RU2433839C1 - Method of transmembrane dialysis of purulent wounds - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely, to surgery, and can be applied for treatment of purulent wounds of various etiology. For this purpose on surface of purulent wound applied is membrane capsule, filled with sorbent. As membrane capsule used is membrane bandage, which consists of polypropylene capsule, which hermetically fixed on it film. Cavity of polypropylene capsule is connected with membrane film, made from polyhydroxyalkanoate with pore size 2.7-3.0 nm, and is filled with dialysing solution, which consists of mixture of 100 ml Octenisept and 6 grams of enterosorbent Polysorb MP. Replacement of dialysing solution in membrane bandage is carried out in postoperative period daily during 10-12 days.

EFFECT: method makes it possible to increase efficiency of treatment of purulent wounds due to prevention of injury of formed granulating tissue and secondary infection.

2 cl, 3 tbl, 1 ex

Description

The invention relates to medicine, in particular to surgery, and can be used to treat purulent wounds, burns, pressure sores and trophic ulcers.

A known method of treating purulent-necrotic wounds [1], which consists in the following: add in 25 ml of xenosplenic homogenate 100 ml of physiological saline, mix, decant and centrifuge at 1500 rpm. The supernatant is mixed with 3 ml of 100% dimexide and the resulting treatment mixture is applied on a gauze napkin at the rate of 1 ml of the mixture per 1 cm ^{2 of} the wound surface. An application is made on the purulent-necrotic surface of the wound of a gauze wipe soaked in the treatment mixture once a day daily. The method allows to improve the penetration of the drug into the tissue, accelerate the healing of wounds. However, this method is difficult to prepare and use. In addition, this method is traumatic for the wound, since the solution applied to the wound surface dries 1 time per day, and the subsequent change of the wound dressing leads to injury to the young granular tissue of the wound, which increases the healing time.

A known method of draining purulent wounds using gel sorbents enclosed in a semipermeable membrane [2]. This drainage consists of a membrane capsule made of a corrugated tubular semipermeable membrane made of cuprofan with a lumen diameter of 20 ± 2 mm, pore size from 1.5 to 3.0 nm, the cavity of which is 1/3 filled with polymer granular preparations, which are in aqueous solutions form soft gels. Gel sorbents absorb the fluid contained in the wound exudate, while removing wound edema. However, this method of drainage is effective only in the first hours after placing the membrane capsule on the wound surface, after which the sorbent is rapidly saturated with wound discharge. In addition, to replace the sorption material, it is necessary to completely replace the membrane capsule, because the contents of the membrane are gel-like, which disrupts the natural healing process and injures the wound.

The task of the invention is to increase the effectiveness of treatment of purulent wounds and reduce the length of stay of patients in a hospital.

The problem is solved due to the fact that a membrane dressing consisting of a polypropylene capsule with a membrane film hermetically fixed on it is used as a membrane capsule, while the cavity of the polypropylene capsule is in communication with a membrane film made of polyhydroxyalkanoate with a pore size of 2.7-3 , 0 nm, and is filled with a dialysis solution consisting of a mixture of 100 ml of Octenisept and 6 g of Polysorb MP enterosorbent, and the dialysis solution in the membrane dressing is replaced daily in the postoperative period but within 10-12 days.

The essence of the invention lies in the fact that as a wound cover a membrane dressing was used, consisting of a polypropylene capsule with a membrane film hermetically fixed on it, while the cavity of the polypropylene capsule was in communication with the membrane film. The polypropylene capsule has a hermetically sealed opening on its surface and is made of medical polypropylene. As a membrane film, a film made of polyhydroxyalkanoate (PHA) at the Institute of Biophysics SB RAS was used in the form of a rectangular sheet with pore sizes of 2.7-3.0 nm, transmitting substances with a molecular weight of up to 12,000 daltons. Since the membrane film is made of a biopolymer, the antigenic load on the wound surface is reduced, compared with other wound dressings used in clinical practice. In addition, the membrane film has the properties of a semipermeable membrane, which allows for transmembrane dialysis of purulent wounds. The used film was hermetically glued to the polypropylene capsule and thereby formed a membrane dressing, the cavity of which was filled with a dialysis solution consisting of a mixture of 100 ml of Octenisept and 6 g of Polysorb MP enterosorbent. Enterosorbent molecules have high cumulative properties, which contributes to greater adsorption of toxic substances, and due to the high osmoticity of the solution, transmembrane dialysis occurs. Due to the osmotic properties of the dialysis solution, active transmembrane sorption of toxins of low and medium molecular weights and fluids in the wound exudate occurs, thereby reducing wound edema, which contributes to the speedy cleaning and healing of the wound. The dialysis solution was replaced every day for 10-12 days as follows: the dialysis solution was injected into the cavity of the polypropylene capsule through a Janet syringe with a PVC pipe attached to its end through a hole on its surface and the spent dialysis solution was aspirated. After emptying the cavity of the polypropylene capsule using another Janet syringe with a PVC pipe attached to its end, a new dialysis solution of the same concentration and volume was injected, after which the opening of the polypropylene capsule was sealed. During the procedure of replacing the dialysis solution, there is no trauma to the wound surface, since the membrane dressing is constantly on the wound surface, thereby preventing secondary infection of the wound.

To prove the effectiveness of the proposed method, two groups of patients with purulent-inflammatory diseases of the soft tissues were treated. The main nosologies were: phlegmonous-necrotic forms of erysipelas, infected soft tissue wounds and trophic ulcers.

The first group (comparisons) consisted of 40 people with purulent-inflammatory soft tissue diseases who received traditional treatment. All patients of the first group after admission to the hospital according to emergency indications underwent surgical treatment of wounds, opening of abscesses, necrectomy. Moreover, all wounds were superficial, with a depth of 5 mm. Surgical treatment was completed by wound drainage. For wound drainage, gauze wipes, rubber graduates, antiseptics and ointments were used.

The use of drugs for local treatment was regulated by the stage of the wound process according to the classification of V.I. Struchkov (1975). During dressings, the wounds were washed with 3% hydrogen peroxide solution, antiseptic solutions, purulent necrotic masses were removed mechanically. Further treatment in the phase of inflammation was carried out using furatsilina, an aqueous solution of chlorhexidine, 0.02% solution of plavecept, a solution of boric acid. To cleanse the wounds, proteolytic enzymes were used: trypsin, chymotrypsin, terrilithin, as well as water-soluble ointments: levomecol, levosin. In the regeneration phase, solcoseryl and methyluracil ointments, sea buckthorn oil, etc. were used until the granulation tissue matured. Then, if necessary, the wound defect was closed by applying secondary sutures. The department conducted complex intensive infusion therapy using antispasmodics, analgesics, antimetabolites, blood substitutes for detoxification and hemodynamic series, aimed at reducing the level of toxinemia. Subsequently, this group received traditional conservative therapy, which included general medication and local treatment. In order to increase the body's resistance, stimulate phagocytosis and regenerate connective and epithelial tissue, methyluracil and pentoxyl were prescribed in generally accepted dosages. Antibiotic therapy was carried out taking into account the results of antibioticograms, possible side effects, compatibility with other drugs. In urgent situations, de-escalation antibiotic therapy was prescribed with broad-spectrum drugs.

Analysis of laboratory data upon admission of patients to the hospital revealed a high level of endogenous intoxication. The luciferase index (LI) was 0.51 ± 0.10 cu, the leukocyte intoxication index (LII) was 5.36 ± 0.9 units, and leukocytosis reached 18.3 ± 1.7 × 10 ⁹ / l (table 1).

Table 1 The dynamics of clinical and laboratory parameters in patients with purulent-inflammatory diseases of the soft tissues against the background of traditional treatment Indicators Day postoperative period (n = 40) To the operas. one 3 5 7 10 fifteen Body temperature, ° С 39.8 ± 1.2 39.2 ± 1.5 38.7 ± 0.8 38.3 ± 0.6 * 38.0 ± 0.5 * 37.6 ± 0.4 * 36.9 ± 0.3 * White blood cells N · 10 ⁹ / l 18.3 ± 1.7 18.4 ± 1.2 17.3 ± 2.2 15.1 ± 0.8 * 13.4 ± 1.2 * 11.9 ± 0.48 * 7.8 ± 0.48 * LII (unit) 5.36 ± 0.9 6.02 ± 0.82 5.96 ± 0.77 6.18 ± 0.43 5.26 ± 0.56 * 3.63 ± 0.71 * 1.94 ± 0.34 * LI blood (c.u.) 0.51 ± 0.10 0.48 ± 0.13 0.44 ± 0.06 0.36 ± 0.07 * 0.35 ± 0.05 * 0.30 ± 0.06 0.26 ± 0.04 * Red blood cells N · 10 ¹² / l 4.2 ± 0.8 4.8 ± 1.2 3.8 ± 0.4 4.0 ± 0.31 4.1 ± 0.4 4.3 ± 0.32 4.3 ± 0.32 Hemoglobin (g / l) 130.0 ± 3.6 141.2 ± 4.1 140.5 ± 5.6 137.4 ± 2.3 130.5 ± 1.1 127.2 ± 2.2 134.5 ± 2.1 Urea (mmol / L) 9.4 ± 0.8 10.7 ± 2.3 10.2 ± 1.9 9.6 ± 1.8 9.1 ± 1.3 * 7.8 ± 1.2 * 6.2 ± 0.7 * Creatinine (μmol / L) 97.4 ± 8.3 98.8 ± 10.8 95.1 ± 9.7 93.4 ± 7.2 87.2 ± 4.9 85.3 ± 5.7 84.1 ± 5.3 AST (mmol / h · l) 0.44 ± 0.05 0.52 ± 0.1 0.48 ± 0.07 0.4 ± 0.1 0.45 ± 0.12 0.42 ± 0.08 0.4 ± 0.09 Alt (mmol / h · l) 0.83 ± 0.1 0.79 ± 0.12 0.74 ± 0.08 0.78 ± 0.08 0.8 ± 0.11 0.63 ± 0.05 * 0.57 ± 0.04 * Total protein (g / l) 64.1 ± 4.2 63.4 ± 2.5 62.3 ± 3.4 65.2 ± 4.3 67.4 ± 1.9 69.6 ± 2.2 70.8 ± 2.3 Bilirubin (μmol / L) 26.4 ± 4.7 25.5 ± 4.3 25.4 ± 1.2 23.8 ± 3.4 20.1 ± 2.6 17.3 ± 2.2 15.5 ± 1.7 Blood sugar (mmol / l) 5.2 ± 0.4 5.0 ± 0.2 4.8 ± 0.8 4,5 ± 0,2 4.1 ± 0.1 4.0 ± 0.4 4.4 ± 0.5 Note: * - significance of differences compared with indicators before surgery (P <0.05).

As can be seen from table 1, despite intensive care on the first day after surgery, the LI of serum was 0.48 ± 0.13 cu, which corresponds to an average degree of intoxication. A significant decrease in the level of LI in the blood serum of patients of the first group was noted only on the 5th day of treatment, it amounted to 0.36 ± 0.07 cu In almost all patients, an increase in intracellular aminotransferases, in particular, ALT, was observed in serum. Indicators of protein metabolism were changed towards catabolism, so the level of urea at admission was 9.4 ± 0.8 mmol / L. A clinically significant decrease in serum urea concentration was noted only on the 10th day of treatment - 7.8 ± 1.2 mmol / L. Hemoglobin, total protein, and erythrocyte counts were within the normal range.

In addition to the traditional treatment, a transmembrane dialysis membrane filled with a dialysis solution consisting of a mixture of 100 ml of Octenisept and 6 g of Polysorb MP enterosorbent was performed by a patient of the study group of 44 people (the second group) with the same nosologies, in addition to traditional treatment. For sterilization, the membrane dressing was placed for 1 hour in 1% formalin solution, and then for 20-30 minutes in physiological saline to wash off formalin. After sterilization, the membrane dressing was filled by 1/3 of the dialysis solution, applied to the previously treated wound surface, after which the membrane dressing was fixed to the skin surface using an adhesive plaster.

Patients of both groups were admitted to the clinic with symptoms of intoxication of varying severity, with complaints of severe throbbing pain in the lesion area, headaches, chills, severe weakness, lack of appetite, fever up to 40 ° C. The severity of the condition of patients was confirmed by clinical and laboratory parameters. The diagnosis was established on the basis of anamnesis, clinical picture of the disease, laboratory data (table 2).

table 2 The dynamics of clinical and laboratory parameters in patients with purulent-inflammatory diseases of the soft tissues against the background of transmembrane dialysis. Indicators Day postoperative period (n = 44) To the operas. one 3 5 7 10 fifteen Body temperature, ° С 39.6 ± 1.3 38.8 ± 0.7 37.9 ± 0.6 * 37.4 ± 0.5 * 37.0 ± 0.4 * 36.7 ± 0.2 * 36.6 ± 0.3 * White blood cells N · 10 ⁹ / l 18.3 ± 1.7 17.5 ± 1.3 15.3 ± 1.2 * 12.8 ± 1.2 * 9.7 ± 1.4 * 7.8 ± 0.9 * 5.4 ± 0.6 LII (unit) 5.36 ± 0.9 5.12 ± 0.74 4.71 ± 0.45 3.28 ± 0.46 * 2.15 ± 0.37 * 1.47 ± 0.38 * 1.39 ± 0.24 LI blood (c.u.) 0.51 ± 0.1 0.45 ± 0.8 0.37 ± 0.05 0.32 ± 0.04 * 0.27 ± 0.03 * 0.22 ± 0.03 * 0.21 ± 0.03 * Red blood cells N · 10 ¹² / l 4.2 ± 0.8 3.9 ± 0.7 4.1 ± 0.4 4.2 ± 0.3 4.4 ± 0.5 4,5 ± 0,2 4,5 ± 0,2 Hemoglobin (g / l) 130.0 ± 3.6 123.5 ± 4.3 128.7 ± 4.9 132.4 ± 3.2 133.8 ± 5.6 134.1 ± 4.7 134.6 ± 2.5 Urea (mmol / L) 10.5 ± 1.8 7.7 ± 2.3 7.5 ± 1.9 7.2 ± 1.8 6.4 ± 1.3 * 6.0 ± 0.9 * 5.2 ± 0.7 * Creatinine (μmol / L) 97.4 ± 8.3 96.5 ± 7.2 91.2 ± 6.8 87.7 ± 4.5 85.2 ± 4.9 82.3 ± 5.7 80.1 ± 5.3 * AST (mmol / h · l) 0.44 ± 0.05 0.50 ± 0.08 0.45 ± 0.06 0.44 ± 0.05 0.42 ± 0.05 0.40 ± 0.04 0.40 ± 0.04 * Alt (mmol / h · l) 0.83 ± 0.1 0.78 ± 0.09 0.72 ± 0.07 0.65 ± 0.07 0.52 ± 0.06 * 0.48 ± 0.05 * 0.44 ± 0.04 * Total protein (g / l) 64.1 ± 4.2 64.0 ± 3.1 65.6 ± 4.5 67.3 ± 3.8 68.8 ± 2.7 70.4 ± 3.1 73.5 ± 3.4 * Bilirubin (μmol / L) 26.4 ± 4.7 24.2 ± 3.8 21.5 ± 2.3 18.7 ± 1.9 16.4 ± 2.2 14.5 ± 1.8 14.4 ± 1.6 * Blood sugar (mmol / l) 5.2 ± 0.4 4.8 ± 0.3 4,5 ± 0,4 4.6 ± 0.3 4.2 ± 0.4- 4.3 ± 0.5 4.2 ± 0.3 Note: * - significance of differences compared with indicators before surgery (P <0.05).

As can be seen from table 2, against the background of transmembrane dialysis with a mixture of 100 ml of Octenisept and 6 g of the Polysorb MP enterosorbent in the second group, an improvement in the general condition, reduction in pain and perifocal edema were noted just a day after the operation. A decrease in body temperature was recorded on the third day of treatment. By 6-7 days of the postoperative period, the temperature did not exceed 37 ° C.

A significant decrease in endotoxicosis occurred on the third day of treatment. So, the number of leukocytes in the blood of patients of the second group was 15.3 ± 1.2 × 10 ⁹ / l, and by the 10th day of treatment this indicator did not exceed the normal level - 7.8 ± 0.9 × 10 ⁹ / l . At the same time, in patients of the first group, a decrease in the number of blood leukocytes occurred only by the 15th day of treatment. A clinically significant decrease in LII in patients of the second group was also noted on the 3rd day of treatment - 4.71 ± 0.45 units, and normalization of this indicator occurred by 10 days of the postoperative period - 1.47 ± 0.38 units. Against the background of traditional treatment in patients of the first group, the decrease in LII to normal occurred only on days 16-18. The change in the integral toxicity of the blood also varied significantly. Against the background of transmembrane dialysis, a significant decrease in LI was observed on the 3rd day of hospitalization of 0.37 ± 0.05 cu, while in patients receiving conventional treatment, this indicator was 0.44 ± 0.06 cu . A decrease in LI to normal in patients of the second group was noted by the 10th day of treatment - 0.22 ± 0.03 cu, while in patients of the first group normalization of the indicator occurred only by the 15th day of treatment - 0.26 ± 0.04 cu

The nature of the course of the wound process during transmembrane drainage of wounds in patients of the second group also differed from the first group of patients (table 3).

Table 3 The dynamics of the course of the wound process in patients of both groups Symptoms Day (n = 40) Day (n = 44) Pain relief 7.2 ± 1.3 2.6 ± 1.5 * The disappearance of perifocal edema 8.6 ± 0.8 3.4 ± 1.3 * The emergence of single granulations 10.8 ± 1.6 5.2 ± 0.7 * The appearance of epithelization of the edges of the wound 12.5 ± 1.1 7.5 ± 1.2 * Complete cleansing of wounds from purulent-necrotic masses 14.8 ± 1.3 8.4 ± 1.5 * Filling wounds with mature granulation tissue 16.7 ± 2.1 9.4 ± 1.8 * Note: * - significance of differences compared with the parameters of the group of patients (P <0.05).

During the initial morphological study of the wounds of patients of both groups before the start of drug treatment, a pattern of a widespread purulent-inflammatory process was revealed. The tissues of the bottom and edges of the wound were covered with purulent-necrotic masses, abundantly infiltrated polymorphic-nuclear leukocytes.

In patients of the first group, by the fifth day of postoperative treatment, microscopic examination of histological preparations of purulent wounds showed fragmentation of the fibrinous-leukocyte layer, but the infiltration of the bottom and wound tissues by polymorphonuclear leukocytes continued. The area of purulent inflammation was covered with a continuous layer of exudate and elements of tissue decay. Sufficiently large foci of purulent exudation and tissue destruction were detected in various areas of the wound. The stability of vascular disorders was noteworthy: dilatation of capillaries and venules, marginal standing of leukocytes, paravasal hydration of interstitium.

On the 10-12th day of inpatient treatment with microscopy of histological preparations, the appearance of superficial areas of necrosis and inflammation was noted, the edges of the wound were thickened. But the periphery formed a few islands of granulation tissue with a large number of collagen fibers and a meager content of cellular elements and blood vessels. Neutrophilic infiltration persisted. On the surface of the granulation tissue layer at the edges of the wound, a layer of loosely located fibroblasts was determined, which did not have blood vessels, but containing a large amount of interstitial substance. Features of collagenogenesis and architectonics of mature connective tissue, represented mainly by dense fibrous strands, testified to the risk of developing a rough scar.

On the 15-18 day of treatment, the morphological picture of purulent wounds was characterized by filling of the wound cavity with granulations, concentric contraction of its edges and walls, and the beginning of epithelization.

The epithelium grew on the surface of granulations in the form of a narrow border, the growth rate is low. No features of wound healing were noted during this period. The average hospital stay for patients of the first group with purulent-inflammatory soft tissue diseases was 22.5 ± 1.4 hospital days.

As can be seen from table 3, in patients of the second group already on the 3rd day of the postoperative period, the wound discharge acquired a serous-fibrinous character, and the wound surface began to clear from purulent-necrotic masses. The duration of the first phase of the wound process was 8.4 ± 1.5 days, whereas with traditional treatment, in patients of the first group, it reached 14.8 ± 1.3 days. Simultaneously with the formation of granulations, epithelization of the edges of the wound and contraction of the wound defect began.

In the initial morphological study in the wounds of patients of the second group, they had a picture of a purulent-inflammatory process with areas of necrosis. A large number of purulent-necrotic masses were determined on the surface of the wounds, the edges and the bottom were edematous, abundantly infiltrated. During microscopy of histological preparations, the vessels were dilated, in some of them mixed thrombi and massive leukocyte diapedesis in the surrounding tissues were found. After the start of transmembrane dialysis on the 3rd day, relief of edema, a decrease in the number of purulent-necrotic masses, and a decrease in tissue infiltration by leukocytes were noted. In some areas, foci of newly formed tissue consisting of thin-walled vessels, young fibroblasts and vagus cells were visualized. In the surface layers of the wound, newly formed vessels in some places took a vertical direction with respect to the wound surface, and the fibroblasts located between them occupied a horizontal direction. On the 9th day, the edges of the wound around the entire circumference were significantly closer due to the active growth of granulation tissue and contraction of the wound. Leukocyte tissue infiltration was negligible. The edges of relatively small wounds, which had an initial size of about 6-7 cm ² , were completely close on the 10th day and covered the wound defect.

On the 12-15th day of treatment, the wound cavity was filled with fresh granulations, the edges of the wounds were reduced, epithelization began. Among the growth features, rapid epithelization of the wound edges was noted. The average hospital stay for patients of the second group with purulent-inflammatory soft tissue diseases was 18.5 ± 1.9 bed days.

Thus, thanks to the application of the proposed method, the treatment of purulent wounds is improved, which leads to a reduction in the time of inpatient treatment of patients. So, the average length of hospital stay of patients of the second group (18.5 ± 1.9 bed days) is reduced by an average of 4 days, compared with patients of the first group (22.5 ± 1.4 bed days).

Clinical example

Patient M., 55 years old, medical history No. 3469. He entered the surgical department No. 2 of the Municipal Clinical Hospital No. 7 of Krasnoyarsk on June 24, 2008 with a diagnosis of Erysipelas of the right lower leg, phlegmonous-necrotic form. Complaints upon receipt of pulsating and bursting pains, swelling and redness in the right lower leg, fever up to 38.6 ° C, sharp weakness.

From the anamnesis it was found that on June 20, 2008, the patient, being in the country, received a household injury to his right leg. In this case, a small, moderately bleeding and slightly painful wound appeared. I did not seek medical help. Gradually, the patient's condition worsened, swelling and hyperemia in the right lower leg and foot increased, body temperature increased to 38.5 ° C. 06/24/2008, he sought medical help, after which he was taken by an ambulance team to the emergency room of the Municipal Clinical Hospital No. 7, where after examination he was hospitalized in the surgical department No. 2.

The patient's condition upon admission is severe, the skin is pale, moist. Body temperature 38.6 ° C. Vesicular breathing, no wheezing, respiratory rate 21 in one minute. Cardiac tones are muffled, rhythmic, blood pressure on both hands 130/80 mm Hg Pulse 112 in min., Rhythmic. The tongue is dry, coated with a white coating. The abdomen is not swollen, participates in the act of breathing, with palpation, soft, painless in all departments. Liver but edge of costal arch. The spleen is not palpable. R-graph of the right lower leg of 06/24/08: no pathology of the bone system was detected. Status localis: upon examination, the right lower limb is swollen to the upper third of the leg, the skin is sharply hyperemic, there is a detachment of the skin in the region of the lower third of the right leg. On the anterolateral surface of the right lower leg in the lower third there is an infected wound up to 4 cm in diameter, irregular in shape with areas of necrosis of the wound edges and purulent discharge. On palpation, sharp pain and fluctuation along the lower third of the right lower leg to the right ankle joint is noted. In blood tests dated 06/24/08: leukocytosis (21.7 × 10 ⁹ / l), ESR - 53 mm / h, hemoglobin - 119 g / l, red blood cells - 4.7 × 10 ¹² / l, blood sugar - 5, 3 mmol / l, leukocyte intoxication index - 4.5 units, the indicator of integral blood toxicity decreased - 48 cu On June 24, 2008, at 19 ⁰⁰ hours, a surgical treatment of the wound of the right lower leg was performed: excision of the necrotic edges of the infected wound. At the same time, antibiotic therapy and massive infusion therapy using introductory-electrolyte solutions were performed. A membrane dressing consisting of a polypropylene capsule with a membrane film hermetically fixed on it was applied to the wound surface, while the cavity of the polypropylene capsule was in communication with the membrane film. The polypropylene capsule has a hermetically sealed opening on its surface and is made of medical polypropylene. As a membrane film, a film made of polyhydroxyalkanoate (PHA) at the Institute of Biophysics SB RAS was used in the form of a rectangular sheet with pore sizes of 2.7-3.0 nm, transmitting substances with a molecular weight of up to 12,000 daltons.

The dressing cavity was filled with a dialysis solution consisting of a mixture of 100 ml of Octenisept and 6 g of Polysorb MP enterosorbent, an aseptic dressing was applied over it. The dialysate was replaced as follows: the dialysis solution was injected into the cavity of the polypropylene capsule via a Janet syringe with a PVC tube attached to its end through a hole on its surface and the spent dialysis solution was aspirated. After emptying the cavity of the polypropylene capsule using another Janet syringe with a PVC pipe attached to its end, a new dialysis solution of the same concentration and volume was injected, after which the opening of the polypropylene capsule was sealed.

By the 3rd day of treatment (06/27/08), body temperature dropped to 37.4 ° C, clinical and laboratory indicators improved - the number of leukocytes decreased to 13.7 × 10 ⁹ / l, the leukocyte intoxication index decreased to 3 units, the indicator integral blood toxicity decreased to 35 cu Significantly decreased swelling and hyperemia of the right lower leg and foot, wound discharge acquired serous-fibrinous nature. By 5 days (06/29/08) the treatment of pain in the wound area was insignificant, body temperature of 37.1 ° C, edema and hyperemia of the wound area significantly decreased, young granulation tissue appeared in the wound, fibrinous plaque decreased. On the 7th day of the postoperative period (1.07.2008), body temperature returned to 36.8 ° C, clinical and laboratory parameters: the number of leukocytes - 8.5 × 10 ⁹ / l, leukocyte intoxication index - 1.8 units, indicator integral toxicity of blood - 28 cu On the 8th day, the membrane dressing was removed from the wound surface, the wound was completely cleaned of purulent-necrotic masses, filled with granulation tissue, the edges of the wound epithelialize. Contraction, epithelization and scarring of the postoperative wound ended on the 1st day of treatment. Patient M. on July 5, 2008, was discharged from the hospital in satisfactory condition for outpatient monitoring by a surgeon in a clinic at the place of residence.

Literature

1. RF patent No. 2313352, A61K 35/28, A61M 35/00, A61P 17/02, BIPM No. 36, 12/27/2007.

2. Gryaznov V.N. The use of gel sorbents in experimental and clinical surgery / V.N.Gryaznov, E.F. Cherednyakov, A.V. Chernykh - Voronezh, 1990. - 88 p.

Claims (2)

1. A method of transmembrane dialysis of purulent wounds, comprising applying to the surface of a purulent wound a membrane capsule filled with a sorbent, characterized in that a membrane dressing consisting of a polypropylene capsule with a membrane film hermetically fixed on it is used as a membrane capsule, while the cavity of the polypropylene capsule communicated with a membrane film made of polyhydroxyalkanoate with a pore size of 2.7-3.0 nm, and filled with a dialysis solution consisting of a mixture of 100 ml of Octenisept and 6 g of enterosorb ent Polysorb MP. 2. The method of transmembrane dialysis of purulent wounds according to claim 1, characterized in that the replacement of the dialysis solution in the membrane dressing is carried out in the postoperative period daily for 10-12 days.