RU2504413C1 - Method of treating trophic ulcers and infected persisted wounds - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to surgery, and may be used in treating trophic ulcers and infected persistent wounds. That is ensured by the exposure to an argon plasma flow in a dose of 100-250 J/cm² at 10-25 cm from the treated surface. The exposure length on one field makes 10-25 seconds. The sound surface treatment is followed by the dynamic exposure to a running argon plasma flow at 10-20 cm in a dose of 80-150 J/cm² over the whole wound surface to form a gloss on the wound surface.

EFFECT: method provides the effective treatment of the given pathology ensured by specifying a mode of the exposure causing the microorganism elimination, wound surface drying, sudden perifocal oedema reduction, as well as epithelial cell growth stimulation on the periphery of the wound, as well as on its free surface.

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Description

The invention relates to medicine, in particular to surgery, and can be used in the treatment of trophic ulcers and infected long non-healing wounds.

Currently, there are many ways to treat trophic ulcers and long-lasting infected wounds, ranging from pharmacological preparations (acerbine, pronasan, various ointments) to the effects of various types of energies on the biological tissue (helium-neon and carbon dioxide lasers, magnetic laser unit, ultrasound radiation, electro-laser and cryocoagulation). Despite the abundance of methods for treating these pathologies, the problem of treating trophic ulcers and infected long non-healing wounds is still relevant, since all available treatment methods do not affect the entire healing process or are a preparatory stage of autodermoplasty is not always successful.

A known method of treating trophic ulcers (Pat. RF No. 2198702, class. A61N 5/067, publ. 02.20.2003). The method consists in non-contact surface treatment of trophic ulcers after necrectomy and is used only as a stage in the preparation of a trophic ulcer for autodermoplasty.

There is a method of treating trophic ulcers and long-term non-healing wounds (Pat. RF №2164426, class A61N 5/067, A61K 33/34, publ. 03/27/2001). The method consists in exposing infrared light to a dialdehyde cellulose napkin placed on a trophic ulcer, followed by the application of the Tykveol plant-based antioxidant and autodermoplasty.

The disadvantage of this method is that it is a preparatory stage of autodermoplasty and as a way to independently close trophic ulcers and long-healing wounds is irrelevant.

A known method of treating trophic ulcers of venous etiology (Pat. RF No. 2357772, class A61N 5/067, A61K 31/409, A61K 33/08, A61P 17/02, publ. 06/10/2009). The method consists in the fact that the surface of the ulcer and the skin around the ulcer is treated with an air-gas stream with a nitric oxide content of at least 2000 ppm at a temperature of 40 ° with an exposure of 10 seconds per 1 cm ² . After that, 0.1% radachlorin gel is applied as a photosensitizer at a dose of 0.2 g per 1 cm with an exposure of 60 minutes. Then carry out the action of laser light with a wavelength of 0.665 microns at a dose of light energy of 150-200 J / cm ² at a distance of 3-5 mm to the wound surface.

After that, intravenous irradiation of blood through a cubital vein is performed with laser light with a wavelength of 0.632 μm with a radiation power of 5 mW with an exposure of 15 minutes. The course of treatment is 10 daily treatments with air-gas flow and intravenous laser blood irradiation, 5-8 photodynamic therapy procedures with an interval of 2 days.

The disadvantage of this method is that as its integral component, intravenous irradiation of blood through a cubital vein with laser light is carried out, fraught with the appearance of air embolism, various types of thrombophlebitis and phlebothrombosis.

Closest to the claimed technical essence and the achieved result, selected as a prototype, is a method of treating trophic ulcers and long-term healing wounds (Pat. RF No. 2231377, CL A61N 5/067, A61N 2/06, A61L 15/22, publ. June 27, 2004).

The method is as follows. Sanitize an ulcer or wound with a chlorhexidine solution. A sterile gauze cloth is placed on the surface of the defect, two emitters with magnetic nozzles are placed. Irradiation is carried out with infrared pulsed laser radiation with a wavelength of 0.89 microns, a frequency of 2 Hz to 12 kHz for 5 minutes. Then, from a distance of not more than 5 mm, remote irradiation is performed simultaneously with laser radiation in the visible spectrum and infrared pulsed radiation in the frequency range from 18 to 30 kHz. The wavelength of the used laser radiation of the visible range is selected taking into account the phase of the process. After irradiation, a wound cover is applied to the ulcer or wound surface. Moreover, in the phase of necrosis and inflammation, “lysosorb” or “gelatin” is applied, in the phase of purification and regeneration, “digispon” is applied, and in the phase of epithelization and scarring, “hashispone”. Treatment in patients with venous ulcers is carried out while taking Detralex. In patients with long non-healing wounds, “NEOTIM NS” is simultaneously used.

The disadvantage of this method is that throughout the course, pronounced perifocal edema persists, the wound is slowly cleansed of microflora, there is no local stimulation of immunity, independent growth of epithelial (and not connective tissue).

The problem to which the invention is directed is the creation of a universal method of healing both trophic ulcers of various etiologies and infected long-healing wounds on unchanged biological tissue.

The technical result from the use of the invention is to increase the effectiveness of treatment by cleansing from microorganisms, drying the wound surface, a sharp decrease in perifocal edema, stimulating the growth of epithelial cells both on the edges of the wound and on its free surface.

This result is achieved by the fact that in a method of treating trophic ulcers and long-lasting infected wounds using radiation, followed by an aseptic dressing, a stream of argon plasma at a dose of 100-250 J / cm ^{2 is} placed at a distance of 10-25 cm from the treated trophic ulcer or infected for a long time non-healing wounds with exposure on one irradiated field for 10-25 seconds, after processing the entire wound surface, its dynamic processing is carried out by moving the argon plasma flow at a distance 10-20 cm at a dose of 80-150 J / cm ² over the entire surface of the wound until the "glossy shine" wound surface.

A method of treating trophic ulcers and infected long non-healing wounds is as follows.

A stream of argon plasma in a dose of 100-250 J / cm ^{2 is} placed at a distance of 10-25 cm from the treated trophic ulcer or infected long non-healing wounds with exposure to one irradiated field for 10-25 seconds. After treatment with an argon plasma stream in the described mode of the entire wound surface, its dynamic processing is carried out by moving the argon plasma stream at a distance of 10-20 cm in a dose of 80-150 J / cm ² over the entire wound surface until a "glossy" wound surface appears. Then the wound is closed with an aseptic dressing (for example, with chlorhexidine water).

With a lower dose of exposure to an argon plasma flow of less than 100 J / cm ² , a distance of more than 25 cm and an exposure time of less than 10 seconds, the therapeutic effect is sharply reduced, with a larger dose of 250 J / cm ² , a distance of less than 10 cm and exposure time more than 25 seconds there is a risk of thermal burn.

Clinical trials of the proposed method for the treatment of trophic ulcers and infected long non-healing wounds were conducted on the basis of the Plasma Medical Center in Nizhny Novgorod.

Example 1. Patient K., 54 years old, came for an infected, long, non-healing wound in the region of the right elbow bend. Suffers from hormone-dependent bronchial asthma. 6 months before the treatment, he independently tried to inject calcium chloride into his vein in order to stop an asthma attack, which resulted in the appearance of post-injection phlegmon of the right forearm. He was treated in a general surgical hospital, an autopsy was performed on phlegmon, and sanitation of a purulent focus was performed against antibacterial therapy followed by autodermoplasty. Subsequently, there was a partial rejection of the skin flap, re-infection, suppuration of the wound.

An objective examination revealed an infected wound in the region of the right elbow bend with moderate purulent discharge. After the wound was sanitized with a 3% solution of hydrogen peroxide, it was treated with an argon plasma stream at a distance of 10 cm from the plasma torch nozzle (plasma-arc apparatus "scalpel plasma SP-CPT" (license No. 99-03-001310, registration certificate number - 29 / 01070802 / 4902-03) with a radiation power of 100 J / cm ² and exposure time of 25 seconds per irradiated field. After treatment, an aseptic dressing was applied to the wound. After 3 sessions, perifocal edema around the wound disappeared, the ulcer cleared of discharge. After 7 sessions, it began overgrowth epit At the edges of the wound, on the free wound surface, islands of epithelial tissue appeared, gradually expanding. At the 16th procedure, the wound was completely covered with its own epithelial tissue. To date, there has been no relapse and complications.

Example 2. Patient E. 18 years old, turned about a trophic ulcer in the region of both legs. He suffers from diabetes for 14 years, was repeatedly treated in surgical hospitals, necrectomies, antibiotic therapy were performed. An objective examination: trophic ulcers on the front surface of both legs with copious purulent discharge, purulent scabs. After sanitation of trophic ulcers with a 3% hydrogen peroxide solution, they were treated with an argon plasma stream at a distance of 25 cm from the plasma torch nozzle, with a radiation power of 250 J / cm ² and exposure time of 10 sec per irradiated field. After treatment, aseptic dressings were applied to the ulcers. At the 5th session, the surface of the ulcers was cleansed, the discharge disappeared, followed by the closure of trophic ulcers with its own epithelial tissue in the 14th procedure.

Example 3. Patient D., 55 years old, applied for diabetic foot syndrome, trophic ulcer of the plantar surface of the right foot. Suffers from type 1 diabetes for 12 years. An objective examination revealed a trophic ulcer on the plantar surface of the right foot. The ulcer described above was treated with an argon plasma stream at a distance of 15 cm from the plasma torch nozzle, with a radiation power of 200 J / cm ² and an exposure time of 10 sec per irradiated field. After treatment, an aseptic dressing was applied to the wound. After 2 sessions, perifocal edema around the wound disappeared, the ulcer cleared of the discharge. After 5 sessions, the growth of the epithelium along the edges of the wound began. At procedure 11, the wound was completely closed with its own epithelial tissue.

Thus, the proposed method for the treatment of trophic ulcers and infected non-healing wounds improves the effectiveness of treatment by cleansing from microorganisms, drying the wound surface, drastically reducing perifocal edema, stimulating the growth of epithelial cells both on the edges of the wound and on its free surface.

Claims (1)

A method of treating trophic ulcers and infected long non-healing wounds using radiation, followed by an aseptic dressing, characterized in that the argon plasma stream at a dose of 100-250 J / cm ^{2 is} placed at a distance of 10-25 cm from the treated trophic ulcer or an infected long non-healing wound with exposure on one irradiated field for 10-25 seconds, after processing the entire wound surface, its dynamic processing is carried out by moving the argon plasma flow to a distance of 10-20 cm at a dose of 80-150 J / s ² over the entire surface of the wound until the "glossy sheen" of the wound surface.