RU2386436C1 - Vast wound healing technique - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: invention refers to medicine, namely to combustiology and surgery, and concerns vast wound healing. That is ensured by covering a wound with a polycomposite dressing representing a combination of gel mixture of water-soluble polysaccharides, and coated with a film containing at least fluorine rubber latex and a plant polysaccharide. ^ EFFECT: combined application of said gel and film of a certain composition provides fast wound epithelisation and reduced potential scarring due to specific horizontal growth of lower basal layer of cells. ^ 3 cl, 4 ex, 3 dwg

Description

The present invention relates to medicine, in particular to combustiology and surgery, and can be used to treat extensive burn wounds II and IIIA degree, as well as extensive wounds of any other origin.

The preparations and means used for these purposes must meet the following requirements: isolate the wound from infection; protect it from drying out, reduce heat transfer, have certain antibacterial properties, create an optimal environment for epithelization. There are many known samples of wound dressings that differ in chemical composition. At the same time, there is still no universal drug (B.A. Paramonov, Ya.O. Porembsky, V.G. Yablonsky "Burns" - management, St. Petersburg, SpecLit, 2000).

A known method of treating burns covered with skin grafts and donor wounds (patent RU 2108078, published 10.04.1998) by applying over the wound perforated film dressing DDB-M, which is a perforated material DDB (dressing, dressing dr. R. Breitman), made of a polyethylene film with Breitman complex powder applied on its surface in the form of a mixture of talc, cephalolexin, streptomycin, erythromycin, terramycin, tetracycline, vibromycin, syntomycin, neomycin, kanamycin, nystatin, dactarin, canesten and rivanola (see. Abstracts of the International Surgical Congress "Wounds, burns, dressing". Israel, Tel Aviv, 1990, s.86-87 and 114). Dressings are carried out as necessary after 24, 48 and 72 hours. Treatment is carried out until the wounds heal and the flap is healed.

However, the presence in the dressing material of a large number of different types of antibiotics increases the frequency of allergic reactions, and the plastic film performs only the function of a mechanical barrier and is foreign to wound tissues.

A known method of treating donor wounds (RU 22265454, published 2005.12.10) after performing autodermoplasty, which consists in the fact that once applied polycomposition perforated film, which contains (wt.%) 9.8-19.8 polyvinyl alcohol, 78.3- 89.4 polysaccharide chitosan, 0.1-0.2 anesthetic, 0.5-2.0 antibacterial substances in the form of an antibiotic of the aminoglycoside series, for example gentamicin.

The disadvantages of this method are that the applied dressing has a low mechanical strength, because does not contain binders. This requires additional fixation with a gauze bandage. In addition, polyvinyl alcohol, partially soluble in wound exudate, has an irritating effect.

The main technical problem, the solution of which the invention is directed, is to accelerate the epithelization of extensive burn wounds II and IIIA degree.

Another challenge is to prevent scarring.

Another objective is to expand the range of dressings suitable for treating extensive wounds, as well as to expand the range of products with low allergenicity.

The tasks are solved in that a method for treating extensive wounds is proposed, comprising applying a multicomposite dressing to the wound, in which according to the invention, a combination of a gel based on a mixture of water-soluble plant-derived polysaccharides and a film containing at least fluoro rubber latex and a polysaccharide of plant origin, while the film is applied over the gel and this dressing is changed every 2-4 days until the wound is completely epithelized.

If necessary, before applying the dressing material, debrizing is carried out - the wound toilet, which includes cleaning the wound of microorganisms, dead tissue, blood and its clots, causing a phagocytic inflammatory reaction.

As a gel, take the hydrogel according to patent RU 2180856 or RU 2194535, mainly containing a water-soluble cellulose derivative, a salt of alginic acid, carrageenan or pectin or a mixture thereof, water and an antiseptic, in the following ratio, wt.%:

Water-soluble cellulose derivative - 1.0-15.0

Alginic acid salt - 0.1-15.0

Carrageenan or pectin or a mixture thereof - 0.03-15.0

Antiseptic - 0.05-0.1

Water - Else

As a film, take a monolayer film according to patent RU 2193896, mainly containing fluorine rubber latex, a water-soluble cellulose derivative or a salt of alginic acid, or carrageenan, or pectin, or their mixture and antiseptic in the following ratio of components in terms of dry matter, wt.%:

A water soluble cellulose derivative, or a salt of alginic acid, or

carrageenan or pectin or a mixture thereof - 2.0-95.0

Antiseptic - 0.05-0.1

Fluororubber Latex - Else

The essence of the invention lies in the fact that experimentally it was possible to select a combination of integumentary materials that ensure the maintenance on the wound surface of conditions optimal for its healing, which leads to a reduction in the treatment time, as well as an improvement in the functional and cosmetic results of treatment by reducing the possibility of scar formation.

In addition, this combination of dressings has a low allergenicity, because does not contain components of animal origin.

Obtaining a technical result is ensured by the fact that the gel, filling all the recesses and irregularities of the wound surface, creates the conditions for the movement ("crawl") of cells on the wound surface from both the surface and deep layers, and their faster reproduction, and the film coating, in the composition of which includes components similar to gel components, and which is placed on top of the gel coating, on the one hand, prevents the gel from drying out and protects the wound surface from contamination by microorganisms and mechanical damage denia, and, on the other hand, ensures the preservation of the physicochemical properties of the gel, necessary for cell reproduction and acceleration of epithelization from the edges of the wound.

It was found that the use of gauze bandages to coat the gel leads to the absorption of the gel in gauze, the gel dries quickly and its action ceases.

The use of “OpSait” film coatings (based on propylene) and an acrylic copolymer (as a spray) and Omiderm (as a thin polyurethane film) for these purposes slows the vapor permeability of the gel-monolayer coating combination, which leads to the accumulation of exudate and worsening conditions for the propagation of fibroblasts on the wound surface.

Thus, the combination in the combined dressing not only of the form of the layers forming it - gel and film coating, but also of the composition of components, in particular polysaccharides of plant origin, which are part of both the gel and the film coating, provides an unobvious result, namely, accelerated healing extensive wounds and the prevention of scarring, while using the combination of the gel according to the patent RU 2180856 or RU 2194535 and the film coating according to the patent RU 2193896, which were previously known only as means and for the treatment of superficial wounds.

The use of only one gel according to the patent RU 2180856 or RU 2194535 provides the formation of a thin porous film on the surface of the wound, which does not have sufficient mechanical strength, dries quickly and collapses with strong wound exudation.

The use of only one film coating provides sufficient mechanical protection, but a “wet environment” for healing is not created enough for extensive wounds. In addition, with extensive wounds, the film coating does not provide tight contact with the entire wound surface.

An unexpected result was a change in the nature of the reproduction of epidermal cells. If the use of only a film coating or only gel led to an increase in the growth of epidermal cells upwards, which led to a slow growth of all layers of the epithelium from the edges of the wound, then the use of a combination of coating and gel leads to horizontal growth and reproduction of the lower basal layer of cells that are only capable of breeding. They quickly cover the surface of the wound, reducing the possibility of scar formation.

This is confirmed by photographs of histological preparations, where in Fig. 1 (with an increase of × 800) a transverse section of a section of a wound surface on the third day of treatment using the proposed method is shown, in Fig. 2 (with an increase of × 400) is a transverse section of a section of a wound surface in third day of treatment with a film coating ("Biokol - film" according to example 1), Fig. 3 (with an increase of × 400) - cross section of the wound surface on the third day of treatment with a gel coating ("Biokol - gel" according to example 1 ) The preparations are traditionally stained according to the Hematoxylin – Eosin technique (“Practical Microtechnics and Histochemistry”, D. Kiseli, Budapest, 1962, p. 115).

As can be seen in figure 1, on the wound surface 1 there is a rapid horizontal growth of basal epidermocytes 2 in 1-2 layers of cells, at the same time when using only a film (figure 2) or only gel (figure 3) coating on the wound surface 1 there is a rapid vertical growth of epidermocytes 2 with its rapid differentiation and keratinization 3.

Slower wound closure with vertical growth of epidermocytes can lead to excessive growth of fibroblasts and the formation of scars.

As clinical observations have shown, the combined use of gel and film coatings has proven to be optimal for treating extensive wounds.

The method was tested in clinical conditions at the Department of thermal injuries, wounds and wound infections of the Russian Medical Academy of Postgraduate Education (RMAPO) on the basis of the burn center of the 36th City Clinical Hospital in Moscow for patients with extensive burn wounds II and IIIA degree. In practice, the treatment is as follows.

If necessary, before applying dressings, the wound is cleaned of microorganisms, dead tissue, blood and its clots that cause a phagocytic inflammatory reaction (debris-wound toilet).

After that, a gel is applied based on plant polysaccharides according to patent RU 2180856 or RU 2194535, which is coated with a film based on fluorine rubber latex and plant polysaccharide according to patent RU 2193896, and the film is applied over the gel and this dressing is changed every 2-4 days to complete epithelialization of the wound.

Example 1

To implement the method, “Biokol - gel I” was prepared as described in patent RU 2180856, containing (in grams) 15.0 carboxymethyl cellulose, 10.0 sodium alginate, 5.0, carrageenan, 0.05 chlorhexidine, water up to 1000, and a monolayer film coating "Biokol - film I", as described in patent RU 2193896, containing (wt.%) 79.95 fluorine rubber latex, 20.0 mixture of sodium alginate and pectin and 0.05 chlorhexidine.

Patient Chernyshev P.N., 58 years old. Diagnosis: Thermal (flame) burn of the head, neck, upper limbs, trunk, left thigh I-II-IIIA degree 48% of the body surface. Injury from 06/27/08. Entered the department on 06/27/08. At the time of admission, the primary wound toilet was carried out. On the third day after removing the patient from shock, a dressing was performed, including a burn wound toilet (debrizing) with application of the Biokol - Gel I gel and the Biokol - Film I wound cover on burn wounds of the upper limb 10% of the body surface. The remaining sections of the burn wound were covered with a “Biofilm I” wound dressing. The patient underwent complex treatment, dressings after 2-3 days. Epithelialization of wounds in the upper extremities began on the 5th day after the start of treatment, and in the head, neck, and torso — on the 8-10th day. Complete epithelization of these wounds was noted on days 20 and 25 after the injury, respectively.

The patient was discharged on the 25th day after the injury in satisfactory condition. Scar tissue formation not noted.

Example 2

Was prepared "Biokol - gel II", as described in patent RU 2194535, containing (in grams) 15.0 methylcellulose, 10.0 calcium alginate, 5.0 carrageenan, 0.05 miramistin, water up to 1000, and a monolayer film coating "Biocol - film II", as described in patent RU 2193896, containing (wt.%) 75.95 fluororubber latex, 24.0 mixture of carrageenan and pectin and 0.05 miramistin.

Patient Boturlin N.I., 28 years old. Diagnosis: Thermal (flame) burn of the trunk, upper and lower extremities of I-II-IIIA degree 62% of the body surface. Concomitant diseases - drug addiction, hepatitis C. Injury from 07/03/08. He was admitted to the department on 07/05/08, a serious condition. A comprehensive intensive treatment of burn disease was performed in the intensive care unit. A primary wound toilet with antiseptics was performed. On the 6th day after the staged debrising, the Biokol - Gel II gel and the Biokol - Film II wound dressing were used during dressing. Dressings after 2-3 days, including toilet wounds, repeated application of the gel and coating Biokol. 5 days after the start of the indicated treatment, the wound surface began to clean and after 7 days it was completely cleansed, active epithelization began. Epithelization was completed 13 days after the start of treatment (19 days after the injury). Scar tissue formation not noted.

Example 3

Was prepared "Biokol - gel III", as described in patent RU 2180856, containing (in grams) 10.0 mixture of methyl cellulose and carboxymethyl cellulose, 10.0 sodium alginate, 10.0 mixture of carrageenan and pectin, 0.05 chlorhexidine, water to 1000, and a monolayer film coating "Biokol - film III", as described in patent RU 2193896, containing (wt.%) 75.95 fluorine rubber latex, 24.0 mixture of calcium alginate and pectin and 0.05 miramistin.

Sick Gorshkov V.A. 54 years old. Diagnosis: Burn flame I-II-IIIAB art. head, neck, trunk, left upper limbs - 20% of the body surface. Injury from 07/13/08. Entered the department on 07/14/08. At the time of admission, the primary wound toilet was carried out. On the third day, ligation using Biokol - Gel III, which was closed and fixed with Biokol - Film III.

The following studies were carried out in a patient: general and biochemical blood tests, culture from a wound for flora and sensitivity, wound cytology (dynamics improved in dynamics).

The flow is smooth. The first dressing after application of the method on day 2, the wound is clean, marked the beginning of active epithelization. The patient was discharged on the 11th day.

Example 4 (for comparison).

Patient Ipolitova R.A. 74 years old. Diagnosis: Thermal (flame) burn of the upper limb, anterior chest and abdominal walls of II-IIIA art. - 8% of the body surface. Concomitant: hypertension of the II st., Obesity 2 tbsp., IHD, postinfarction cardiosclerosis. Injury from 09/08/07. Received in the department on 09/16/07; general condition is serious. In connection with the existing concomitant disease, intensive treatment was carried out. On the 6th day after hospitalization, the Geleplan wound cover (TU9303-008-52708501) was applied to the wound surface.

At the first dressings, suppuration under the dressings was noted. Subsequently, the inflammation was stopped, however, there were no signs of epithelization on the 12th day after the start of local treatment using Gelepran.

Thus, the above examples 1, 2, 3 of the implementation of the proposed method confirm the possibility of its use for the successful treatment of extensive wounds, in particular extensive burns II-IIIA degree. Epithelization of the wound surface begins, depending on the severity of the damage, 5-7 days after the start of applying the combination of gel and a monolayer film containing water-soluble polysaccharides of plant origin, while the use of the Geleplan wound cover (TU9303-008-52708501) (example 4) did not lead to the onset of epithelization even on the 12th day after the start of local treatment.

The examples of specific performance confirm that the proposed method is feasible. With its help, 21 patients with extensive wounds of various localization and etiology, including burn wounds, were treated.

Claims (3)

1. A method for treating extensive wounds, comprising applying a multicomposite dressing to a wound, characterized in that a combination of a gel based on a mixture of water-soluble plant-derived polysaccharides and a film containing at least fluorinated rubber latex and a plant-derived polysaccharide is used as a dressing; which is applied on top of the gel, while the hydrogel containing, wt.%:
water soluble cellulose derivative 1.0-15.0 alginic acid salt 0.1-15.0 carrageenan or pectin or a mixture thereof 0.03-15.0 antiseptic 0.05-0.1 water rest
and as a film, a film containing, wt.%:
water soluble cellulose derivative, or a salt of alginic acid, or carrageenan or pectin, or a mixture thereof 2.0-95.0 antiseptic 0.05-0.1 fluorine rubber latex rest 2. The method according to claim 1, characterized in that the dressing is changed every 2-4 days until the wound is completely epithelized. 3. The method according to claim 1, characterized in that if necessary, before applying the gel, a wound toilet is carried out.

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