RU2290085C2 - Method for preparing to fulfill limb's replanting - Google Patents

Abstract

FIELD: medicine, traumatology, resuscitation, field surgery, medicine of catastrophes.

SUBSTANCE: the present innovation deals with helping patients at any variant of limb's detachment at its preparing to replantation. Into soft tissues of detached limb one should introduce oxygenated perfluorane at the dosage of 30 mg/kg of detached limb, and then it should be placed into replantation sac. The innovation enables to hold back the development of ischemic toxicosis due to creating the stock of oxygen carrier, temporarily, up to the moment of replanting, improve tissue structures, up to the moment of replantation, improve the safety of tissue structures and increase the quality of replant's functioning.

EFFECT: higher efficiency.

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Description

The invention relates to medicine, namely to traumatology, resuscitation, military field surgery, disaster medicine, and can be used to provide assistance to victims with any option for limb separation. The invention can also be used in pathophysiology.

The term “replantation” introduced in the literature by E. Hopfner (1903), and in our country by N. A. Bogoraz (1913), means the engraftment of a limb to the body.

An obstacle to the successful solution of the problem of limb replantation is acute organ anoxia (Kovanov V.V., 1979), which leads to disorganization of the structural integrity of tissues, disruption of tissue and cellular homeostasis, diffuse autolytic changes (Sarkisov D.S., 1976; Panchenko L. . F. et al., 1976, 1978). These changes become the cause of severe post-ischemic disorders both in the limb itself and in the recipient's body after replantation (V. Rudaev. Preparing the limb for replantation. Kemerovo, “Traditional Medicine”, 1993, p.11). Therefore, measures should be taken to prevent the serious consequences of replantation.

A known method of regional resuscitation of a severed limb by perfusion of a severed limb before replantation, according to which the toxic products of anaerobic metabolism, toxins, blood clots are mechanically washed out of the severed limb. As the perfusate, use physiological saline with heparin, protein-salt solutions, cryoprecipitate plasma, perfluorocarbon solution (Datiashvili P.O. Replantation of limbs. - M .: Medicine. - 1991. P.111).

The disadvantages of this method: the lack of cooling.

Perfusion leads to severe tissue edema, mechanical damage to the vascular walls, impaired microcirculation, etc.

Perfusion as a procedure requires a certain time and therefore delays the restoration of normal blood circulation in the replant.

The perfusion technology does not allow the known method to be performed at the prehospital stage.

There is also a method of regional resuscitation of a severed limb before replantation, including isolated limb perfusion using an oxygen-assisted blood circulation machine in a “gentle mode”, detoxification of ischemic tissues with a hemoadsorbent, normalization of metabolic processes in ischemic limb tissues by incorporating canned tissue into the perfusion nitrogen in the perfused nitrogen circuit donor liver (Rudaev V.I. Preparation of a limb for replantation / V.I. Rudaev, A.L. Krichevsky, L.I. Kostandya - Kemerovo: Folk Medicine 1993 pp 21, 100).

The disadvantages of this method: the lack of cooling.

Perfusion as a procedure requires a certain time and therefore delays the restoration of normal blood circulation in the replant.

The perfusion technology does not allow the known method to be performed at the prehospital stage.

Incomplete prevention of ischemic toxicosis.

There is also known a method of preparing organs (heart, lung) for transplantation by introducing perfluoran to a donor at a dose of 10-15 ml / kg of weight with the aim of anti-ischemic protection of these organs (Shumakov V.I., Onishchenko N.A., Santagareev R.Sh., Tarabarko N.V. Use of perfluorocarbon emulsions in organ transplantation (results, prospects), Perfluorocarbon compounds in biology and medicine, Pushchina, 1999, p.143-145).

The advantages of this method are: improving the preservation of tissue structures and improving the quality of the functioning of the graft under the condition of intravascular infusion of perfluorane.

There is no data on the use of this method for limb implantation.

There is also known a method of preserving a limb, according to which a limb is covered with snow or ice ("dry cooling") (Datiashvili P.O. Replantation of limbs. - M .: Medicine.-1991. S. 24).

Temperature, according to the physical definition, is the speed of movement of molecules. Lowering the temperature means a decrease in this speed and, consequently, a decrease in metabolic activity (Rapaport F., Dosse J. Transplantation of organs and tissues in humans, M., Medicine, 1973, S. 494-495). With decreasing tissue temperature, not only the ability of tissues to assimilate oxygen decreases, but also the need for tissues in it (Girgolav S.S., Aryev T.Ya., Gamov BC Experience of Soviet Medicine in the Great Patriotic War of 1941-1945, M ., Medgiz, 1951. P.220).

The disadvantage of this method is that direct contact of a limb with ice (snow) leads to supercooling of tissues, it is impossible to conduct complete and uniform cooling of tissues, especially large segments of the limbs. Uneven cooling of tissues leads to the fact that along with intact tissues there are tissues with degenerative and necrotic changes (the theory of disseminated necrosis). Areas with a large number of foci of necrosis and degenerative changes are characterized by reduced viability and reduced tissue resistance to infection (Girgolav S.S., Aryev T.Ya., Gamov BC Experience of Soviet Medicine in the Great Patriotic War of 1941-1945, M. , Medgiz, 1951. S.218-219). In addition, lowering the temperature of the aquatic environment leads to structural changes (crystallization), causing significant damage to conserved living systems (Rapaport F., Dosse J. Transplantation of organs and tissues in humans, M., Medicine, 1973. P.495).

There is also known a method of preserving a limb, in which a severed limb is placed in an implantation bag, which is a double bag (two plastic bags nested in one another), the amputated segment of the limb is placed in the inner section, and pieces are placed in the outer section (around the inner bag) ice with water, the capacity of the package is sealed with plugs (Datiashvili PO Replantation of limbs. - M .: Medicine. - 1991. P.25).

An advantage of the known method is that the growth and reproduction of bacteria in the wound is inhibited, which contributes to the prevention of postoperative infectious complications. The design of the bag allows for uniform cooling of the severed limb.

A disadvantage of the known method of preservation of the limb is that it does not sufficiently inhibit the development of ischemic toxicosis.

The objective of the invention is to restrain the development of ischemic toxicosis by creating a supply of oxygen carrier, temporarily, until the moment of replantation, to improve the safety of tissue structures and improve the quality of functioning of the replant.

This task is achieved by the fact that in the method of preparing the limb for replantation, in which the severed limb is placed in the replantation bag before placing the severed limb in the replantation bag, oxygenated perftoran is introduced into its main muscle groups at a dose of 30 mg / kg of body weight.

The method is as follows. In soft tissues of the severed limb, oxygenated perftoran is introduced into the main muscle groups at a dose of 30 mg / kg of the mass of the severed limb, and then it is placed in an implantation bag. Following this, the victim and his limbs are delivered to the nearest department where re-implantation can be carried out.

The introduction of oxygenated perftoran helps to inhibit the development of ischemic toxicosis by optimizing the oxygen regime, improve the preservation of tissue structures and improve the quality of the functioning of the replant.

Muscle groups contain myoglobin, which carries oxygen. Myoglobin, like hemoglobin, performs a respiratory function, promoting the absorption of oxygen from oxygenated perftoran and its use in oxidative processes that occur in muscle tissue (K.S. Merezhkovsky, Kune, Bunge). Myoglobin functions as an oxygen reserve in the muscles, carrier and intracellular catalyst. Myoglobin plays the role of a short-term oxygen reserve in the muscles and is part of the oxygen transport system inside the cells. The properties of myoglobin are well adapted by nature to carry out this function: it has a higher affinity for oxygen than hemoglobin, can combine with oxygen and dissociate, releasing oxygen very quickly (P.A. Verbolovich Mioglobin and its role in the physiology and pathology of animals and humans, M., Medgiz, 1961, p. 47-54).

An example of a specific application of the method.

Studies were performed on outbred laboratory rats weighing 250-350 g. The experimental animal was anesthetized to remove both hind limbs at the level of the thigh. After 1 hour, oxygenated perfluorane was introduced into the soft tissues of one limb (PO ₂ = 250 mmHg at a dose of 0.5 ml). Perftoran was not introduced into the second limb. After 6 hours of thermal anoxia, the muscles of both limbs were examined for the content of lipid peroxidation products (LPO). The amount of active products of thiobarbituric acid (TBA) was determined. In the limb muscle homogenate without perfluorane, the concentration of TBA products was 35, and in the limb muscle homogenate with perfluorane, it was 28. This indicates a certain inhibitory effect of perfluorane on LPO. An angiography of 76% urographin - 7 ml was also performed. In both limbs, small, rare, small extravasates were observed. In addition, only the main artery was contrasted in the limb without perfluorane. In the limb into which perfluorane was introduced, arteries of the 3rd and 4th orders were clearly contrasted. This indicates a greater patency of the vascular bed for contrast of the limb into which perfluorane was introduced. A similar result of angiography indirectly indicates a greater preservation of the vascular bed in the limb with perfluorane.

The advantages of the proposed method

The method allows to restrain the development of ischemic toxicosis, improve the preservation of tissue structures and improve the quality of the functioning of the replant.

The method is easy to use.

The method can be used at the prehospital stage.

Claims (1)

A method of preparing a limb for replantation, in which a severed limb is placed in an implantation bag, characterized in that before placing the severed limb in the replantation bag, oxygenated perftoran is introduced into its soft tissues at a dose of 30 mg / kg of the mass of the severed limb.