RU2476231C1 - Method for reducing necrosis of incisional wound edges following ankle replacement - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly orthopaedics and traumatology, and may be used for treating and preventing necrotic changes of skin of an incisional wound following ankle replacement. For this purpose, with underlying drug-induced therapy aiming at prevention of purulent-septic and thrombotic complications, leech therapy assisted by a Doppler laser flowmeter is conducted in the following regimen: on the first 3 days - 3 leeches each day, on the 4^th-5^th days - 1 leech each day, on the 6^th day - pause, on the 7^th-8^th day - 1 leech each day. If observing capillary blood slowing down by 50-60% of the initial values, the absence of progressing edge necrosis is stated.

EFFECT: method enables well-timed reduction of starting edge necrosis of the incisional wound and technical acceptability.

3 dwg, 1 tbl

Description

The invention relates to medicine, in particular to orthopedics and traumatology, namely to postoperative recovery, and is intended for the treatment and prevention of necrotic skin changes in the area of a postoperative wound after total cemented ankle replacement followed by hirudotherapy.

Given the volume of surgical intervention, it is quite natural that the endoprosthetics operation causes significant physiological and metabolic changes. In the postoperative period, pronounced inflammatory and traumatological processes are observed: venous stasis, microthrombi, local aseptic inflammation and similar processes that lead to circulatory hypoxia and oxidative stress, as a result, to local reparative disorders. The ankle joint is the most distal large joint, which lacks a muscle mass rich in blood vessels, but has dense connective tissue fascia with a small adaptive reserve of blood supply.

The need for regenerating tissues in substrates of oxidation, oxygen, removal of toxins and metabolic products in the postoperative period increases sharply. Against the background of local trophic disturbances, acidosis develops that triggers the lipid peroxidation (LP) reaction, and a circular metabolic mismatch forms with the accumulation of a large number of post-traumatic metabolites.

Considering postoperative hypodynamia, which excludes dynamic muscle contraction - the main pushing force of venous return from the lower extremities, increasing venous blood viscosity, the development of chronic ischemia, increased soft tissue swelling, the possible development of compartment syndrome, a larger percentage of complications is understandable in comparison with prosthetics of other large joints. This, according to many experts, is associated with the development of local trophic disorders.

Known methods of stimulating blood circulation in obliterating diseases of the arteries of the limbs (RU 2093085 C2, publ. 10.10.2002) and stimulation of peripheral blood supply (RU 2190370 C2, publ. 10.10.2002).

However, these methods are not acceptable for this category of patients, since technically they do not allow the application of trepanation holes, tunneling of the bone and the imposition of an external fixation device for dosed compression-distraction efforts in the distal section of the bone metaphysis.

A known method of plastic defects of integumentary tissues of the bone (RU 2149596 C2, publ. 27.05.2000).

However, this method is applicable for existing extensive defects of the skin and cannot be used to treat incipient marginal necrosis of the suture of the postoperative wound.

Known methods of using hirudotherapy for various human diseases and pathologies, namely: A method for the treatment of scoliosis of the I-II degree (RU 2299055 C2, publ. 05.20.2007), A method for the treatment of osteochondrosis of the lumbar spine (application No. 2004122284, publ. 2006.01.27) , A method for the treatment of osteochondropathy (RU 2195947 C2, publ. 2003.01.10), A method for hirudotherapy of varicose veins (RU 2231360, publ. 2004.06.27), A method for the treatment of acute vascular optic neuropathy (RU 2281071 C2, publ. 2006.08.10).

However, in the known methods, hirudotherapy is not used for the relief of necrosis of the edges of the skin after arthroplasty.

The objective of the present invention is the timely relief and treatment of regional necrosis of the skin of the postoperative wound after arthroplasty.

The specified technical result is achieved by the fact that in the method of stopping necrosis of the edges of the skin of the postoperative wound after ankle replacement, including drug treatment aimed at preventing purulent-septic and thrombotic complications, at the same time, under the control of a laser Doppler flowmeter, hirudotherapy is carried out in the mode: the first 3 days - 3 leeches, 4-5 days - 1 leech, 6 days - a break, 7-8 days - 1 leech, to reduce capillary blood flow velocity by 50-60% of the initial value - determine the absence of progression of marginal necrosis.

The present invention is illustrated in the detailed description and illustrations, which depict:

Figure 1 is a view of a postoperative wound on the 14th day after ankle replacement, 4th session of hirudotherapy;

Figure 2 is a view of the postoperative wound on day 22 after endoprosthetics, the 7th session of hirudotherapy;

Figure 3 - in the process of measuring the speed of capillary blood flow with a laser Doppler flowmeter.

The method is as follows.

Patients according to the standard method perform ankle replacement. In the postoperative period, appropriate medication is prescribed, aimed at the prevention of purulent-septic and thrombotic complications, as well as restorative, antispasmodic and analgesic.

And if after the operation, despite the therapeutic measures taken, in the wound zone of the postoperative suture is noted: congestive hyperemia, edema, marginal necrosis of the postoperative wound - they carry out a hirudotherapy course (Gt) in the mode: the first 3 days - 3 leeches, 4-5 days - 1 leech (Figure 1), day 6 - a break, 7-8 days - 1 leech (Figure 2).

In the first three days of treatment, “three leeches” are “placed” with an arrangement in the region of marginal necrosis of the postoperative suture, medially and laterally in the region of the most pronounced edema. From the 4th day of treatment, "put" one leech.

The duration of the session is from 20 to 100 minutes and depended on the time of complete saturation of leeches, that is, independent separation.

Leeches are used once with subsequent disposal.

At the end of the procedure, a cotton-gauze dressing is applied.

For an objective assessment of the changes occurring in the suture area of the postoperative wound and in the adjacent soft tissues, studies were performed using a laser Doppler flowmeter (LDF), which allows measuring the speed of capillary blood flow (CC). The studies were carried out before, during and after the hirudotherapy session proximal and distal, medial and lateral in the suture area of the postoperative wound (Figure 3).

The obtained indicators were averaged and processed using statistical programs.

Prior to the start of the HT session, the capillary blood flow velocity indices were 3 times higher than on the intact limb.

After the first session of hirudotherapy, capillary blood flow decreased by 33.7% and edema in the area of the leech attachment was noticeably reduced.

On average (see table), after each HT session, capillary blood flow decreased by 16.3%.

Table Averaged capillary blood flow velocity during hirudotherapy sessions Units 1st session 3rd session 5th session 7th session to GT after gt to GT after gt to GT after gt to GT after gt ml / min × 100 g cm ³ tissue 8.6 ± 2.02 5.7 ± 0.76 6.6 ± 1.94 5.33 ± 0.73 5.6 ± 0.99 4.6 ± 0.55 4.03 ± 0.52 3.6 ± 0.51 % 33.7 19,2 17.9 10.7 Total 58.1% credibility p <0.01

In the course of treatment, a further decrease in edema was noted, the skin integuments acquired a physiological color, the necrosis area was completely stopped.

Using the proposed method in the clinic FSBI RRC "WTO" them. Acad. G.A. Ilizarova showed that its use provides a complete relief of inflammatory and necrotic phenomena that occurred in the postoperative period after ankle replacement, which is confirmed by stabilization of capillary blood flow.

Claims (1)

A method of stopping necrosis of the edges of the skin of a postoperative wound after ankle replacement, including drug treatment aimed at preventing purulent-septic and thrombotic complications, characterized in that hirudotherapy is performed under the control of a laser Doppler flowmeter in the mode: first 3 days - 3 leeches, 4 -5 day - at 1 leech, 6 day - a break, 7-8 day - at 1 leech, to reduce the capillary blood flow velocity by 50-60% of the initial indicators determine the absence of progressive Ania marginal necrosis.

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