RU2553376C2 - Method of burn wounds treatment - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to combustiology, and can be applied in process of treating burn wounds of III a and III b degree. For this purpose applied are cultured dermal allofibroblasts on 5-8 passage with concentration 250000 cells/ml as part of composition, which includes as carrier hydroxyethylcellulose natrosol and native collagen. After uniform distribution of medication on wound surface relief fixing with inert mesh covering "Lomatul-N" is carried out.

EFFECT: invention makes it possible to achieve fast recovery skin, reduction of probability of burn disease complications, improvement of functional and cosmetic results of treatment.

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Description

The method relates to the field of medicine, namely to combustiology. and can be used in the treatment of burn wounds III a, b degrees, as well as during the monitoring of donor sites.

The following main methods of treating burn wounds using cultured fibroblasts are known. The first method consists in applying a monolayer culture of fibroblasts adsorbed on film wound coverings [Rakhaev A.M., 2000; Zhirkova E.A., 2011]. The second method involves the use of a suspension culture of fibroblasts in complex compositions, including collagen, fibronectin, laminin, hyaluronic acid in various combinations. The disadvantages of these methods can be considered the use of expensive nutrient media and growth biostimulants, the long terms for obtaining a transplant and, as a result, the difficulty of introducing methods into wide clinical practice.

The objective of the invention is the exclusion from the technological cycle of expensive nutrient media and biostimulants of growth, reducing the time to obtain a transplant in a form that allows the application of cell cultures to significant wound surfaces.

This object is achieved by the use of cultured dermal allofibroblasts as part of a composition comprising natrosol (NATROSOL ® 250 Pharm, Hercules, Holland) as a carrier, a hydroxyethyl cellulose polymer widely used as a gelling agent in pharmaceutical production, as well as native collagen. The transplanted fibroblasts of the human dermis (postoperative skin fragment of a 7-year-old child) in the form of a 3-4-day suspension culture at passage 5-8 with a concentration of 250,000 cells / ml before use are a gel contained in a 20 ml syringe.

A wide-diameter needle (16 * 11/2 ″ blunt) is attached to the syringe to ensure convenient application of the gel on the wound surface, as well as a mesh inert coating "Lomatul-N" (made in Germany) for better fixation of the gel on the wound surface (Fig. one).

The method is applied as follows.

Before transplantation of allofibroblasts, a thorough wound toilet was performed. The treatment was carried out using antiseptic solutions, subsequently carefully removed, in order to exclude the altering effect by washing with sterile saline. After application of a gel containing cell cultures, fixation was carried out with a mesh inert coating “Lomatul-N”, on top of which a wet-drying dressing impregnated with physiological saline was applied.

Examples

Example 1. Patient A., 29 years old, medical history No. 6889/530742, was admitted to the intensive care unit with a diagnosis of burn disease, a flame burn of 42% (26%) / head, neck, trunk, lower extremities. Inhalation injury. Smoke poisoning. Shock III.

On the 27th day of hospitalization, the patient underwent free autodermoplasty with a perforated split transplant on a total area of 3040 cm ² . The perforation coefficient was ¼. During surgery, allofibroblasts were applied in a gel medium to perforated grafts. Production of crops produced in 3 days. The first dressing - on the 7th day after the operation. Full engraftment of the transplants was recorded, in the area of perforations - active epithelization with their complete closure by 11 days of the postoperative period. Thus, the patient was prepared for the second surgery to restore the skin in the shortest possible time.

Example 2. Patient C., 66 years old, medical history No. 9790/533920, was admitted to the burn department with a diagnosis of burn with hot water 6% / III and Art. left lower limb. Concomitant pathology: type II diabetes mellitus, subcompensation.

On the 3rd day after the injury, the patient carried out the application of allofibroblasts in a gel medium to a burn wound. The skin was completely restored on day 14, despite the deterioration of the microvasculature in the area of trauma.

The positive effect of the application of this method is determined by observing border burns of III, 6 degree stimulation of the proliferation of epidermocytes localized in the accessory elements of the skin. In relation to deep burns of IIIB-IV degree, the use of allofibroblast cultures provides epithelization of perforation cells by activating the proliferation of epidermocytes of the autograft. Thus, the method allows you to achieve the fastest possible restoration of the skin, reduce the likelihood of developing complications of a burn disease, reduce the length of stay of victims in a hospital, and improve the functional and cosmetic treatment results. The natrosol used as a carrier (NATROSOL ® 250 Pharm, "Hercules", Holland) does not have cytotoxicity, does not prevent the adhesion and spreading of fibroblasts on the wound surface, contributes to the long-term retention of the composition on the entire surface of the wound, has hydrophilicity, analgesic and anti-inflammatory properties, makes it possible quick coverage of extensive body surfaces with complex relief, easy to use.

Methodological simplicity, the exclusion of expensive nutrients and growth biostimulants from the technological cycle, and the reduction of the time required to obtain a transplant to 3 days make it possible to introduce the method into wide clinical practice. The method was tested on 54 victims with thermal injury.

Claims (1)

A method of treating burn wounds III a, b, including the use of cultured dermal allofibroblasts, characterized in that 3-4-day suspension fibroblast cell culture is transplanted onto the surface of a wound formed as a result of thermal injury at passage 5-8 at a concentration of 250,000 cells / ml s using the hydroxyethyl cellulose of Natrosol as a polymer carrier, achieving uniform distribution over the relief of the wound surface, and fixing is carried out with an inert mesh coating “Lomatul-N ″.

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