RU2350292C2 - Method of treatment of panaritium of middle and nail phalanxes of finger - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention concerns medicine area, namely to surgery. The essence consists in the following: open a suppurative focus, carry out necretomy, drain the wound. Treat the wound in thirty minutes after an operative measure repeatedly. An aseptic bandage is applied on the basic phalanx of the damaged finger and a sterile glove with the cut off manual part is put on the hand, except the amased finger which is immersed in the rubber glove rest. Enter the water-soluble ointment possessing antimicrobial and anti-inflammatory action into a rubber part of the glove finger.

EFFECT: use of the given invention allows raising efficiency of treatment, to provide immediate constant contact of a postoperative wound to water-soluble ointment, constant medical effect on wounded a surface, to lower an edema and squeezing of soft tissues of a finger that, in turn, improves blood supply and a wound repair, provides good cosmetic effect.

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Description

The present invention relates to medicine and relates to methods for treating panaritium.

The key to success in the treatment of panaritium is a timely and adequate surgical intervention, the final stage of which in the postoperative period is the timely treatment of the wound and the introduction of medicinal substances into it, taking into account the stage of the wound process.

There is a method of treating panaritium, according to which, after opening a purulent foci, a Voskopran wound cover containing levomekol is applied directly to the wound (see Chadayev A.P. Modern methods of local drug treatment of infected wounds / A.P. Chadayev, A.D. Klimiashvili // Surgery. - 2003. - No. 6. - S.54-56), but with panaritium the use of this method is technically difficult due to the peculiarities of postoperative wounds.

There is a method in which subcutaneous panaritium of the nail or middle phalanx is treated by opening a purulent lesion, necrectomy and conducting a flow-washing drainage, sanitizing a purulent lesion with antiseptic solutions (see Meleshevich A.V. Panaritsy and phlegmon brush: Textbook / Grodno State University . - Grodno. - 2002. - 185 p.). However, this treatment method often causes complications in the form of suppuration of the wound due to the presence of a purulent necrotic substrate in it, which leads to repeated surgical interventions and a decrease in the effectiveness of the treatment.

The closest is the method of treatment, according to which, after opening the purulent foci, a necrectomy is performed, wound drainage with a dressing with water-soluble ointments (see Konychev A.V. Purulent hand surgery / I.A. Yeryukhin, B.R. Gelfand, S.A. .Shlyapnikov // Surgical infections. - St. Petersburg: Peter, 2003. - S.457-509). However, part of the water-soluble ointment, “absorbed” into the dressing, ceases exposure to the wound surface. The amount of therapeutic substance decreases, the effectiveness of its use decreases. In addition, the ointment dressing adheres to the wound surface and when it changes, granulation is damaged.

The technical result of the proposed method is to provide a permanent therapeutic effect on the wound surface, thereby increasing the effectiveness of treatment, as well as reducing postoperative complications and the duration of treatment.

What is new in achieving the technical result is that after the bleeding stops, the wound is reprocessed, an aseptic dressing is applied to the main phalanx of the finger.

It is also new that a sterile glove is put on the hand and the affected phalanx is immersed in a water-soluble ointment inserted into the glove finger corresponding to the affected phalanx, while the remaining finger part of the glove is cut off.

Performing re-treatment of the wound under conditions of stopped bleeding ensures constant contact of the wound surface with the ointment, since there is no leaching of the drug substance from the wound.

The application of an aseptic dressing on the main phalanx prevents the flow of the therapeutic agent, providing a constant therapeutic effect of the wound surface.

Immersion of the affected phalanx in a sterile glove with a water-soluble ointment reduces the swelling of the phalanges of the finger and squeezes the soft tissues of the finger in a limited space, which improves blood circulation and increases the effectiveness of treatment.

Immersion in a water-soluble ointment of the affected finger allows for direct permanent contact of the postoperative wound with the ointment, postoperative wounds heal with gentle longitudinal scars, providing a good cosmetic effect.

Repeated dressing with drainage of the wound under conditions of constant contact with the drug reduces complications and allows patients to be discharged without changing the fitness category for military service with good cosmetic results.

A method of postoperative treatment of panaritium of the middle and nail phalanges of the finger of the hand by re-treating the wound by immersing the affected phalanx in a sterile glove with a water-soluble ointment can reduce swelling and squeezing of the soft tissues of the finger in a limited space, which improves blood circulation and increases the effectiveness of treatment.

Comparative analysis with the prototype shows that the proposed method differs from the known one in that after stopping the bleeding, the wound is reprocessed, an aseptic dressing is applied to the main phalanx of the finger, a sterile glove is put on the wrist and the affected phalanx is immersed in a water-soluble ointment inserted into the glove finger corresponding to the affected finger phalange, while the rest of the finger part of the glove is cut off, which meets the criterion of "novelty."

A new set of features allows to increase the effectiveness of treatment for panaritium, provides direct permanent contact of the postoperative wound with a water-soluble ointment, which has a constant therapeutic effect on the wound surface, having antimicrobial and anti-inflammatory effects, and the pronounced osmotic activity of the ointment reduces swelling and compression of the soft tissues of the finger in a limited space, which, in turn, improves blood circulation and wound healing, preparing it for early closure with sutures, It provides a good cosmetic effect. All this meets the criterion of "industrial applicability".

The method is as follows.

Under conduction anesthesia, a purulent lesion is opened, necrectomy is performed, and dressings are performed. 30 minutes after the operation, the aseptic dressing is removed and, in conditions of stopped bleeding, the wound is reprocessed, and drainage is established. An ointment on a water-soluble basis (levomekol, levosin) is introduced into the wound. In a sterile glove, the finger part is cut off, except for the interested finger. An aseptic dressing is applied to the base of the affected finger, with a width not exceeding the main phalanx. The glove is put on the brush, 3-5 grams of water-soluble ointment are introduced into the rubber part of the “glove finger” and the affected phalanx is immersed. Dressing is carried out daily for 2-3 days. After the operation, a course of antibiotic therapy and analgesics are prescribed for 3-4 days.

The proposed method was used by the authors in 23 patients, all patients were discharged without changing the fitness category for military service, with good cosmetic results.

The method is illustrated by a clinical example.

Example 1. Patient V., 20 years old, weight 72 kg, was admitted to the military hospital on 08/16/2006 with a diagnosis of Subcutaneous felon of the middle phalanx of the second finger of the left hand. He considers himself sick for five days, when after a microtrauma, pain appeared in the middle phalanx of the second finger of the left hand. On August 14, 2006, a panaritium was opened in a medical center; they performed dressings with levosin. 08/15/06, the pain intensified, the night the patient did not sleep, 08/16/06 he was sent to the surgical department of a military hospital. Heredity and history are not burdened.

Upon admission, the patient's condition is satisfactory. Complains of bursting pain in the finger, poor general health. The skin is physiological in color. Peripheral lymph nodes are not enlarged. In the lungs, vesicular breathing, no wheezing. Heart sounds are clear rhythmic. Blood pressure - 120/80 mm Hg, pulse - 70 beats. per minute. The abdomen is soft, painless. Basting on the area of the kidneys is painless on both sides. The second finger of the left hand in a bent state, the middle and main phalanges are thickened, on the back surface on the middle phalanx moderate hyperemia, on the lateral surface a postoperative incision of 0.2 × 1.0 centimeter with purulent discharge. On palpation with a button probe, sharp pain on the palmar surface of the middle phalanx. Movement in the joints of the finger is painful.

Upon admission, a general blood test: red blood cells - 4.6 × 10 ¹² / l, hemoglobin - 128 g / l, white blood cells - 10.9 × 10%, ESR - 17 mm / hour; urine analysis is normal. X-ray of the second finger of the left hand: no bone pathology was detected.

The patient was taken to the operating room. Under conduction anesthesia according to Oberst-Lukashevich, a mid-side (mediolateral) longitudinal incision 10 mm long was made along the working surface, along the inoperative surface of the finger, the abscess was opened with a 30 mm long longitudinal incision. Stand out 3.0 ml of purulent discharge, which is taken for sowing and the sensitivity of microflora to antibiotics. A necrectomy was performed. The wound was abundantly washed with a solution of hydrogen peroxide, drained with a strip of glove rubber with levomekol. The wound bleeds slightly. Aseptic dressing. Postoperative diagnosis: Subcutaneous panaritium of the middle phalanx of the second finger of the left hand. After 30 minutes, the patient was re-taken to the operating room. On examination, the wound does not bleed, is re-treated with a solution of hydrogen peroxide, an aseptic dressing is applied to the main phalanx of the finger. Levomekol was introduced into the wound. In a sterile glove, the finger part is cut off, except for the second finger. A glove is put on the brush, 5 grams of levomecol are introduced into the rubber part of the “glove finger” and the affected finger is immersed. Left hand on a scarf.

The night the patient was asleep. 08/17/06, the patient complains of minor pain in the postoperative wound, notes an improvement in overall health. On dressing: finger swelling decreased, wound with scanty serous discharge, dressing with levomekol was repeated.

Sowing on the flora: St.aureus, OMC - 10 ⁸ , high sensitivity to gentamicin, weak sensitivity to cefazolin and penicillin. From the first day, the patient received: gentamicin 80 mg × 3 times No. 5; further to discharge from the hospital: metronidazole 0.25 g × 2 times, a solution of dipyrone 50% - 2.0 ml + diphenhydramine 1% - 1.0 ml × 2 times a day intramuscularly, UHF on the affected finger, 08/19/06 g A drainage was installed through which flow-washing washing with antiseptic solutions was carried out for 3 days. 08/22/06, the drainage is removed. The postoperative period without complications, the wound healed. The patient was discharged in satisfactory condition on day 9.

Examined after 4 months: on the lateral surfaces of the middle phalanx of the second finger of the left hand, postoperative tender longitudinal scars, painless on palpation.

Claims (1)

A method of treating panaritium of the middle and nail phalanges of the finger of the hand by opening the purulent focus, necrectomy, drainage of the wound, characterized in that the wound is re-treated thirty minutes after surgery, an aseptic dressing is applied to the main phalanx of the affected finger, and a sterile glove with a cropped finger is put on the wrist part, except for the affected finger, which is immersed in the remaining part of the rubber glove, while a water-soluble ointment is introduced into the rubber part of the glove finger, ayuschuyu antimicrobial and anti-inflammatory action.