RU2358757C1 - Persistent wound healing approach in patients suffering from pancreatic diabetes - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: persistent wound and trophic ulcer healing in the patients suffering from pancreatic diabetes is ensured by application of medicinal leeches on the wound surface 2-3 times a day followed by application of ointment Piyavit within preparation of the wound surface. The procedure follows until the entire ulcerous bottom is filled with granulation tissue. Then skin flap pre-cured with the ointment Piyavit is transplanted. From the first postoperative days, medicinal leeches are applied on the skin flap in number of 1-3 pieces per a session for course 8-10 days. Then the operative wound is closed with a sterile dressing applied over bandage with ointment Piyavit. The whole therapeutic course involves introduction of capsulated Piyavit in dose 300 mg 2 times a day.

EFFECT: reduced intensity of inflammatory reaction; accelerated start of wound healing with decreased area and reduced recurrence.

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Description

The invention relates to medicine, namely to surgery, and can be used to prepare long-term non-healing wounds in patients with diabetes mellitus for autodermoplasty.

There is a method of treating ulcerative defects in diabetic foot syndrome, including pre-treatment of the wound and the use of dressings, while Activetex wipes are used as dressings, periodically moistened and changed every two days in the following sequence: first, the Activetex HVIT napkin is applied , then "Activtex HVIT-complex", then sequentially: "Activtex X", "Activtex F", "Activtex HF" and "Activtex FHF", while one course of treatment lasts 12 days and is repeated ryaetsya before healing of the defect. RU 2178310, 7 A61K 45/06, A61L 15/20, A61L 15/28, A61P 17/02, 2000.12.18.

The proposed method is based on the alternation in a certain sequence of drugs that suppress the entire spectrum of the microbial flora present in the wound, reduce wound soreness and accelerate healing. However, the leading place in the pathogenesis of diabetic ulcers belongs to polyneuropathy, which this treatment method has no effect on. As a disadvantage of this method, one can also indicate the high cost of dressings.

A known method of treating destructive forms of a diabetic foot is to pre-treat a purulent necrotic lesion, apply a broad spectrum antibiotic to the wound surface and cover it with a moist gauze dressing moistened with 1% hydrochloric acid solution. Dressings are performed daily until fresh granulations appear and the wound is completely cleansed of pus. RU 2184551, 7 A61K 33/00, A61P 31/04, 2001.09.10.

The disadvantage of this method is the use of antibiotics, which can cause adverse and allergic reactions. Locally used antibacterial drugs are toxic, their dose regimen has not been studied, which does not exclude the risk of overdose. This treatment method does not improve neurotrophic function in patients with diabetes mellitus.

A known method of treating long-term non-healing wounds and trophic ulcers, including the operation of skin grafting with a free split dermal flap followed by closing the operating and donor wounds with sterile dressings, the wound being previously closed with a dialdehyde cellulose cloth containing copper soaked in an photosensitizer of the photosensitizer and after keeping the wipes on the wound for 24 hours, irradiate the wound with light with a wavelength of 670 nm, and after performing autodermatoplasty, the operating room also Orsk wounds closed dialdehydecellulose napkin containing herbal antioxidant "Tykveol". RU 2164426 (51), 7 A61N 5/067, A61K 33/34, 1999.07.06.

The disadvantages of the method include the use of additional equipment, non-standard dressings and the use of rare reagents.

The closest analogue to the claimed solution is a method of treating nonhealing wounds and trophic ulcers in patients with diabetes mellitus, including preparing the wound surface for skin plastic surgery, which consists in treating the surface of the wound with Piyavit ointment 2-3 times a day, performing skin plastic surgery by skin flap transplantation, taking Piyavit capsules in an amount of 300 mg 2 times a day for the entire course of treatment. Hirudotherapy in the complex treatment of diabetic foot syndrome. E.A. Leontiev. Bulletin of new medical technologies. 2007, No. 3, p. 152-154.

However, the use of Piyavit ointment and Piyavit capsules is not enough to effectively treat long-term non-healing wounds and trophic ulcers.

The objective of the invention is to develop a method for the treatment of increased effectiveness of long-term healing wounds and trophic ulcers with a shorter treatment period, as well as expanding the arsenal of funds for this purpose.

The technical result is to reduce the risk of relapse, the absence of side effects, reducing treatment time due to the integrated effect on the wound surface.

This is achieved by the fact that in the method of treating nonhealing wounds and trophic ulcers in patients with diabetes mellitus, which includes preparing the wound surface for skin grafting operation, which consists in treating the wound surface with Piyavit ointment 2-3 times a day, performing skin grafting surgery by transplantation skin flap, surgical wound closure with sterile dressings with Piyavit ointment over the dressing, taking Piyavit capsules in an amount of 300 mg 2 times a day for the entire course of treatment, according to the invention, when preparing For the operation and application of the Piyavit ointment to the wound surface, initially medical leeches are placed on the wound surface until the entire ulcerous bottom is filled with granulation tissue and the appearance of marginal epithelization, and during skin plastic surgery, the skin flap is preliminarily kept in the Piyavit ointment, and after transplantation starting from the first day, 1-3 medical leeches are placed on the skin flap per session for a course of 8-10 days.

A method for the treatment of nonhealing wounds and trophic ulcers in patients with diabetes mellitus is as follows. First, they prepare for the operation of skin plastic surgery. For this purpose, after treating the wound surface with a 0.06% solution of chlorhexidine bigluconate with a cotton swab dipped in 70 ° alcohol, medical leeches are placed for 10-21 days before surgery and kept on the patient until completely saturated, after which the leeches spontaneously disappear, and 0.2% ointment “Piyavit” is applied to the wound surface 2-3 times a day with a layer thickness of 1 mm. The procedure is carried out until the surface of the ulcer defect is cleansed of necrotic tissues, the granulation tissue is filled with the entire ulcerous bottom and the appearance of marginal epithelization. Then, a skin graft is transplanted onto the prepared surface. For this, a split flap containing the epidermis and part of the underlying dermis, 0.25-0.38 mm thick, is kept in the Piyavit ointment. Starting from the first day after transplantation of a skin flap, medical leeches are put on the flap in the amount of 1-3 pieces per session. Exposure depends on the time of complete saturation of leeches and is 30-40 minutes. Sessions are carried out daily, the course of treatment lasts from 8 to 10 days. The wound after the bite is treated with a solution of iodine, closed with a sterile dressing with the application of ointment "Piyavit" over the dressing.

In addition, during the entire course of treatment take Piyavit capsules in an amount of 300 mg 2 times a day.

The difference of the proposed method from the known one is the use of Piyavit ointment and Piyavit capsules in conjunction with the setting of medical leeches at the stage of preparing the wound surface for skin plastic surgery, at the stage of the operation and in the postoperative period. In addition, for the operation of skin plastic surgery, the skin flap is preliminarily incubated in Piyavit ointment.

It is known that after autodermoplasty, suppuration of a wound or microbial lysis of a skin autograft is very often observed. The leading place in the pathogenesis of diabetic ulcers belongs to neuropathy. Changes in the somatic and autonomic nervous system lead to the discharge of venous blood through arteriovenous anastomoses. In this case, the capillaries run and obliterate, which leads to ischemia with an outcome in necrosis with the subsequent formation of long-term non-healing ulcers. Induction and sclerosis of the surrounding skin and subcutaneous tissue and the associated violation of the lymph outflow exacerbate the severity of the disease. To eliminate the phenomenon of local tissue hypoxia, the skin flap is preliminarily incubated in the Piyavit ointment and medical leeches are staged. The skin flap aged in the ointment on the first day after the operation has a pale color with areas of exfoliated epidermis, glides along the surface of the wound, there is abundant serous discharge. After staging a medical leech, the skin flap turns pink, and on the second day after the operation, a firm fixation of the flap to the surface of the granulation is determined, which is scanty and serous, which is separated from the wound. On the 10th day, about 90% of the graft surface fully engraft.

Example 1. Patient T., 67 years old, Diagnosis: Diabetes mellitus type 1, severe. Peripheral neuropathy with significant sensorimotor disorders. Diabetic foot syndrome, neuropathic ulcer 3 tbsp. 3 fingers of the right foot. At the base of the 3 toes of the right foot on the plantar surface there is a purulent necrotic wound 2 × 3 cm with severe perifocal inflammation, the wound is made of fibrin. Upon admission, the right foot is swollen, hyperemic. Ripple on the rear of the right foot is saved. Palpation is painless - serous-purulent discharge from the wound appears. Suffers from diabetes for 12 years. 7 months ago he was hospitalized for phlegmon of the right foot, operated on. In the postoperative period, a long non-healing ulcer was formed. Analyzes: blood sugar - 11.7 mmol / l, sugar in the urine - traces, acetone - negative.

Preoperative preparation: infusion therapy, endocrinologist consultation, Piyavit capsules in the amount of 300 mg 2 times a day. For 14 days, a medical leech was placed on the area of the diabetic ulcer and 0.2% ointment “Piyavit” was applied 2 times a day with a layer thickness of 1 mm on the wound surface. The appearance of marginal epithelization was noted on the 12th day, cleansing from fibrinous deposits and filling the entire ulcerous bottom with granulations on the 14th day, when the autodermoplasty operation was performed. Before the operation, they were kept in Piyavit ointment for 7 minutes. For 10 days, medical leeches were placed on the skin flap and treated with Piyavit ointment. On the first day after the operation, the skin flap is pale with areas of exfoliated epidermis, glides along the surface of the wound, there is abundant serous discharge. After staging a medical leech, the skin flap turned pink. Dressed with ointment "Piyavit." The grafts were re-treated on the 2nd day after the operation, the firm fixation of the flaps to the granulation surface was determined, and the scanty, serous discharge from the wound was determined. On the 10th day, about 90% of the graft surface fully engrafted. Against the background of the complex therapy of the postoperative period, by the beginning of 3 days the swelling of the foot and lower leg had decreased, the temperature had returned to normal, blood sugar - 9.75 mmol / l, urine sugar - traces, acetone - negative. The patient was discharged under the supervision of a doctor in the Diabetic Foot cabinet. At discharge: blood sugar - 7.37 mmol / l, sugar in the urine - negative.

Example 2. Patient K., 43 years old. Diagnosis: Type 1 diabetes mellitus, severe. Peripheral neuropathy with significant sensorimotor disorders. Diabetic foot syndrome, diabetic ulcer 3 tbsp. Rear of the right foot. A diabetic ulcer formed about a year ago against the background of a thermal burn of the right foot of 2 tbsp. S = 1%. In the rear of the right foot there is a purulent necrotic wound 4 × 5 cm with severe perifocal inflammation, the wound is made of fibrin. Upon admission, the right foot is swollen, hyperemic. Palpation is painless. Upon admission, the patient's condition is satisfactory. From the internal organs pathology is not detected. The patient had been treated at the purulent surgery department before 27 days. Analgesics, antibiotics were administered to the patient, staged necrectomy, dressings with antiseptic solutions, and ointments on a water-soluble basis were performed. The surface of the ulcer was cleansed of purulent deposits, a free autodermoplasty operation was performed. On day 5, complete transplant lysis occurred. Preoperative preparation lasted 8 days according to the claimed method, the skin flap was preliminarily kept in the Piyavit mixture for 5 minutes, and after the autodermoplasty operation was performed, medical leeches were placed on the skin flap for 10 days and treated with Piyavit ointment. The graft surface engraftment is complete. The patient was discharged from the ward in satisfactory condition under the supervision of a doctor in the Diabetic Foot cabinet. The patient returned to work in his profession.

From the presented examples, it follows that in patients whose treatment complex included hirudotherapy, cleansing of the surface of the ulcer defect from necrotic tissues, filling it with granulation tissue and the appearance of marginal epithelization occurred more than two times faster than in patients whose treatment consisted of applying ointment "Piyavit" and taking capsules "Piyavit." A comparative analysis of the dynamics of a decrease in the circumference of the lower leg in its upper and lower (ankle) thirds in patients of both groups during treatment revealed a significantly faster decrease in the circumference of the lower leg at both measured levels in patients who received hirudotherapy in addition to standard treatment. When comparing the dynamics of changes in average indicators of blood coagulation time according to Sukharev, it was found that the blood coagulation time in the studied groups of patients slightly increases, however, the inclusion of hirudotherapy in the standard treatment complex for diabetic foot syndrome does not significantly affect the blood coagulation time. The average prothrombin index in both groups of patients during the treatment had a slight decrease, but this decrease in both groups was almost the same.

Thus, the claimed method of treatment gives a pronounced and quick clinical effect, which is expressed in the fact that the use of Piyavit ointment in conjunction with staging medical leeches and keeping a skin flap in Piyavit ointment reduces the severity of the inflammatory reaction and accelerates the onset of wound contraction during this period. This leads to a significant decrease in the area of the wound. The use of the invention allows to reduce the risk of relapse and to reduce treatment time due to the integrated effect on the wound surface.

Claims (1)

A method of treating nonhealing wounds and trophic ulcers in patients with diabetes mellitus, including preparing the wound surface for skin grafting surgery, which consists in applying Piyavit ointment to the wound surface 2-3 times a day, performing skin grafting by transplantation of a skin graft, closing the operating room wounds with sterile dressings with Ointment Piyavit over the dressing, taking Piyavit capsules in an amount of 300 mg 2 times a day for the entire course of treatment, characterized in that when preparing the wound surface for op radios before each application of the Piyavit ointment, first the medical leeches are placed on the wound surface until the entire ulcerous bottom is filled with granulation tissue, and during skin plastic surgery, the skin flap is preliminarily kept in the Piyavit ointment, and after the operation, starting from the first day, on the skin the flap is put on medical leeches in the amount of 1-3 pieces per session course of 8-10 days.