RU2528905C1 - Method of soft tissue wound healing of various aetiology - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: biologically active additive Laviocard+ is prescribed orally 1 capsule 2 times a day with food for 21 days. That is combined with daily wound irrigations with neutral analyte of anhydrohexitol nucleic acid with leaving a sterile gauze bandage impregnated with neutral analyte of anhydrohexitol nucleic acid in the wound until it is clean. That is followed by daily bandaging with Lavitol cosmetic dihydroquercetin powder applied on the wound surface 1-2 mm thick until the wound is healed.

EFFECT: reduced length of wound healing by stimulating the regeneration processes in tissues.

1 ex, 3 tbl

Description

The invention relates to medicine, in particular to surgery, and can be used to treat soft tissue wounds of various etiologies.

An integrated approach to the treatment of wounds consists in adequate local treatment of wounds and stimulation of the regenerative abilities of the body [Shevchenko Yu.L. et al., 2009, 1]. In recent years, there has been an increase in virulence and increasing microflora resistance to most commonly accepted antimicrobial agents, and a decrease in general and local immunity [Zarivchatsky MF, 2008, 2].

Among the agents with a pronounced antimicrobial effect is the neutral anolyte ANK [http: //echaros.rf/katalog-oborudovaniya/lektrokhimicheski-aktivirovannye-rastvory/anolit.3; http: //echaros.rf/katalog-oborudovaniya/lektrokhimicheski-aktivirovannye-rastvory, 4]. The ANK neutral anolyte is prepared on an STEL-type electrolyzer [http://www.bakhir.ru/eng/publications/18-medalphabet-11-2006.htm, 5] according to the instructions for this installation [http://mkolga.ru/catalog /ustanovki-stel.html, 6; technical description and operating instructions for the installation STEL-10N-120-01, 7]. Known methods for local treatment of wounds with a neutral anolyte ANK did not provide for the additional use of antioxidants [Gridin A.V., 2005, 8; Bachmanov A.E., 2009, 9]. Currently, it is known that the activation of free radical reactions (CPP) of lipid peroxidation (LPO) causes disruption of the wound process, therefore, the use of various exogenous inhibitors of CPP is the basis of pathogenetic treatment of wounds [Lutsevich O.E., 2011, 10]. Dihydroquercetin (taxifolin) is one of the agents with a pronounced antioxidant effect [http://www.ametis.ru/production/lavitol-dihydroquercetin/application, 11]. Known methods of local application of funds containing dihydroquercetin in the form of a balsam gel [No. 2381810, 12], and wound gel coatings “Flamen” [http://www.vitalcrystal.ru/flamena-small.html, 13]. However, these methods have the following differences: 1) do not include the use of a neutral anolyte ANK in the local treatment of wound healing and the simultaneous oral administration of antioxidants; 2) the concentration of dihydroquercetin in the form of a powder in the wound is higher than in the composition of the gel and wound dressings; 3) the production of balsam gel and wound dressings is technically more complex and is carried out only in the conditions of pharmaceutical enterprises, which increases their cost.

In addition, there is a method of using the biologically active additive "Laviocard +" containing dihydroquercetin to stimulate the healing of postoperative breast wounds [patent No. 2428198, 14]. This method is distinguished by the fact that it is used exclusively to stimulate the healing of clean uninfected surgical wounds (with sutures) of the mammary gland and consists only in the oral administration of Laviocard +, does not provide for local exposure of the neutral anolyte ANK and the antioxidant dihydroquercetin to the wound.

The objective of the invention is the creation of a treatment method that reduces the healing time of wounds.

The essence of the method: the proposed method of treating soft tissue wounds of various etiologies, which allows to reduce the healing time due to local application of the neutral anolyte ANK in the phase of inflammation and dihydroquercetin powder "Lavitol cosmetic" - in the regeneration phase in combination with the oral administration of biologically active additives "Laviocard +", containing dihydroquercetin for 21 days.

The task is achieved due to the following: 1) the neutral anolyte ANK allows you to effectively suppress the wound microflora and cleanse the wound from necrotic tissue, which reduces the phase of inflammation; 2) topical application of Lavitol cosmetic dihydroquercetin powder in the regeneration phase stimulates reparative processes in the wound, shortening the duration of the regeneration phase; 3) oral administration of the biologically active additive “Laviocard +” helps to correct violations of lipid peroxidation (LPO) processes and activation of antioxidant defense (AOD) in homeostasis.

The proposed method is as follows. After surgery (incision, drainage, removal of necrotic tissue) in the phase of inflammation, the wound is washed daily with ANK neutral anolyte and a sterile gauze cloth impregnated with neutral APK anolyte is left in the wound until the wound is completely cleansed, and the Laviocard + dietary supplement is administered orally 1 capsule 2 times a day with meals for 21 days. After cleansing the wound (in the regeneration phase), daily dressings are performed with Lavitol Cosmetic dihydroquercetin powder, which is applied to the wound surface with a layer of 1-2 mm until the wound is epithelized independently or secondary sutures are applied to the wound or before and after performing autodermoplasty with a free split skin flap .

A comparative analysis of the results of the application of the method was carried out in patients of the main (7) and control groups (7). The proposed treatment method was applied to patients of the main group, patients in the control group received conventional local treatment (in the phase of inflammation - 0.1-0.5% chlorhexidine solution; in the regeneration phase - levomycol).

In the main group - 3 women and 4 men; in the control group - 2 women and 5 men. The average age of patients in the main group was 46.3 years, and in the control group - 45.6 years. In the main group, autodermoplasty with free split skin flap was performed in 3 patients, in the control group - in 3 patients. In 2 patients of the main group and 3 patients of the control group, the wounds healed due to self-epithelization. Secondary sutures were applied to two patients of the main group and one patient of the control group. The diagnoses of patients are presented in table 1.

Table 1 The diagnosis of patients in the main and control groups Diagnosis Main group Control group Phlegmon of the lower extremities 2 one Necrotic form of erysipelas one 2 Soft tissue abscess one 2 Pressure ulcer III Art. one one Burn wounds 2 one Total: 7 7

The results of the application of the proposed method were analyzed on the basis of the course of the wound healing process, microbial contamination of the wounds, the study of lipid peroxidation indexes (diene conjugates, malondialdehyde) and antioxidant protection AOD (vitamin E, ceruloplasmin) on the first day and day 21 of treatment.

The course of the wound process in patients of the main and control groups is shown in Table 2.

table 2 The course of the wound process in the main and control groups Wound healing indicators Main group Control group Duration of wound cleansing (days) 3.2 ± 0.2 6.3 ± 0.1 The timing of the appearance of granulations (days) 4.3 ± 0.6 7.8 ± 0.5 Dates of onset of marginal epithelization (days) 6.3 ± 0.1 9.1 ± 0.4 Duration of wound epithelization (days) 17.3 ± 1.2 24.4 ± 2.6 Wound scarring time (days) 21.1 ± 1.6 28.3 ± 3.3 Terms of preoperative preparation (days) 6.3 ± 1.2 12.1 ± 1.3

Patients of the main group who received treatment with the proposed method noted earlier periods of wound cleansing from necrotic tissues (3.2 ± 0.2 days), the appearance of granulations (4.3 ± 0.6 days), marginal (6.3 ± 0 1 day) and complete epithelialization of the wound (17.3 ± 1.2 days), scarring of wounds (21.1 ± 1.6 days) compared with patients in the control group (6.3 ± 0.1 days; 7.8 ± 0.5 days; 9.1 ± 0.4 days; 24.4 ± 2.6 days; 28.3 ± 3.3 days, respectively).

The terms of preoperative preparation for autodermoplasty in the main group of patients as a result of the reduction in the phases of the wound process were less (6.3 ± 1.2 days) than in the control group (12.1 ± 1.3 days).

Thus, in patients of the main group treated with the proposed method, the timing of the phases of the wound process decreased by 1.5-2 times compared with the main group. The duration of preoperative preparation for autodermoplasty in the main group was 1.9 times less than in the control group.

The study of microbial contamination of wounds on the 1st and 10th day of treatment in patients of the main and control groups showed a pronounced antimicrobial effect of the neutral anolyte ANK on the wound flora. At the beginning of treatment, microbial flora was isolated in patients of both groups, in which Staphylococcus aureus, Klebsiella spp., E.coli, Proteus spp. Prevailed. Microbial contamination at the beginning of treatment reached 10 ^5-6 mt on 1 cm ² . By the 10th day in patients of the main group, microflora was absent in the wound or its content decreased to 10 ^2-3 mt per 1 cm ² , whereas in the control group microbial seeding persisted and amounted to 10 ^4-5 mt on 1 cm ² . The data obtained indicate the antimicrobial effectiveness of the neutral anolyte ANK.

Indicators of lipid peroxidation and AOZ activity in patients of the main and control groups are shown in Table 3.

Table 3 Indicators of lipid peroxidation and AOP in patients of the main and control groups Indicators Research days Main group Control group Diene conjugates (nmol / ml) one 43.4 ± 2.4 42.1 ± 1.8 21 30.2 ± 1.3 36.3 ± 2.4 Malondialdehyde (nmol / ml) one 5.7 ± 1.4 6.0 ± 1.6 21 3.4 ± 1.3 5.3 ± 1.2 Vitamin E (μg / ml) one 41.3 ± 1.6 41.6 ± 1.1 21 53.6 ± 2.4 44.1 ± 2.2 Ceruloplasmin (mg / 100 ml) one 22.7 ± 1.2 23.5 ± 1.4 21 28.6 ± 2.0 24.2 ± 1.5

Indicators of lipid peroxidation (diene conjugates, malondialdehyde) and AOD (vitamin E, ceruloplasmin) in patients of the main and control groups on the 1st day of treatment did not have significant differences. By the 21st day of treatment in patients of the main group, a significant decrease in the content of LPO products was noted compared with the control group. The diene conjugate indices decreased by 30.4% (from 43.4 ± 2.4 nmol / ml to 30.2 ± 1.3 nmol); malondialdehyde - by 40.4% (from 5.7 ± 1.4 nmol / ml to 3.4 ± 1.3 nmol / ml), while in the control group diene conjugates - by 13.8% (from 42, 1 ± 1.8 nmol / ml to 36.3 ± 2.4 nmol / ml); malondialdehyde - by 11.7% (with nmol / ml 6.0 ± 1.6 to 5.3 ± 1.2 nmol / ml). In patients of the main group, the content of AOD components increased more than in the control group. In patients of the main group, the content of vitamin E increased by 22.9% (from 41.3 ± 1.6 μg / ml to 53.6 ± 2.4 μg / ml) and ceruloplasmin - by 20.6% (from 22 , 7 ± 1.2 mg / 100 ml to 28.6 ± 2.0 mg / 100 ml), and in the control group vitamin E - by 5.7% (from 41.6 ± 1.1 μg / ml up to 44.1 ± 2.2 μg / ml) and ceruloplasmin - by 2.9% (from 23.5 ± 1.4 mg / 100 ml to 24.2 ± 1.5 mg / 100 ml).

Thus, in patients of the main group who applied the proposed method, there was a significant increase in the content of AOD components on the 21st day of treatment and a decrease in the content of LPO products compared to the control group.

When using the proposed method, there were no allergic reactions and other side effects with topical application of neutral anolyte APC and dihydroquercetin powder "Cosmetic Lavitol", as well as oral administration of biologically active additives "Laviocard +".

We give examples of the practical implementation of the proposed method

Example 1

Patient G., 35 years old (I. B. No. 263)

Diagnosis: Infected wound complicated by phlegmon of the left leg. 4 days ago I accidentally injured my left lower leg with a sharp object and did not attach any importance to this. Then there was pain, swelling of the left lower leg, inflammation in the wound area, fever up to 38.5 ° C. The state of moderate severity. The skin is hot, dry. Temperature 38.2 ° C. Vesicular breathing. Heart sounds are clear, rhythmic. Pulse 98, rhythmic. Hell 120/90 mmHg The abdomen is soft, painless. The liver is not enlarged. Diuresis is not broken.

St.localis. The left lower leg is enlarged due to edema. On its front surface in s / 3 there is an inflammatory infiltrate of 12 × 14 cm thick, painful, the skin above it is hyperemic. In the center of the infiltrate, the wound is 2 × 1 cm with abundant purulent discharge, the edges of the wound are sharply infiltrated, the bottom is covered with purulent-necrotic tissue. Under general conditions, an 8 cm incision was made through an existing wound and an additional drainage incision up to 5 cm along the lateral edge of the infiltrate, necrotic tissue was removed, and the wound was revised. The wound cavity is 10 × 7 cm and is located in the subcutaneous tissue. The wound was washed with 3% r-rum of hydrogen peroxide and the neutral anolyte ANK (phase of inflammation). Rubber drains and napkins moistened with ANK neutral anolyte were installed. Subsequently, local treatment was carried out: in the phase of inflammation, wound debridement with the ANK neutral anolyte and gauze dressings with it daily. At the same time, Laviocard + dietary supplement was prescribed, 1 capsule 2 times a day during (21 days total). On the 4th day, the wounds cleared of purulent-necrotic discharge. Since that time (regeneration phase), Lavitol Cosmetic dihydroquercetin powder was applied topically, which was applied to the wound surface with a layer of 1-2 mm daily. A gauze cloth was applied over the powder layer. Additionally, the patient received antibacterial, detoxification, symptomatic therapy. The wound process went smoothly. Granulation on the wound surface appeared on day 5, marginal epithelization - on day 7. Given the positive dynamics of the wound healing process, on the 8th day rare secondary sutures were placed on the skin, continuing to apply topically the Lavitol Cosmetic dihydroquercetin powder. After 9 days, the sutures were removed, healing by secondary intention.

In dynamics, the content of LPO and AOD products was evaluated on the 1st and 21st days. A decrease in lipid peroxidation products was noted: diene conjugates from 46.1 nmol / ml to 27.3 nmol / ml, malondialdehyde from 24.2 nmol / ml to 7.3 nmol / ml. The level of AOD components increased: Vitamin E - from 42.4 μg / ml to 50.7 μg / ml, ceruloplasmin - from 21.1 mg / 100 ml to 31.4 mg / 100 ml.

Microbiological examination of wounds on the 1st day revealed Klebsiella spp.10 ⁷ per 1 cm ² ; on the 10th day, microflora was absent. According to the cytological examination of wounds on the 1st day and 10th day, a decrease in the number of neutrophils (from 88% to 1.3%), as well as an increase in the number of fibroblasts (from 0% to 23%), epithelial cells (from 0% to 70%), which characterizes the regenerative type of cytogram.

Thus, the proposed method, combining the use of the neutral anolyte ANK and dihydroquercetin, helped to reduce the course of the wound process, stimulate the reparative processes in the wound, which made it possible to lay secondary sutures in the early stages and achieve complete wound healing.

Example 2. Patient S., 41 years old (medical history No. 5434).

Diagnosis: thermal burn (flame) of the face, neck, trunk, upper and lower limbs IIIAB degree 20% of the surface of the body (PT). Thermo-inhalation injury.

Received 5 days after receiving a burn with a flame of the head, trunk, upper and lower extremities 20% bp Personal injury (in case of fire). From 03/18/12 to 03/23/12, she was treated at the trauma department of the Central District Hospital where she received anti-shock therapy. After stabilization, it was transferred to the department of thermal lesions for further treatment. The condition is serious. The skin is pale, warm. Hard breathing, weakened in the lower parts. No wheezing BH 20 per minute. Heart sounds are rhythmic, muffled. Heart rate is 90 per minute. HELL 130/80 mm. RT Art. The tongue is wet. The stomach is soft. Palpation is painless.

St.localis. Wounds were located on the back, right lower and upper limbs. They were represented by a black wet scab. The total area of the wounds is 20% of the body surface (4500 cm ² ).

The treatment was carried out in the intensive care unit for 5 days, then in the department. Received antibacterial, infusion-transfusion, anticoagulant, symptomatic therapy, enteral and parenteral nutrition, rehabilitation fibrobronchoscopy. Local treatment included: staged necrectomy of the scab in conditions of general anesthesia, treatment of wounds with a neutral anolyte ANK. Napkins with ANK neutral anolyte (inflammation phase) were applied over wounds. From the moment of admission, the patient orally received Laviocard +, 1 capsule 2 times a day for 21 days. After cleansing the wounds on the 8th day (regeneration phase), Lavitol Cosmetic dihydroquercetin powder was applied to the wounds with a layer of 1-2 mm daily, a gauze napkin was applied on top. Active granulation appeared on the 17th day. Independent epithelization of wounds of the upper and lower extremities occurred on the 22nd day, scarring - on the 27th day. On the 19th day and 30th day of treatment, the patient completed 2 stages of autodermoplasty with a free split skin graft of granulating back wounds of 2000 cm ² . On top of the autodermal skin flap, Lavitol Cosmetic dihydroquercetin powder was applied. As a result of the active course of reparative processes, good engraftment of autodermal flaps was achieved and the skin was restored almost completely. Healing of back wounds - on the 34th day.

In dynamics, indicators of lipid peroxidation and AOD were evaluated on the 1st and 21st day of treatment. A decrease in LPO products was noted: diene conjugates - from 49.4 nmol / ml to 45.3 nmol / ml; malondialdehyde - from 6.0 nmol / ml to 5.2 nmol / ml. The level of AOD components increased: vitamin E - from 30.9 to 40.9 mcg / ml; ceruloplasmin - from 23.4 mg / 100 ml to 24.7 mg / 100 ml.

Microbiological examination of wounds on the 1st day revealed Pseudomonas aeruginosa 10 ⁶ , on the 21st day - no microflora. According to the cytological examination of wounds on the 1st day and the 21st day, a decrease in the number of neutrophils from 92 to 44%, an increase in the number of fibroblasts from 0 to 13%, and epithelial cells from 0 to 52% were noted. The patient was discharged in satisfactory condition on the 35th day at the place of residence for outpatient treatment.

The above example demonstrates that the proposed method of treating wounds contributed to the successful treatment of a patient with extensive burns, allowed to achieve self-epithelialization of wounds on the extremities and complete engraftment of autodermal flaps on the back with almost complete restoration of the skin.

Thus, the proposed method, combining the use of a neutral anolyte ANK and dihydroquercetin in the form of Lavitol cosmetic powder for topical use and oral administration of the Laviocard + dietary supplement, is effective in treating wounds of various etiologies.

The technical result of this invention is to reduce the healing time of wounds by reducing the duration of the phases of the wound process and stimulating regeneration processes.

The proposed method is well combined with various surgical methods for treating the wound, such as necrectomy, secondary sutures, autodermoplasty.

Bibliography

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Claims (1)

A method for treating soft tissue wounds of various etiologies, including administering the Laviocard + dietary supplement orally 1 capsule 2 times a day with meals for 21 days and daily washing the wound with neutral anolyte ANK leaving a sterile gauze cloth soaked in neutral in the wound anolyte ANK, before cleansing the wound, after which daily dressings with Lavitol Cosmetic dihydroquercetin powder are performed, which are applied to the wound surface with a layer of 1-2 mm until the wound heals.