RU2289332C2 - Apparatus for treatment of wound surface - Google Patents

Abstract

FIELD: medical equipment, in particular, wound surface treating facilities.

SUBSTANCE: apparatus has shank and head with abrasive coat formed from medicinal drug Xemidon. Head is sized and configured depending on area and configuration of surface to be treated. Shank is adapted to be secured in cartridge of surgical electric drill.

EFFECT: enhanced stimulation of healing processes causing intensified healing of wounds and trophic ulcers.

3 cl, 1 dwg, 1 ex

Description

The device relates to medical equipment, in particular to tools for treating a wound surface.

The basis of this device is the principle - radical gentle removal of necrotic tissue in the direction from the superficial layers to the deep with minimal trauma to the patient. To paraphrase a well-known aphorism, we can say - "the optimal necrectomy should be as large as necessary, and as small as possible." Various methods of mechanical, physical and chemical antiseptics are used to repair wounds and ulcers by using a steel scalpel, necrotomes, abrasive tools, laser, ultrasound, keratolytic agents (proteolytic enzymes, salicylic acid, etc.) / Autoallodermoplastika / Ed. G.A. Izmaylova. - Kazan: Polygraphizdat, 1980. - 98 p .; Burykh M.P. General principles of surgical technology. - Rostov-on-Don: Publishing house "Phoenix", 1999. - 544 p .; A.S. USSR N 1000026, class A 61 B 17/16, 1981; A.S. USSR N 1235496, class A 61 B 17/16, 1986; A.c. N 1260000, cl. A 61 B 17/16, 1986; A.S. USSR N 1475614, class A 61 B 17/16, 1989; Catalog illustre d 'instruments de chirurgie, Paris, 1966, p.1-27, XI, 3185].

Known devices containing circular knives for cutting dead tissue, thermocauters, or based on the relatively long (up to 7-10 days) local use of proteolytic enzymes are rather traumatic and not safe for the patient. In addition, the use of a laser or ultrasound requires expensive and complex installations [Autoallodermoplastika / Ed. G.A. Izmaylova. Kazan: Polygraphizdat, 1980. 98 p .; Burykh M.P. General principles of surgical technology. - Rostov-on-Don: Publishing house "Phoenix", 1999, - 544 p .; Gostishchev V.K. Operative purulent surgery. - M .: Medicine, 1996. - 416 p .; Izmailov S.G., Izmailov G.A. Purulent-inflammatory and necrotic diseases of the skin and subcutaneous tissue. - Nizhny Novgorod: Publishing house ABAK, 1999. - 144 p .; Wounds and wound infection / Ed. M.I. Kuzina and B.M. Kostyuchenok. - M .: Medicine, 1981. - 688 p .; General Surgery / Ed. V. Schmitt, V. Hartig, M.I. Kuzin. - Joint publication of the USSR-GDR: In 2 volumes. T.2. - M .: Medicine, 1985. - 368 p.]. Known devices have other significant disadvantages:

- difficulties in dosing the thickness of the removed devitalized tissues;

- when using high energies, burns of undamaged viable tissues occur at the treatment site;

- The use of chemical necrolytic therapy for a long time, delays the treatment time, and pronounced allergic reactions are not excluded.

A device containing a reservoir is known from which an antiseptic solution is supplied to a wound surface under pressure [Izmailov SG, Izmailov GA Purulent-inflammatory and necrotic diseases of the skin and subcutaneous tissue. - Nizhny Novgorod: Publishing house ABAK, 1999. - 144 p .; Wounds and wound infection / Ed. M.I. Kuzina and B.M. Kostyuchenok. - M .: Medicine, 1981. - 688 p .; General Surgery / Ed. V. Schmitt, V. Hartig, M.I. Kuzin. - Joint publication of the USSR-GDR: In 2 volumes. T.2. - M .: Medicine, 1985. - 368 p.].

However, using such devices it is impossible to remove solid purulent-necrotic masses and tissues, which we often have with a dry scab. In such a situation, another device is also ineffective (patent N 2133107 of the Russian Federation, 1999; a.s. 1593631 of the USSR, 1990), which is based on the principle of exposure of necrotic tissue to the force of a shock wave supplied by pressure to various wound fluids under pressure. The vortex or pulsating fluid flow formed in this case is effective only with moist and loose, easily removed fibrinous-purulent deposits or purulent exudate. In addition, the use of such devices is associated with a high consumption of expensive antiseptic solutions and requires additional technical means (electric suction pump, etc.), as evidenced by many years of own experience.

Of all devices for necrectomy, mechanical ones with the use of manual or mechanized instruments are considered the best [A.s. USSR N 1132929, class A 61 B 17/16, 1984; A.S. USSR N 1187797, class A 61 B 17/16, 1985; Kabatov Yu.F., Krendal P.V. Medical commodity science. - M .: Medicine, 1984. - 384 p. 3].

A device for treating the surface of the bone [A.S. USSR N 1187797, class A 61 B 17/16, 1985]. The device consists of a shank and a housing, on the cylindrical surface of which a spiral groove is made with a twisted Jigley saw laid in it. The bone surface is processed during the rotation of the body by gripping the tissue with a protruding Jigley saw. Such a rough peeling of the tissue is not only traumatic, but often leads to a slowdown in the healing of a tissue defect.

Known de-epithelializer (SU 1475618, publ. 30.04.89) containing a handle, a holder (shank) in the form of a rod and a working element (head) with an abrasive coating. However, this device does not allow radical controlled removal of necrotic tissue, since:

The tool is not connected to the rotary apparatus, and manual processing is traumatic and long in time.

There is no reliable stability while holding and manually rotating the tool.

One device size, the absence of a replaceable coating and the constancy of the geometric shape of the working part limits the indications for its use.

The abrasive coating on the working part in the form of longitudinal grooves allows only a perforation hole with a strictly perpendicular installation with respect to the eardrum. Moreover, the perforation should have the same diameter around the entire circumference for a possible uniform capture of the edges.

Smooth, flat surface of the protrusions of the abrasive coating reduces the performance of the device.

The abrasive surface performs only a mechanical function, not possessing the property of stimulating the processes of tissue regeneration and repair.

The aim of this invention is the creation of an abrasive tool that helps stimulate the healing processes of non-healing wounds and trophic ulcers.

This goal is achieved by the fact that on the working surface of the inventive device applied abrasive chips of a drug, for example, crystalline drug Xymedon.

Xymedon-1- (β-hydroxyethyl) -4,6-dimethyl-1,2-dihydro-2-hydroxypyrimidine is one of the simplest non-glycoside analogues of pyrimidine nucleosides, synthesized in 1964 by Order of the Ministry of Health of the RSFSR dated 07.12.93 N 287 Xymedon is approved for use in medicine and is included in the Register of Medicines.

Xymedon is non-hygroscopic, melting point 138-142 ° C. The substance of xymedon is in the form of crystals of irregular polyhedral shape with extremely high strength with sharp spike-like protrusions, which was one of the reasons for choosing it as an abrasive material. Another reason was his ability to enhance local immunity, physiological regeneration and tissue repair, especially the processes of epithelization and the formation of granulations (2nd phase of healing) [Izmailov SG et al. Xymedon in a clinical pact. - Nizhny Novgorod: Publishing house of the NMMD, 2001. 188 p.].

The drawing shows a device for processing a wound surface, General view.

The device consists of a shank 1, a metal head 2 fixed on it, on the surface of which a thin abrasive layer of crystalline drug Xymedon is applied using glue used for medical purposes. The heads can be of various shapes and sizes with an outer diameter, for example from 10 to 30 mm.

The device operates as follows.

Depending on the area and relief of the wound surface being treated, the head 2 is selected in the required size and shape. Next, the shank is clamped into the cartridge of the surgical drill and the device is rotated. The wound is treated with the surface of the device on which the abrasive material is applied.

Processing is carried out in the following mode - after 15 "-20" abrasion, idle rotation of 10 "-15" in a 10% aqueous solution of Xymedon is carried out.

Clinical and experimental testing of the prototype of the proposed device showed its high performance. At a rotation speed of 1450 rpm, high abrasive properties with the possibility of visual dosing of the cutting depth of necrotic tissues without overheating of the underlying viable layers were revealed [a.c. USSR N 1187797, class A 61 B 17/16, 1985]. Abrasion was stopped when there was a slight capillary bleeding from the tissues of the bottom of the wound or ulcer. Such treatment of the wound surface in 12 patients with long-term non-healing wounds and trophic ulcers showed that tissue regeneration processes were 2-3 days ahead of those in the control group, where known devices were used. No complications were observed when using the proposed device.

As an illustration, we give one example.

Patient G., 63 years old, was admitted on 03.03.00 to the purulent surgical department with a diagnosis of a long-term non-healing wound in the region of the right ankle joint. Upon receipt, the general condition is satisfactory. More than 10 children suffer from deforming osteoarthrosis of the lower extremities. 2 months ago, hydrocortisone with novocaine was injected into the right ankle joint, after which, on the 2nd day, 4 × 4 cm tissue necrosis occurred at the injection site. Using the proposed device, necrectomy was performed to bleeding tissues with autodermoplasty with a split flap that completely survived. Discharged home.

Based on the positive results of clinical use, the device can be recommended in the widespread practice of surgeons.

Claims (3)

1. A device for treating a wound surface, comprising a shank and a head with an abrasive coating, characterized in that the abrasive coating is made of Xymedon drug, and the shank is made for fixing in a cartridge of a surgical electric drill, and the size and shape of the head are selected depending on the area and topography of the treated surface. 2. The device according to claim 1, characterized in that the head has an outer diameter of from 10 to 30 mm 3. The device according to claim 1, characterized in that the abrasive material is fixed to the metal head by means of glue.