-di-methyldihydropyrimidone-2], which is thermostable and resistant to hydrolysis in an aqueous medium (Patent RF 2044730, 1992. Method for producing N- (β-hydroxyethyl) -4,6-dimethyl-dihydropyrimidone-2. Authors: Dbdrakhmanov I.Sh., Khisamutdinov G., Belyaev P.G. et al.). According to the Nizhny Novgorod Research Institute of Hygiene and Occupational Pathology, the drug belongs to class 14 according to GOST 12.01.007-76 (a dose of 20,000 mg / kg does not cause a detailed outcome when white mice and rats are introduced into the stomach. It does not have cumulative properties, does not cause a violation of the immune status, relates to the "O" class on the irritating effect on the skin of animals (guinea pigs, rabbits), does not have an irritating effect on the mucous membranes of the eyes of a rabbit. The drug is much cheaper than xymedon, it is very soluble in water, which allows you to create slightly acidic aqueous races high concentration creatures (50% or more) with a stable concentration of hydrogen ions.The pH value does not depend on dilution with wound contents, which is extremely important for creating adverse conditions in the wound for the development of Pseudomonas aeruginosa.

When xymedon is combined with an acid, for example, with HCl in the human stomach, the drug turns into xymedon hydrochloride, which is thermostable and resistant to hydrolysis, as established by joint experimental studies in the laboratories of IOFh im. A.E. Arbuzov KSC RAS (Kazan) and the SRI "Crystal" (Dzerzhinsk). According to our data, with enteral use in the experiment and in the clinic, xymedon hydrochloride is equivalent to xymedon in its therapeutic effect. The latter, when used locally in a pure, isolated form in any dosage form, does not have a noticeable antibacterial effect in the Pseudomonas flora, so it must be combined with boric acid.

In recent years, various technical devices, which are a large section of modern physical antiseptics, have gained popularity in the treatment of wounds.

Laser radiation in the form of a beam of low power has a bactericidal effect and does not have a damaging effect on the tissue. A carbon dioxide laser is mainly used, the focused beam of which has an evaporating effect on necrotic tissues and microorganisms. A very thin coagulation film is formed on the walls and bottom of the wound, which prevents the penetration of microorganisms and their toxins into the tissue. Use laser light to treat wounds.

Low frequency ultrasound has a bactericidal effect. In a liquid medium (in a wound, a closed cavity), ultrasound exhibits physical and chemical properties.

The bactericidal effect of ultrasound increases when an antiseptic substance is added to the voiced object. The most commonly used 0.05% solution of gibitan. Pressure pulses, the speed of which exceeds the speed of sound, increase the pressure in the cell to 300 atm and the temperature to 700 ° C (Technique and methods of physiotherapeutic procedures / Edited by V.M. Bogolyubov. - M .: Medicine, 1983; Burykh M.P. General principles of the technology of surgical operations. Rostov-on-Don .: Publishing house "Phoenix", 1999). In a medium exposed to ultrasound, a cavitation effect is created - shock waves appear in the form of short pulses with the formation of cavitation bubbles. At the same time, under the influence of ultrasound, water ionizes with the formation of H ⁺ and OH ^- , under the influence of which redox processes in the microbial cell cease. The method of treating wounds using ultrasonic cavitation was taken by us as a prototype (Handbook of a Practitioner in Physiotherapy / Edited by A. Obrosov - M .: Medgiz, 1957). However, the prototype has the following disadvantages:

- the method of using ultrasound in a solution of antibacterial drugs (furatsilin, antibiotics, etc.) directly in the wound cavity is feasible only with its full opening, which is practically possible only during surgical treatment;

- ultrasonic vibrations of high intensity have a detrimental effect on the surrounding tissue, especially in the presence of loose granulations;

- scoring with solutions of an antiseptic has a predominantly antimicrobial effect and helps to accelerate the rejection of necrotic masses;

- the development of allergic reactions is possible;

- insufficiently high concentration of voiced solutions does not contribute to a high cavitation effect.

The aim of the invention is a new tool, method and device that increase the effectiveness of the treatment of purulent wounds and cavities, preventing the development of complications in the treatment process.

This goal is achieved by a qualitative improvement in the rehabilitation of wounds and cavities through the use of solutions of xymedon hydrochloride. To do this, a moistened gauze swab with a 30-50% solution of xymedon hydrochloride in the first phase of the wound process is removed through contraperthesis in the upper pole of the wound or cavity, and the specially proposed combined smooth-fritted drainage is placed in the lower pole, and in the postoperative period after preliminary filling of the wound cavity 30 With a 50% solution of Xymedon hydrochloride, fractional intra-drainage sounding is performed using low-frequency ultrasound.

A new pyrimidine derivative of xymedon hydrochloride in the form of a sterile 30-50% aqueous solution with high osmotic activity was taken as a pharmacological drug. By the amount of water absorbed, it slightly exceeds that of polyethylene glycol and is 10 g for the same duration of the experiment. In addition, the antibacterial and desensitizing ability of the drug is proven.

To ensure passive outflow of wound exudate and tissue detritus, we have proposed a device that represents a combined elastic smooth-corrugated tubular mesh drainage of biologically inert material. For example, a smooth tubular segment is made of silicone, while a corrugated mesh segment is made of coarse-grained lavsan, which has an extremely high initial modulus of elasticity, very high strength in dry and wet conditions, and is characterized by a high degree of crease resistance. When heated, it easily melts, which allows, if necessary, welding the ends of the tubes, the edges of the fabric or tape (Movshovich I.A., Vilensky V.Ya. Polymers in traumatology and orthopedics. - M .: Medicine, 1978; Kabatov Yu.F. , Kredal P.E. Medical commodity science.M .: Medicine, 1984), as well as form corrugations.

The invention is illustrated graphic material, where

figure 1 - General view of the device for the rehabilitation of purulent wounds and cavities;

figure 2 - installation diagram of the drainage into the wound cavity;

figure 3 - location of the device in the wound cavity in the working position, side view;

figure 4 - view of the drainage after pulling smoothbore segment.

A device for sanitizing purulent wounds and cavities is made (Figure 1) in the form of a smooth-walled polymer tube 1 with side holes 3 at one end 2. Tube 1, with its perforated end 2, is placed inside a corrugated elastic cover 4 in contact with the wound surface made of inactive synthetic material, for example from coarse lavsan, thus forming the working part of the device. One end of the cover 4 is fixed on the border 5 between the working part and the discharge of the wound detachable end 1. The device is a single combined drainage system, the components of which are interdependent and subordinate to one goal - an effective effect on the accelerated and unhindered removal of wound contents.

The device and method of rehabilitation are as follows.

The device for rehabilitation, in the initial state after sterilization, the working part of the drainage tube 2 is installed in the drained cavity. The proximal branch of the outlet tube 1 through contraperture strictly in the lower pole of the cavity (Figure 2) is brought out to the fixation site 5 and attached to the skin, for example with adhesive plaster or using suture 6. Importance after installing the drainage device in the very flat part of the cavity and removing it in a downward direction they attach the patient to the patient, who is offered to take the postural position most favorable for the outflow of pus. In the upper pole of the cavity between the extreme preimposed provisional sutures 7 and 8, a gauze swab 9 impregnated with a 30-50% aqueous solution of xymedon hydrochloride is loosely introduced with its partial placement in the lumen in the end part of the cover 4, which gives drainage continuity. The sutures 7, 8 and the rest are sequentially tied 10, closely bringing together the edges of the wound, making sure that there is no crushing of the cover 4 of the working part of the device and the gauze swab 9 (Figure 3). The cavity through the outlet end 1 of the device is filled with a 30-50% aqueous solution of xymedon hydrochloride. In this case, the drained cavity is expanded, its walls do not cover the holes in the cover 4, which is due to its corrugation. Then, an ultrasonic emitter is introduced into the lumen of the tube 2 of the working part of the device and the intracavitary effect is produced by sounding on average for 4-10 minutes, evacuating the solution from the cavity through the outlet end 1 of the device with a vacuum suction and filling it with fresh. Ultrasonic cavitation is carried out using the domestic installation URSK-7N. During the procedure, the radiating surface of the waveguide, whose diameter is 6 mm, does not touch the surface of the wound, which guarantees its non-damage.

Sounding is carried out with a resonant frequency of 26.5 kHz with an oscillation amplitude of the end of the working tool 55-60 microns. The exposure of ultrasonic cavitation depends on the volume of the cavity and its condition and ranges from 2.5 to 10 minutes. An aseptic gauze dressing is applied to the wound with the removal of the outlet end 1 over it with the closure of a sterile napkin. This procedure is repeated every 6-8 hours (in the first three days) with a gradual increase in time to 12 hours during the entire drainage period, which usually amounted to several days. As a rule, on the 3rd day (all this time, the draining function of the gauze tampon 9 was preserved and was most pronounced in the first 48 hours), the gauze drainage 9 was removed by pulling the discharge end 1 through the counter-hole. In this case, the corrugation of the distal part of the cover 4 is straightened out with a decrease in its diameter and the cells of the cover 4 expand, which made it possible to maintain and prolong the main function of the collector of the device, which is due to the free passage of wound exudate. During treatment, periodically synchronously, along with scoring, tighten tube 1 until the device is completely removed from the cavity.

The criteria for evaluating the effectiveness of ultrasonic cavitation in complex therapy were the improvement of the general status of the patient, normalization of body temperature, reduction of intoxication, normalization of sleep, cessation of the release of wound purulent exudate and obtaining a clean wash solution for aspiration, the disappearance of signs of inflammation, and the receipt of a negative bacteriological study of lean discharge. At the same time, the amount of the washed solution decreased, indicating a decrease in the volume of the wound cavity.

Such well-known effects that occur in a fluid under the influence of ultrasound, such as acoustic flows, cavitation, traditional and sound pressure wash the walls of the cover 4 and the drained cavity, followed by emulsification of the wound discharge, which provides intensive sanitation of the purulent wound or cavity. In addition, a qualitatively new unknown effect has been ascertained - an increase in the intensity and an increase in the functioning time of the gauze tampon 9 and the drainage device by increasing capillary or surface forces. The latter is confirmed by experimental in vitro studies with a 1: 1000 eosin solution according to the methodology of Yu.F. Kabatov and P.E. Krendal (Medical Commodity Science. -M.: Medgiz, 1984. - P.69-70) without (control) and with ultrasonic treatment (experience) of a gauze strip. Compared with the control in the experiment, the solution rose from the liquid level much faster and amounted to 10 cm for 40 minutes (in the control, respectively, 10 cm for 1 hour).

The proposed method was used in the treatment of 14 patients mainly with purulent diseases and soft tissue wounds of the limbs in the first phase (hydration) of inflammation. Patients showed a reduction in treatment time by 7-9 days compared with patients treated with traditional methods. No complications were noted. The greatest therapeutic effect was noted in individuals with the presence of Pseudomonas aeruginosa.

EXAMPLE. Patient S., 57 years old, was admitted to the surgical department with a laceration in his right thigh 20 days after receiving a road injury. The dressing is colored blue with a pronounced smell of spicy hay. In the paravular zone, the skin is macerated, inflamed. A deep muscle wound 18 × 10 cm is covered with flaccid granulations with fibrinous-purulent plaque. Of the concomitant diseases, type II diabetes mellitus is in the stage of subcompensation. Assigned to a comprehensive conventional therapy. On the 5th day after hospitalization under anesthesia, late secondary surgical treatment of the wound with drainage according to the described method and suturing of its edges to the drainage was performed. Intra- and postoperative intra-drainage dosing by ultrasound of the wound cavity was carried out according to the proposed method. On the 3rd day, the gauze swab was removed, and on the 7th, a drainage device. The wound healed by type of primary tension. He was discharged home on the 14th day after surgery.

In the end, we can assume that the proposed tool, drainage device, a method of treating purulent wounds and cavities has significant advantages over the prototype, expressed in the following:

- 30-50% solution of Xymedon hydrochloride has not only a large dehydration effect, but also has an antiseptic and stimulating effect on the processes of physiological regeneration and tissue repair;

- the drainage device does not cause compression of the contacting tissues, takes the form, respectively, of the configuration of the drained cavity, maintains its main function for a long time, due to its design features;

- installation of tubular drainage in the downward direction at the lower point of the drained cavity as a passive collector, and in the upper (lying) gauze swab in the upward direction, using the principle of "wick", it is scientifically justified. With this arrangement of drains, a passive outflow of pus is ensured according to the principle of its gravity (gravity) and capillarity;

- fractional lavage of the cavity in combination with ultrasonic cavitation not only has an antibacterial effect, but also significantly activates the outflow of wound contents through tubular drainage, and also significantly increases the capillary strength of the gauze swab;

- a new approach to scientifically based technology of passive drainage using original medication and technical means allows you to accelerate the rehabilitation of purulent wounds and cavities, increase the effectiveness of their treatment with the exception of complications associated with the use of drainage;

- based on my own experience, on the whole, the proposed and developed new original combined technology of passive rehabilitation of tightly sutured purulent wounds and cavities after surgical treatment is simple to implement, affordable, does not require additional technical devices, can be applied in any hospital and for good results clinical testing may be recommended for implementation in wide medical practice.

Claims (5)

1. Means for capillary drainage of purulent wounds and cavities, which consists in the fact that it is made in the form of gauze swabs moistened with a 30-50% aqueous solution of xymedon hydrochloride. 2. Device for draining purulent wounds and cavities, containing a drainage tube enclosed in a cover, characterized in that its working part is perforated, and the cover is corrugated as a cover - a skirt of coarse biologically inert material, such as lavsan. 3. A method for draining purulent wounds and cavities, characterized in that the tampon is introduced loosely in the form of strips of rare gauze in the uppermost part of the wound cavity before connecting to the tubular part of the drainage and it is withdrawn in an upward direction. 4. The method according to claim 3, characterized in that they produce during and postoperative intra-drainage fractional ultrasonic treatment followed by aspiration with a 30-50% aqueous solution of xymedon hydrochloride. 5. The method according to claim 3, characterized in that the discrete removal of the drainage device is performed while rinsing with a 30-50% solution of Xymedon hydrochloride and treating the cavity with ultrasound.

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