RU2531143C1 - Diagnostic technique for inflammatory process accompanying ingrown nail - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: technique involves impedancemetry accompanying surgical intervention. A one-side ingrown nail requires measuring an impedance of the involved and healthy nail folds. The measurements are taken at a frequency 2 of kHz and voltage 1 V. A coefficient K is calculated as a relation of the involved to healthy impedances. The value K of 1.5 or less testifies to an inflammatory reaction.

EFFECT: technique simplifies diagnostics and reduces its time.

2 ex, 1 dwg, 1 tbl

Description

The invention relates to medicine and can be used in surgery for the diagnosis of the inflammatory process with an ingrown nail. There is a method of diagnosing the inflammatory process with an ingrown nail based on histological examination of tissue biopsies with subsequent morphometry (Nikolaeva EA Comparative analysis of the surgical treatment of recurrent and complicated forms of ingrown toenails. Thesis for the degree of candidate of medical science. Science. Novgorod. 2005. - S. 59-61).

The existing method for diagnosing the inflammatory process with an ingrown nail is laborious, requires long preparation of the material for the study and a qualified specialist morphologist.

The technical result of the invention is to simplify the method of diagnosing the inflammatory process with an ingrown nail and reducing the time of the study.

The essence of the proposed method consists in the fact that during the surgical procedure, bioimpedanceometry (BIM) of the affected and healthy side of the tissues of the periungual ridges is carried out with a unilateral ingrown nail by introducing two needle-shaped bipolar electrodes into them at a distance of 1 cm from each other, measure the electrical impedance at a frequency of 2 kHz and a voltage of 1 V, after which the coefficient K is determined as the ratio of the impedance of the affected side to the healthy side, and if K is less than or equal to 1.5, then there is an inflammatory reaction.

The distance between the electrodes of 1.0 cm, the frequency of measurement of tissue electrical impedance of 2 kHz were determined experimentally as the most informative for identifying the biophysical features of the periungual ridges.

The voltage used is standard for the BIM-II.

To measure BIM, we used the BIM-II apparatus developed by Center for Transfer of Innovation Developments LLC, Smolensk (Industrial Design Patent No. 83,370) and original measuring electrodes (Patent No. 2318435).

It is known that using BIM it is possible to objectively evaluate the intensity of blood flow, which is based on the fact that all biological tissues are able to conduct both direct and alternating electric current and are characterized by a certain resistance. Thus, with a pronounced inflammatory process with a predominance of the alterative stage of inflammation, a decrease in impedance is observed due to the predominance of vasodilation. With a decrease in the inflammatory process, an increase in impedance occurs, which is associated with cell swelling and a decrease in intercellular spaces, blood stasis, an increase in the osmotic and oncotic pressure of tissue fluid, exudation of the liquid part of the blood and lymph with an increase in the volume of intercellular spaces. Such changes are equivalent to an increase in the cross-sectional area of the current conductor and a decrease in its specific resistance.

The scheme of the proposed diagnostic method is shown in the drawing, where 1 is the electrodes for measuring impedance, 2 is the periungual ridges, 3 is the nail.

The method is as follows: after the antiseptic treatment of the operative field and the stage of local conduction anesthesia of the distal phalanx of the toe according to Oberst-Lukashevich using 2-4 ml of a 2% solution of lidocaine during surgery, sterile needle bipolar electrodes are introduced at a distance of 1.0 cm from each other and measure the electrical impedance at a frequency of 2 kHz and a voltage of 1 V. Measurements are made on the healthy, then on the affected side of the finger, and then determine the coefficient nt K as the ratio of the impedance of the affected side to healthy and if K is less than or equal to 1.5, then indicate the presence of an inflammatory response. Depending on the presence or absence of inflammation, surgical tactics are determined.

Thus, in our study, in a comparative aspect, the passive and active electrical properties of healthy tissues of the periungual ridges and in the inflammatory process were investigated. This allows you to specify the stage and severity of the inflammatory process, which is important for assessing the effectiveness of the treatment (with recurrent forms of ingrown toenails) and the choice of rational treatment tactics in the postoperative period.

Example 1. Patient M., 39 years old, turned to the "Center for Laser Surgery" with complaints of pain in the first toe of the right foot when pressed, periodic swelling of the soft tissues of the periungual roller on the medial side. From the anamnesis: I was ill for about two years, when the above symptoms first appeared. Twice operated by the surgical method in the clinic at the place of residence with an interval of 1.5-2 years.

Objectively: the inner periungual roller of the first toe of the right foot is swollen, hyperemic. Palpation is sharply painful, with palpation scanty purulent discharge.

After processing the surgical field and anesthesia according to Oberst-Lukashevich with a 2% solution of lidocaine 2.0 ml, bioimpedanceometry of the soft tissues of the medial and lateral periungual ridges was performed, and then a section of the nail plate with its base was excised.

The electrical impedance of the affected side was significantly higher than on the healthy one and amounted to 4.07 kOhm and 2.46 kOhm, respectively. In the calculation, the coefficient K was 1.65. Thus, the K coefficient for this patient is above 1.5, which indicates the absence of an inflammatory reaction.

In order to control the proposed method, a histological examination of the removed periungual platen was performed. No signs of inflammation have been identified.

Since there were no signs of inflammation, the patient’s postoperative wound was treated with a 5% potassium permanganate solution daily, with healing under the scab.

Example 2. Patient K., 23 years old, turned to the Center for Laser Surgery with complaints of pain in the first toe of the left foot, pain when walking. From the anamnesis: sick for about two months, when the above symptoms first appeared. He went to the clinic at the place of residence, conservative therapy was prescribed - without effect. According to the patient, the father noted ingrown nails on both toes in childhood.

Objectively: the inner periungual roller of the first toe of the right foot is swollen, hyperemic. The nail plate is cut obliquely from the inside. Palpation is sharply painful, with palpation abundant purulent discharge.

After processing the surgical field and anesthesia according to Oberst-Lukashevich with a 2% solution of lidocaine 2.0 ml, bioimpedanceometry of the soft tissues of the medial and lateral periungual ridges was performed and a section of the nail plate with its base was excised.

The electrical impedance of the affected side was lower than on the healthy one and amounted to 2.20 kOhm and 2.35 kOhm, respectively. In the calculation, the coefficient K was 0.94. Thus, the K coefficient in this patient is below 1.5, which indicates the presence of an inflammatory reaction of the soft tissues of the medial periungual roller.

In order to control the proposed method, a histological examination of the removed periungual platen was performed. Identified signs of inflammation.

Since signs of inflammation of the periungual platen were revealed, after the operation and in the next 3-5 days (in the first phase of the wound healing process), the wound was washed with ozonized physiological saline (OGF) with an ozone concentration of 6-8 mg 03 / L and treated ozone-oxygen (ACS) gas mixture containing 30-40 mg 03 / l. Ozone treatment of the wound was completed by applying the sorbing alginate dressing "Urgosorb". In the 2nd phase of regeneration and proliferation of the wound healing process, the wound was washed with OGF with an ozone concentration of 4-6 mg / l and a lipid-colloid dressing with Ag (Urgotui S Ag) was applied for 2-3 days. In the 3rd phase of the wound healing process (epithelization and remodeling), a bandage with ozone oil was applied to the wound.

Of the 15 patients examined, 4 had a K coefficient greater than 1.5 and a histologically inflammatory reaction was not determined (Table). At the same time, histological studies of excised sections of the nail plate with its base showed that the removed tissue was a piece of stratified squamous epithelium with the formation of multiple keratinization foci and fields of porous (fine cystic) tissue, which almost merged into a continuous finely bubble mass. There was no granulation tissue. No histological signs of inflammation were noted.

In the remaining 11, the coefficient K was equal to or less than 1.5, and an histological examination revealed an inflammatory reaction of varying severity. Histological studies of excised sections of the nail plate with its base showed that the removed tissue was a piece of skin with deep acanthotic strands, high papillae, focal formation of granulation tissue fields, powerful, extensive, mainly lymphoplasmacytic infiltration, and blood vessels of the microvasculature. Thus, histological signs of inflammation were present.

In patients without signs of nail roller inflammation, the postoperative wound was treated with a 5% potassium permanganate solution daily, and in patients with an identified inflammatory process, a treatment regimen using ozone therapy and special dressings was used, which improved the treatment results.

Thus, the proposed method for the diagnosis of the inflammatory process with an ingrown nail is simple, objective, reliable, does not take much time, does not require long-term preparation of histological material for morphological examination and a specialist morphologist, is carried out during surgery and can be widely used in clinical medicine that will allow you to adjust treatment in the postoperative period, depending on the severity of the inflammatory process.

Table A method for the diagnosis of the inflammatory process with an ingrown nail Patient No. / Frequency 2 Hz Coefficient K The histological conclusion Affected side Healthy side one 4.07 2.46 1.7 Signs of inflammation are not expressed. 2 1.99 1.65 1,2 Moderate purulent-productive inflammation 3 4.85 1,62 2.9 No signs of inflammation detected four 1.12 0.76 1,5 Moderate, predominantly productive inflammation with the formation of a significant amount of granulation tissue 5 3.10 1.42 2/2 There are practically no signs of inflammation. 6 1.77 1.16 1,5 Moderate purulent-productive inflammation 7 1.39 1.16 1/2 Moderate purulent-productive inflammation 8 2.20 2,35 0.93 Severe productive inflammation 9 1.38 0.95 1/45 Moderate purulent-productive inflammation 10 2.83 3.08 0.92 Peptic ulcer, granulation tissue, severe purulent-productive inflammation eleven 3.26 2.17 1,5 Necrosis. Severe purulent-productive inflammation 12 3.84 1.22 3.14 Identified signs of damage to the connective tissue. Inflammatory reaction is not expressed 13 0.68 1.21 0.56 Necrosis. Severe purulent-productive inflammation fourteen 1.39 1.16 1,2 Moderate purulent-productive inflammation fifteen 1.01 0.9 1.12 Severe inflammatory, predominantly productive reaction

Claims (1)

A method for diagnosing an inflammatory process with an ingrown nail, characterized in that during the surgical intervention, bioimpedanceometry of the affected and healthy side of the tissues of the periungual ridges is carried out with a unilateral ingrown nail by introducing two needle-shaped bipolar electrodes at a distance of 1 cm from each other, and measure the electrical impedance at a frequency 2 kHz and a voltage of 1 V, after which the coefficient K is calculated as the ratio of the impedance of the affected side to the healthy side, and if K is less than or equal to 1.5, then this is evidence It indicates an inflammatory reaction.

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