RU2320349C1 - Method for treating burn wounds - Google Patents

Abstract

FIELD: medicine, combustiology.

SUBSTANCE: the present innovation deals with treating vast burn wounds of IIIa degree. It is necessary to carry out wound toilet (scrubbing up, trimming and washing procedures). Then wound should be covered with a biological bandage that contains cultivated live human allogenic fibroblasts. Moreover, biological bandage should be applied on the 1^st-2^nd d after trauma happened. On removing the bandage one should cover the developed neoepithelium with liquid polymeric polysiloxane-polycarbonate film as aerosol. The innovation shortens the terms of therapy without development of hypertrophic cicatrix and protects epithelium under development against drying and mechanic lesions.

EFFECT: higher efficiency of therapy.

1 cl, 7 dwg, 3 ex

Description

The invention relates to medicine, in particular combustiology, dermatology, and can be used to treat burn wounds IIIa degree.

A known method of treating Burns wounds, in which, after carrying out a wound toilet, its surface is covered with a biological bandage based on type I collagen containing healthy donor serum with the AB (IV) Rh-Kell phenotype (application No. 2006122784 from 06.27.06). However, the neo-epithelium formed on the wound needs additional special protection from drying out and mechanical damage, because otherwise, it becomes a scab, which significantly affects the speed and nature of healing of a burn wound.

A known method of treating a burn wound, including surgical treatment and closure of the wound with a graft containing a culture of living fibroblasts of the human fetus (AS No. 16990047, USSR, A61K 35/48, 1989). Growth and transplantation of a fibroblast culture was performed on a Karbosil-P polymer film (due to its physicochemical properties, the film promoted the regeneration of the epithelium).

The known method allows to reduce the healing time of the wound by 5-7 days compared to self-healing burn wounds. However, with this method of stimulating the healing of a IIIa burn wound, epithelium regeneration over the entire wound surface is extremely rapid, and actively proliferating neoepithelium needs special protection from drying, mechanical damage and microbial invasion from the moment of formation of the epidermocyte monolayer to the formation of the entire multicellular structure of the epidermis. There are ways to protect the monocellular layer of neoepithelium by applying textile dressings that are wet-drying or saturated with various ointments. However, these dressings adhere to the surface of the forming epithelium and seriously injure it. In addition, such dressings cause a violation of wound gas exchange, which is manifested by a perversion and a slowdown in the process of differentiation of the multilayer structure of the mature epithelium, which leads to the formation of a hypertrophic scar.

In addition, the most appropriate application of a dressing based on live cultured allogeneic fibroblasts on the surface of a burn wound in 1-2 days after the injury. At these times, the wound surface is reasonably well protected by immune cells from microbial invasion, and the composition of the burn exudate is a balanced cocktail of growth factors and cytokines, the total activity of which is manifested by a powerful stimulating effect on the proliferation of all cells participating in the wound process. Later, a burn wound quickly loses these properties.

The objective of the invention is to shorten the treatment of burn wounds of the IIIa degree without the formation of a hypertrophic scar and protect the forming epithelium from drying out and mechanical damage.

The problem is solved in that in a method of treating burn wounds, including a toilet and covering the wound with a biological dressing containing a culture of live allogeneic fibroblasts of the human fetus, the dressing is applied to the wound 1-2 days after the injury, and after its removal, the regenerating neo-epithelium is covered with liquid polymer polysiloxane -polycarbonate (PS-PC) film in the form of a 5-6% solution in chloroform in the form of an aerosol, and the PS-PC block copolymer contains both flexible and rigid blocks.

The method is as follows. A dressing based on live cultured allogeneic human fetal fibroblasts is applied on its surface 1-2 days after the injury and the toilet of a burn wound of III degree. After 3 days, the biological dressing is removed. The unicellular layer of neoepithelium formed by this time over the entire surface of the burn wound is covered with a liquid polymer polysiloxane-polycarbonate ("Pentazol") dressing in the form of an aerosol. The copolymer block consists of rigid and flexible blocks and is in the form of a 5-6% solution in chloroform. This composition of the organosilicon polymer allows the formation of a thin (not more than 20 μm), strong, transparent, elastic film on the wound surface that perfectly simulates the relief of the wound surface. The aerosol is sprayed for 2-5 seconds with short pulses at a distance of 15-25 cm from the surface of the wound. Quickly drying, the polymer forms a uniform layer of a protective film, which is well fixed both on the surface of the wound and on the epithelium without the use of additional adhesive. The protective polymer layer provides reliable protection of the wound surface from microbial invasion and drying, prevents the formation of a scab. Excess exudate (which can exfoliate the dressing) does not accumulate under the polymer dressing, because the gas vapor permeability of the protective polymer dressing is comparable to the gas exchange characteristics of healthy human skin. These polymer qualities contribute to the metabolic comfort of tissues in the wound and favorably affect the course of reparative processes.

The aerosol polymer dressing can also be used to protect the burned skin of the victim immediately after an injury before applying a biological dressing based on live cultured allogeneic fibroblasts, the preparation of which takes more than 1 day. The polymer coating is easily removed from the surface along with dead tissue during surgical treatment of wounds. Due to the hydrophobic nature of the polysiloxane-polycarbonate polymer, the wound cover is removed quickly and painlessly with a gauze swab.

The effectiveness of the proposed method is confirmed by clinical examples.

Example 1

Patient O., 57 years old, diagnosis: burn with boiling water IIIa degree 16% p.t. Was admitted to the hospital 3 hours after the injury. On the second day, all burn wounds were covered with a biological dressing based on cultured living allogeneic human fibroblasts. After 3 days, the biological dressing was removed, neoepithelium formed on all wound surfaces. The wounds were treated with Pentazol polymer aerosol. On the seventh day there was a complete scarless epithelization of burn wounds. The polymer film itself exfoliated from the surface of the restored skin.

Example 2

Patient O., 28 years old, diagnosis: burn with a flame IIIa degree of 20% p.t. Delivered to the hospital 4 hours after the injury. Upon receipt, all surfaces of the burn wounds were treated with the Pentazol polymer aerosol. Photo 1 shows the appearance of the aerosol, photo 2 shows a method of applying a polymer dressing to the surface of a burn wound. The next day, the toilet for burn wounds was completed, the polymer film was easily removed from the surface with gauze swabs along with dead tissue (photo 3). The wound surfaces with an area of 1600 cm ^{2 were} covered with a healing dressing based on live cultured allogeneic fibroblasts (photo 4a, b). After 3 days, during the staging, the biological dressing was removed. All surfaces of burn wounds under a biological dressing are covered with a layer of neo-epithelium, which is illustrated by photo 5. To protect the neo-epithelium from drying out and mechanical damage, it was coated with an aerosol method using a Pentazol polymer film. A full multilayer epithelium with a well-formed stratum corneum recovered on the seventh day (photo 6) without signs of hypertrophy. Photo 7 shows the result of a morphological study of the biopsy specimen, which indicates the formation of the entire structure of the multilayer epithelium with a well-defined stratum corneum. The PS-PC polymer film detached independently and painlessly.

Example 3 (for comparison)

Patient A., 18 years old, diagnosis: burn flame II-IIIa degree 45% PT Delivered to the hospital 5 hours after the injury. After 18 hours, the toilet for burn wounds was completed, part of the wounds was covered with a thin scab, which could not be removed. The scab-free wound surfaces with an area of 1800 cm ² were covered with a biological dressing based on live cultured allogeneic fibroblasts, the rest of the wounds with gauze dressings soaked with Levomikol ointment. Three days after application, a neo-epithelium forms under a biological dressing. Biological dressing removed. The surface of the forming epithelium is treated with a polymer aerosol. On the seventh day, under the aerosol coating, the formation of a complete multilayer epithelium without signs of a hypertrophic scar occurred. The wounds, the treatment of which was carried out using dressings based on the water-soluble ointment “Levomikol”, after removal of the scab, they healed on their own only 24 days after the injury with a hypertrophic scar.

Thus, the use of a biological dressing based on live cultured allogeneic fibroblasts at a strictly pathogenetically substantiated stage of the wound process 1-2 days after the injury to stimulate reparative processes in the burn wound in combination with adequate protection of the regenerating epithelium with a liquid polysiloxane-polycarbonate polymer in the form of an aerosol made it possible to reduce terms of scarless healing of extensive burn wounds of IIIa degree up to 7-8 days, which is 2.5-3 times faster than spontaneous epithelization. The use of the described combination for the treatment of 17 patients with extensive burns of the IIIa degree led to a complete scarless restoration of the epithelial structure over the entire surface of the wound. Of these, only one patient had suppuration of a limited area of the wound, which was associated with damage to the polymer film during manipulations that were not related to local treatment. By 14-15 days after the injury, in all observed cases, signs of pigmentation restoration and hair growth were observed in the epithelium.

Claims (2)

1. A method of treating extensive burn wounds of the IIIa degree, comprising a toilet and covering the wound with a biological dressing containing a culture of living cultured allogeneic human fibroblasts, characterized in that the biological dressing is applied to the wound 1-2 days after the injury, and after its removal, the resulting neo-epithelium is covered liquid polymer polysiloxane-polycarbonate film in the form of an aerosol. 2. The method according to claim 1, characterized in that a polysiloxane-polycarbonate block copolymer containing both flexible and rigid blocks, in the form of a 5-6% solution in chloroform, is used as a polymeric wound dressing.

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