RU2559752C1 - Method of treating hand burns and preventing post-burn cicatrical deformities and syndactylies - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: surgical debridement of the burning hand surface is followed by covering it with urethane foam gel, which is presented by LOCUS preparation containing nanocrystalline boehmite. The hand is freely placed palm down over a surface covered with a sterile polyethylene film. The coating is applied successively, first on the back of the hand with the fingers fixed slightly flexed in a physiologically normal position, then on web spaces with the fingers spread as much as possible throughout the depth of the web spaces and along the length of the fingers. The exposure is held until the coating polymerises completely; then the hand is turned palms up and the polyurethane foam gel is applied on the palmar surface and fingers so as to form a polyurethane glove covering 2 or 3 cm of the intact skin. The glove is held until the polyurethane foam polymerises completely; the polyurethane foam glove is removed as long as it is detached with the wound fluid collects there. The procedure is repeated until the burn wounds epithelise completely.

EFFECT: reducing the length of treatment by creating the optimum healing environment caused by the way and conditions of applying the polyurethane coating.

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Description

FIELD OF THE INVENTION

The invention relates to medicine, in particular to polymer-based dressings, and may find application in surgery for the treatment of burns of the hand and the prevention of post-burn scar deformities and syndactyly.

State of the art

The prior art method of treating burns of the hand, in which a variety of painkillers, antiseptic, bacteriostatic and adsorbing agents are used: lotions, powders, ointments, antiseptic emulsions. The burn wound is protected with a dressing slightly soaked with sterile sea buckthorn, peach, petroleum jelly, sunflower oil or antiseptic emulsion. Dressings are rarely done, the burn itself is re-treated without removing the layer adjacent to the wound, and an ointment dressing is again applied. It is advisable to enclose the affected brush in a specially treated plastic bag or glove. This protects the burn wound of the hand from a secondary infection and allows early active finger movements (Reid, 1974).

The choice of method for treating burns of the hand depends on the length, depth of the burn, the general state of health of the victim and other conditions. The surgeon's task is to prevent the development of infection, constricting scars, contractures and ankyloses of fingers and hands. For this it is necessary, having processed the burn wound, to prevent bandaging of the fingers brought together, to splint the hand in a functionally advantageous position (E. V. Usoltseva, K. I. Mashkara. Surgery of diseases and injuries of the hand http: // bone-surgery .ru / view / ozhogi_kisti /).

However, it is not always possible to choose the optimal treatment method that provides healing of a burn wound without constricting scars and in a short time when it is necessary to start active movements of the hand and fingers in a timely manner. Dressings in most cases are traumatic and painful for the patient, time-consuming medical staff.

Closest to the claimed is a method for the prevention of post-burn cicatricial deformities and syndactyly of fingers of a hand (Patent for invention RU 2454947, АВВ 17/00, A61F 13/10), which includes continuous dilution of fingers in the background of traditional treatment before epithelization of burn wounds. To do this, in the interdigital spaces of 2-5 fingers, a device is made that is made of elastic elastic material, which contains a base and interdigital arches extending from it, which form indentations for phalanges of 2-5 fingers of the hand, the base and interdigital arches are made according to the dimensions of the patient’s palm, half the width of the proximal phalanges of 2-5 fingers, with streamlined edges, and the arches are narrowed in the central part, while in the process of evolution of scar tissue the device is used both constantly and peri cally during the day.

This method of prevention and treatment of post-burn cicatricial deformities and syndactyly of the fingers is as follows. In the presence of burn wounds on the hands, each finger is bandaged separately and a general dressing is applied with drugs in the form of a “glove”. After that, in the interdigital spaces of 2-5 fingers there is a device made of elastic material consisting of a base (platform) and interdigital arches extending from it, which form indentations for the fingers of the hand and fix the proximal phalanges of 2-5 fingers at the maximum dilution position . The base and interdigital arches are made according to the palm of the patient, half the proximal phalanges 2-5 fingers wide, with streamlined edges. The interdigital temples are narrowed in the central part, expanded at the junction with the base and on the free part. The recesses formed by the narrowed in the central part of the arches are designed for the location of the proximal phalanges of 2-5 fingers and fixation without additional manipulations, surgical interventions and benefits due to the elasticity of the material of the interdigital positional retainer. Arms of the device are located in the interdigital spaces of 2-5 fingers, while the base abuts against the metacarpophalangeal joints so that the expanded free part of the arches is visible from the back of the hand and spreads fingers as much as possible, putting pressure on the interdigital spaces. In adult patients, additional fixation is not required; for children, a cotton-paper glove is put on over the interdigital positional fixative. Thus, a therapeutic and prophylactic effect is achieved in the treatment of the effects of burns of the hand with damage to the interdigital spaces and the prevention of cicatricial deformities and syndactyly. The device is used constantly until epithelization of burn wounds, during the evolution of scar tissue, the interdigital positional fixative is used both constantly and periodically throughout the day.

However, with this method, treatment remains routine with all its inherent disadvantages: pain for the patient applying and especially removing the dressing, a long time of the procedure itself, insufficient absorption and insulation properties of gauze bandages. The positional retainer provides only the breeding of the fingers, while not providing a physiological half-bent state of the palm for the prevention of contractures.

Disclosure of invention

The objective of the present invention is to provide a more effective method of treating burn wounds of the hand with damage to the interdigital spaces and the prevention of cicatricial deformities and syndactyly.

The technical result, to which the claimed invention is directed, is to reduce the treatment time by creating optimal conditions for healing, the comfort of wearing a polyurethane foam coating for the patient, and painlessness during dressings.

The problem is solved in that after surgical treatment on the burn wounds of the hands of the hand, polyurethane foam of low-temperature polymerization in gel form is applied. A polyurethane foam coating in this state allows you to congruently fill the complex relief of the bottom of the burn wound and the wrist and fingers, as well as to achieve additional sterilization of the wound, since the polyurethane foam is bactericidal in the gel phase. The wrist is freely placed on the surface covered with a sterile plastic film, palm surface down, and the coating is applied sequentially to burn wounds of the back surface of the palm of the hand, then into the interdigital spaces, with the fingers extended as far as possible across the entire depth of the interdigital spaces and along the length of the fingers, withstand exposure complete polymerization of the coating. Applying the coating first on the back of the hand allows you to fix the fingers slightly bent, in a physiologically correct position, which is important to eliminate contractures and early activation of finger movements. Next, the hand is turned with the palm surface up and low-temperature polymerization polyurethane foam is applied in a gel state to the burn wound of the palm surface and fingers, forming a "polyurethane glove" with a grip of 2-3 cm of intact skin around the burn wound and subsequent soaking until the polymerization of the polyurethane foam. The “polyurethane foam glove” is removed as the wound is accumulated in it with the repetition of the procedure as necessary until the epithelization of burn wounds or referral for dermaplasty surgery.

As a gel-like polyurethane foam, the drug "LOCUS" is used, the composition of which contains nanocrystalline boehmite (see patent RU No. 2424825).

The application of a polyurethane foam coating in a gel state with the formation of a “polyurethane foam glove” ensures full correspondence of the bottom of the burn wound to the inner surface of the coating, and the absence of adhesion of the coating to the wet surface of the burn wound - its subsequent painless removal. The dressing procedure is simple and does not take much time from the medical staff.

Brief Description of the Drawings

The invention is illustrated by drawings, where in FIG. 1-3 shows a diagram of the application of polyurethane foam on the brush, in FIG. 4, 5 - a photograph of a burn wound of the patient’s hand (example 1), is presented; 6-8 - the steps of applying polyurethane foam (example 1), FIG. 9 is a photograph of a burn wound of the patient’s hand (example 2), FIG. 10, 11 - stages of applying polyurethane foam (example 2).

The implementation of the invention

After surgical treatment, low temperature polymerization foam in a gel state is applied to burn wounds of the hand, for which the components of the polyurethane coating (polyol and isocyanate) are thoroughly mixed. In this case, the hand is freely placed on the surface covered with a sterile plastic film, palm surface down (Fig. 1), and the gel-like coating (1) is applied sequentially to burn wounds (4) of the back surface of the palm, then into the interdigital spaces, with fingers extended as far as possible. brushes along the entire depth of the interdigital spaces and along the length of the fingers (2). The exposure is maintained until the coating is fully polymerized, after which the hand is turned with the palm surface up (Fig. 2) and low-temperature polymerization polyurethane foam is applied in the gel state (1) onto the burn wound (4) of the palm surface, interdigital spaces and fingers (2, 5) , forming a "polyurethane foam glove" (Fig. 3), with the capture of 2-3 cm of intact skin around the burn wound (3) and subsequent exposure until the polymerization of the polyurethane foam. The “polyurethane foam glove” is removed as the wound is accumulated in it with the repetition of the procedure as necessary until the epithelization of burn wounds or referral for dermaplasty surgery.

The polyurethane foam coating in the present method can be formed by the drug "LOCUS", made, for example, according to patent RU 2424825, the composition of which contains nanocrystalline boehmite, characterized by improved sorbing properties. The coating consists of two liquid components (polyol and isocyanate), which are located in a specially designed container (patent RU 2457992), and are mixed immediately before application to the burn wound. The use of this drug in the claimed method - gel-like polyurethane foam, is explained by a number of its properties, which distinguish it from foam materials of a different nature. Firstly, a gel-like polyurethane foam coating is obtained immediately before application to the wound, which ensures sterile closure of wounds in both clinical and extreme field conditions. Secondly, the coating has an open porous structure, which provides excellent absorption properties of the dressing, which allows you to remove wound. Thirdly, such a coating is easy to apply on the entire surface of the wound. It is known that the physical and mechanical properties are responsible for the sorbing properties of polyurethane elastic foam. The capillary system is formed by open foam cells, interconnected by the so-called Plateau-Gibbs channels. In ordinary elastic polyurethane foam of open cells of the order of 60-70%, respectively, the same 60-70% of the foam volume is involved in the sorption process. It is known that the stability of polymer foam and the drainage properties are better, the higher the physical and mechanical properties of the coating material. In addition, it is known that the solid mechanical particles used as a reinforcing filler of polyurethane are centers of formation of gas bubbles, the so-called nucleosiates. The smaller the nucleucleates, the smaller the gas bubbles, the smaller the radius of the Plateau-Gibbs channels, the higher the drainage capacity of the capillary system of the foam coating. One of the well-known fillers that improves the mechanical properties of polyurethane foam is boehmite (see paragraph 2271929 above). However, the use in the composition according to patent RU 2424825 of boehmite nanoparticles increases the sorbing properties of polyurethane foam. The use of boehmite, particles of which are from 10 to 50 nm, is due to the fact that they are uniformly dispersed throughout the mass of the polymer, which increases the number of open cells and Plateau-Gibbs channels, and, as a result, the drainage properties of the entire foam volume increase. With this amount of filler added and with this size, the maximum elasticity and strength of the capillary system is maintained.

The invention is illustrated by examples of practical use of the proposed method.

Example No. 1. B-naya N., 54 years old. Received with a circular burn of the right hand III degree A. After surgical treatment, the Locus polyurethane foam coating was applied first on the back surface of the hand, then on the palm surface with the formation of a “polyurethane foam glove”. The procedure was repeated after the coating was completely saturated with wound discharge three times. After cleansing the burn surface from non-viable tissues and forming granulations, an autodermoplasty operation was performed with good graft engraftment. The healing period was 17 days, the patient noted the convenience of wearing dressings and painless dressings.

Example No. 2. Boy L., 30 years old. Entered with a circular burn of the right hand. II degree. After surgical treatment, the Locus polyurethane foam coating was applied first on the back surface of the hand, then on the palm of the hand with the formation of a “polyurethane foam glove,” the procedure was repeated until self-epithelialization. The healing period was 10 days, the patient noted the convenience of wearing dressings and painless dressings.

Claims (2)

1. A method for the treatment of burns of the hand and prevention of post-burn cicatricial deformities and syndactyly, including surgical treatment of burns of the hand with subsequent application of a gel-like polyurethane foam, while the hand is freely placed on the surface covered with a sterile plastic film, palm surface down, and the coating is applied sequentially first on the back surface of the palm, fixing the fingers slightly bent, in the physiologically correct position, then into the interdigital spaces, at the maximum diluted fingers of the brush along the entire depth of the interdigital spaces and along the length of the fingers, withstand exposure until the coating polymerizes completely, after which the hand is turned with the palm surface up and the gel polyurethane foam is applied onto the palm surface and fingers with the formation of a “polyurethane foam glove” with a grip of 2-3 see intact skin, followed by soaking until the polymerization of polyurethane foam and the removal of the "polyurethane gloves" when it is torn away as the wound from it accumulates divided with repetition of the application procedure until the complete epithelization of burn wounds. 2. The method according to claim 1, characterized in that the polyurethane foam coating is formed with the LOCUS preparation, the composition of which contains nanocrystalline boehmite.

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