RU2441618C2 - Perianal and sacrococcygeal area wound healing stimulation technique and the device designed for its performance - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: inventions referred to medicine, colorectal surgery and can be used for perianal and sacrococcygeal area wound healing stimulation during the post surgical period in patients operated for anal fistula of various localizations, as well as for pilonidal cyst chronic inflammation treatment. For this purpose thermal treatment of recess and sinus tract cavity in the wound is performed. In this case a needle electrode is inserted into the wound surface bio-tissue down to 5-15 mm and is fed with impulse high-frequency current for 3-10 seconds, the current frequency being at the range of 2-6 MHz, relative impulse duration - 6-10, pulse repetition frequency - 1-10 kHz, voltage impulse amplitude - 160-200 V, average power - 3-5 W. The device consists of the high-frequency electric impulse generator, modulator providing for the required relative high-frequency current impulse duration, timer, foot lever, electronic unit for needle electrode metered shift device control, electro-mechanical needle electrode metered shift unit with a needle electrode.

EFFECT: reduction of the time required for perianal and sacrococcygeal area wound healing during the post surgical period in patients operated for anal fistula of various localizations; allows pilonidal cyst chronic inflammation treatment.

6 cl, 1 dwg, 1 ex

Description

The invention relates to medicine, namely to colorectal surgery, and can be used to treat postoperative wounds of the perianal and sacrococcygeal region.

A known method of treating wounds of the perianal and sacrococcygeal regions in the postoperative period, based on local antibacterial and stimulating wound healing therapy. It is carried out by washing the wounds with solutions of antiseptics (a solution of chlorgesidine, betadine, etc.), as well as applying dressings with water and fat-soluble ointments (levomekol, methyluracil ointment, etc.) on the wound surface (Kuzin M.I., Kostyuchenko B.M. Wounds and wound infection. - M., 1990 [1] and Datsenko BM Theory and practice of local treatment of purulent wounds. - Kiev, 1995 [2]).

The disadvantages of this method are :.

- the prevalence of multi-resistant strains among potential pathogens of infectious wound complications, which significantly reduces the effectiveness of local antiseptic therapy;

- a decrease in the activity of antibacterial and stimulating agents due to their partial inactivation in the wound due to binding to proteins;

- treatment using traditional dressings is long, lingering, dressings are painful due to the drying of the dressing to the wound.

A known method of surgical treatment of epithelial coccygeal passage [RU 2283632, publ. 09/20/2006], which is the prototype of the proposed method for the treatment of purulent wounds of the perianal and sacrococcygeal regions, which consists in laser treatment of the cavity of pockets and fistulous passages with purification and evaporation of devitalized and altered biological tissues. Processing is carried out by means of a 2-3-fold interstitial laser thermotherapy with a laser operating continuously with a wavelength of 970 nm and a power of 2.5 W. As a means of delivering laser radiation to the irradiation site, a flexible monofilament fiber is used, the distal end of which is immersed in the fistulous passage through the primary openings or transcutaneously. The immersion depth of the distal end of the fiber is controlled by ultrasound. The duration of laser exposure is in the range of 30-180 s.

The disadvantages of this method are:

- the complexity of processing a large area of the wound surface;

- the need for a large number of radiation sessions;

- individual patient sensitivity to the procedure;

- the impossibility of visual control of the irradiation zone during thermal exposure;

- the difficulty of optimizing the radiation dose both in time and in area and depth of exposure for a particular patient;

- the reserve capabilities of his body are not taken into account.

All this reduces the effectiveness of the treatment process, increases the healing time of wounds in the postoperative period.

The aim of the invention is to reduce the healing time of wounds of the perianal and sacrococcygeal region in the postoperative period in patients operated on for fistulas of the rectum of various localization, as well as chronic inflammation of the epithelial coccygeal passage.

The specified goal is achieved in the following way. In the proposed method for stimulating wound healing of the perianal and sacrococcygeal region in the postoperative period in patients operated on for rectal fistula of various localization, as well as for treating chronic inflammation of the epithelial coccygeal passage after treating the surgical field with an antiseptic agent, a needle electrode is introduced into the biological tissue, and fed to the electrode pulsed high-frequency current for a period of 3 to 10 seconds, that is, they heat-treat the cavity of the pockets and fistulous passages in the wound. The introduction of a needle electrode into the biological tissue is carried out to a depth of 5-15 mm. The depth of introduction of the needle electrode into the biological tissue is determined by the nature of the pathomorphological process and is 5-15 mm.

It should be noted that the pulse high-frequency current is supplied to the needle electrode only after it is introduced into the biological tissue to the mentioned depth, and the needle electrode is removed from the biological tissue only after the pulse high-frequency current is stopped.

By moving the electrode in a checkerboard pattern with a step of 5-15 mm and, each time after injection, applying a pulsed high-frequency current to the needle electrode introduced to the given depth into the biological tissue, the entire wound surface is treated in this way.

The frequency of the high-frequency current is in the range of 2-6 MHz, the duty cycle of the pulses is 6-10, the pulse repetition rate, which ensures the high efficiency of the method, lies in the range of 1-10 kHz, the voltage amplitude (160-200) V, the average exposure power (3-5 ) Tue As a rule, the procedure is prescribed once for 2 days after surgery. In difficult cases, the procedure is repeated up to 3 times with an interval of 3-4 days.

Also, this goal is achieved by using the device according to the present invention. The drawing shows a device for stimulating wound healing in the perianal and sacrococcygeal region in the postoperative period in patients operated on for rectal fistula of various localization, as well as for the treatment of chronic inflammation of the epithelial coccygeal passage, which contains a generator (1) of high-frequency electric pulses (high-frequency current generator ), a modulator (2), providing the above duty cycle of high-frequency current pulses, a timer (3), a pedal (5), an electronic control unit (4) of the device dosed movement of the needle electrode, an electromechanical module (6) dosed movement of the needle electrode with a needle electrode (7).

The device operates as follows. The electromechanical module (6) of the metered movement of the needle electrode (7) is installed on the wound surface. Set the duty cycle of pulses 6-8, the exposure time of the high-frequency current in the range of 3-10 seconds. Press the pedal (5), the signal from which is fed to the timer (3). From the timer, the signal enters the electronic unit (4) for controlling the dosed movement of the needle electrode, from which a signal is supplied to start the electromechanical module (6) of the dosed movement of the needle electrode (7). The movement (translational movement) of the needle electrode begins, which is introduced into the biological tissue perpendicular to the wound surface to a predetermined depth of 5 to 15 mm.

After the needle electrode (7) is pulled out from the unit of the dosed movement device to a length corresponding to the depth of introduction of the needle electrode mentioned above, a signal is sent from the timer to start the high-frequency current generator, the current of which, modulated by the modulator (2), is supplied to the needle electrode (7). A current from said electrode (7) passes through biological tissue to a return electrode (not shown), thereby performing a monopolar method of electrosurgical treatment.

After the high-frequency current is supplied to the needle electrode from the electronic control unit for the dosed movement of the needle electrode (after a set time, of the order of 3-10 seconds), a signal is triggered on this unit, which starts the procedure of moving the needle electrode (7) inside the unit.

It should be noted that the voltage from the high-frequency generator (1) is sequentially supplied only to the extended needle electrodes (7).

Next, the electromechanical module (6) of the dosed movement of the needle electrode (7) is moved to a new place and the previously described procedure is repeated until the wound surface is completely treated.

To accelerate the treatment of the wound surface, the needle electrode (7) can contain from one to four needles, each of which is supplied with a high-frequency current strictly in a predetermined sequence, the needle electrodes (7) are advanced from the electromechanical module (6) of the dosed movement of the needle electrodes (7) independently from each other both individually and all at the same time, which is set by the operating staff.

This design of a multi-needle electrode can significantly reduce the time of the electrotherapeutic procedure and eliminates the mutual influence of the needle electrodes.

Clinical example:

Patient A., 47 years old, IS No. 482-09, was admitted with complaints of purulent discharge from the anus, pain in the anal canal during defecation.

With an external examination of the perianal region, the anus is closed, the perianal reflex is alive. At 6 hours, a funnel-shaped retraction-external fistulous opening about 2 mm in diameter is determined. With a digital study of the rectum, the sphincter tone and volitional efforts are satisfactory. At 6 o’clock in the area of the posterior crypt, a scarred internal fistulous opening up to 2 mm in diameter is determined. When examining with a button probe, the course of the fistula is transfunctional.

The patient was diagnosed with a posterior transsphincter fistula of the rectum.

02/12/09, the patient underwent surgery in the amount of excision of the fistula, opening and drainage of the intersphincter flow. On the second day after surgery, the patient underwent the procedure of electropulse stimulation of the wound by the proposed method. A multi-needle electrode (7) with two needle electrodes was used. The frequency of the RF current is 2.64 MHz, the duty cycle of pulses is 8, the voltage is 160 V, the average power is 5 W, the exposure time for each injection was 6 seconds. Using this method, a 5 cm ² surface was treated.

The postoperative period was uneventful. The appearance of marginal epithelization was recorded on the third day after the procedure, by the ninth day after the operation, wound cleansing with the most complete formation of granulation tissue was observed, by the fourteenth day a decrease in the size of the postoperative wound was observed, and on the twentieth day the complete epithelization of the wound with the formation of a postoperative scar was determined macroscopically.

Thus, the method and device for its implementation according to the present invention allows:

- reduce the time of wound healing after surgery for rectal fistula and chronic inflammation of the epithelial coccygeal passage due to the acceleration and simultaneous occurrence of phases of the wound process;

- reduce postoperative hospital stay;

- reduce the time of social and labor rehabilitation.

Claims (6)

1. A method of stimulating wound healing of the perianal and sacrococcygeal region in the postoperative period in patients operated on for rectal fistula of various localization, as well as treatment of chronic inflammation of the epithelial coccygeal passage, which consists in heat treatment of the cavity of the pockets and fistulous passages in the wound, characterized in that the treatment of the wound surface is carried out by introducing a needle electrode into the biological tissue to a depth of 5-15 mm and applying a pulsed high-frequency current to it for a time of 3-10 s, while the frequency of the mentioned current is in the range of 2-6 MHz, the duty cycle of the pulses is in the range of 6-10, the pulse repetition rate is in the range of 1-10 kHz, the amplitude of the voltage pulses of the mentioned current is in the range of 160-200 V, the average exposure power is in the range 3-5 watts 2. The method according to claim 1, characterized in that the removal of the needle electrode from the biological tissue is carried out only after the cessation of the supply of pulsed high-frequency current to it. 3. The method according to claim 1, characterized in that the needle electrode is moved in a staggered manner until the entire wound surface is completely treated. 4. A device for stimulating wound healing in the perianal and sacrococcygeal region in the postoperative period in patients operated on for rectal fistula of various localization, as well as for the treatment of chronic inflammation of the epithelial coccygeal passage, containing a high-frequency electric pulse generator that provides a current frequency in the range of 6-10 MHz, the amplitude of the voltage pulses in the range of 160-200 V and the average exposure power in the range of 3-5 W, a needle electrode connected to the said generator and installed Indicated in the electromechanical module for the dosed movement of the needle electrode, said electromechanical module moves the said needle electrode under the action of a signal from the electronic control unit of the device for the dosed movement of the needle electrode connected to a timer that sets the time of the action of the said electrode on the biological tissue. 5. The device according to claim 4, characterized in that it further comprises a pedal, when pressed, an electrical signal is applied to said timer. 6. The device according to 4, characterized in that the needle electrode contains from one to four needles.

Images