RU2712183C1 - Method of treating the patients with scarring skin lesions - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention refers to medicine, namely to plastic, maxillofacial, reconstructive and general surgery, and represents a method of treating the patients with cicatrical skin lesions, involving surgical excision of the cicatrix with subsequent approach of the wound edges with the continuous removed suture, suturing in a subcutaneous fat layer with immobilization of wound tissues, applying a strip of Steri-strip plaster on the wound, characterized by that after immobilization of tissues and suturing, plasma enriched with growth factors at rate of 0.1–0.2 ml per 1 cm of suture is introduced tunneling along the entire length of the suture, and then on the wound area the "Ceroxin" gel is applied with a thin layer, in the postoperative period the similar introduction of plasma is performed on 6–8 and 18–21 days after the operation, at that the "Ceroxin" gel is applied to wound for 3–6 weeks twice in day.EFFECT: invention provides activation of regenerative processes in connective tissue and epithelium, reduced length of wound healing without scar formation upon completion of treatment.1 cl, 2 ex

Description

The invention relates to medicine, namely to plastic, maxillofacial, reconstructive and general surgery and can be used to treat patients with cicatricial skin lesions, including after burns.

There is a method of treating postoperative, post-traumatic and other wounds (cut, stabbed, gunshot) using Zvar ointment for healing, and the claimed ointment is applied to the wound 2 times a day and at night in the form of an ointment dressing (RF Patent 2526152, IPC A61K 9/06, publ. 2014).

The disadvantage of this method is the possibility of using the ointment only externally. It is also known that in most cases, cicatricial damage extends not only to the upper, but also to the deeper layers of the skin and subcutaneous fat. Also, the use of ointment does not take into account the individual characteristics of the course of the inflammatory process and the features of regeneration in the area of the postoperative wound. That is why the use of this ointment limits the possibility of a complex effect on all layers of scar tissue, which does not contribute to the effectiveness of treatment in such patients.

A known method for the prevention of hypertrophic scars in the treatment of soft tissue phlegmon (RF Patent 2587972, IPC A61N 1/30, publ. 2016), comprising a complex of conservative therapy with the introduction of Longidase 1.0 ml intramuscularly once every 3 days in an amount of 10 injections, local applying ointment Egallohit for 10 days, and if the W phase of the wound process is detected, ultrafonophoresis of Kontraktubeks gel for 10 days, then Karipazim electrophoresis 350 PE for 10 days, laser therapy for 10 minutes for 5 days.

The disadvantage of this method is its lack of effectiveness, since it is possible to use it only in the treatment of soft tissue phlegmon. The treatment process is complicated by the need to constantly carry out diagnostic procedures, which delays the treatment process, makes it more expensive, in addition, the invasive method, which causes permanent injury to the wound area. Physiotherapeutic equipment is required, which is not always possible.

The closest is a method for treating patients with cicatricial lesions of the skin (Clinical protocol for the diagnosis and treatment of patients with cicatricial lesions of the skin, approved at a meeting of the StAR Association of Maxillofacial Surgeons and Dental Surgeons Section on April 21, 2014), including surgical excision of the scar with subsequent rapprochement of the wound edges with a continuous removable suture, suturing in the subcutaneous fat layer with immobilization of wound tissue, applying a strip of Steri-strip patch to the wound. The method involves surgical correction of keloid scars by dissecting the tissue with the sharpest scalpel to the subcutaneous layer to the full depth, without touching the dermal layer of the skin with instruments, then the wound edges are brought together by a continuous removable suture applied in the subcutaneous fat layer, and when the skin wound is tensioned, the defect is closed a thin skin graft whose edges extend beyond the skin wound.

The disadvantage of this method is the high degree of injury, the risk of postoperative complications, the likelihood of re-development of severe scarring, requires cutting an additional skin graft. In addition, the proposed method of surgical treatment of scars is aimed only at the first phase of the wound healing process. There are no measures to activate regeneration in the 2nd and 3rd phase of regeneration, which can lead to relapse and the formation of deeper scars.

The task of the invention is to remedy these disadvantages, increase the efficiency of the operation, reduce injuries due to surgical treatment with local tissues and there is no need to cut out a free skin flap.

To solve this problem, in the treatment of patients with cicatricial lesions of the skin, including surgical excision of the scar with subsequent rapprochement of the wound edges with a continuous removed suture, suturing in the subcutaneous fat layer with immobilization of wound tissue, applying a strip of Steri-strip to the wound, it is proposed after immobilization tissues and suturing, plasma enriched with growth factors at the rate of 0.1-0.2 ml per 1 cm of suture is injected tunnelingly along the entire length of the seam. After that, the Zeroxin gel is applied to the wound area with a thin layer, in the postoperative period, a similar plasma injection is performed on 6-8 and 18-21 days after the operation, while the Zeroxin gel is applied to the wound for 3-6 weeks twice a day .

The use of Zeroxin gel allows you to soften the postoperative wound and its scar component, which additionally contributes to the healing effect, accelerated healing, and the general combination of surgical methods for scar tissue and additional ones: the introduction of plasma and external application of Zeroxin gel not only prevent the formation of scars, but completely restore the skin. In addition, this gel has the ability to glue the wound, which allows suturing only to bring the edges of the wound together and does not require suturing on the skin, and this in turn also reduces injury to the skin, and subsequently makes the treatment result aesthetic.

The inventive combination of selected methods in the optimal amount, provides the claimed therapeutic anti-scar effect. Other combinations of various methods do not allow achieving the required anti-scar effect in a short time in a fairly short time and will not allow the rehabilitation of patients with both hypertrophic and keloid and atrophic scars so effectively.

The method is as follows

After examination and the absence of contraindications for surgical treatment, the patient is treated with an operating area with cicatricial lesion of the skin with an antiseptic solution. The method is carried out under local infiltrative anesthesia, in rare cases with large volumes of cicatricial skin lesions under anesthesia. Then, according to the previously planned marking, an infiltrative anesthesia is carried out using a sterile marker with the appropriate solution (50 ml of physiological saline, 1 ml of 1% adrenaline, 10 ml of ropivacaine 100 mg / ml), the amount of injected anesthesia is calculated based on the size of the scar.

It must be borne in mind that the needle injection during infiltration should be located only in areas of scar tissue that must be removed. Then, with a scalpel, mainly of size 15-s, the scar is excised to the subcutaneous layer to the entire depth, without touching the instruments to the dermal layer of the skin. If cicatricial deformity affects several layers of the skin in layers, including subcutaneous fat, dissection to the subcutaneous layer to the entire depth was performed. Further, the edges of the wound are immobilized, departing 1.0-1.5 cm from the scar and they are brought together by a continuous, removable suture applied in the subcutaneous fat layer.

Blood sampling is carried out from the patient's peripheral vein into vacuum tubes with a volume of 3-9 ml (depending on the required plasma volume). Blood is mixed with an anticoagulant, which is used as a 3.8% solution of sodium citrate. To mix blood with citrate, the tubes are inverted 4-5 times.

Then the blood is centrifuged for 4-6 minutes with a centrifuge speed of 3000 rpm. During rotation, the blood in the test tubes is divided into three layers: the lower is red blood cells, the middle is a thin layer of white blood cells, and the upper is plasma enriched with platelets.

Using a laboratory dispenser, the upper plasma layer enriched with growth factors is extracted into a separate tube. After this, the plasma is activated with calcium ions: per 1 ml of plasma - 50 μl of calcium gluconate.

The fluid is mixed by carefully turning the tubes. Thus, the plasma is ready for use and should be used within 5-10 minutes. The plasma volume required for the procedure depends on the size of the skin scars.

All of the obtained plasma enriched with growth factors is drawn into syringes of the required volume and injected under the seam tunnelwise along its entire length. The introduction of plasma enriched with growth factors is carried out at the rate of 0.1-0.2 ml per 1 cm of scar. After that, the Zeroxin gel is applied in a thin layer on the wound area.

Zeroxin gel contains cerium oxide, water-soluble cellulose derivatives, water-soluble polysaccharide pectin, water-soluble polysaccharide fucoidin, water-soluble polysaccharide alginate, target additive, the rest is water (RF Patent 2699362):

The operation ends with the application of a strip of Steri-strip on the wound.

In the postoperative period, perioperative anti-inflammatory, analgesic therapy and protective regimen are prescribed. Within 5-8 days, as a rule, moderate swelling is observed in the postoperative zone, after which the swelling decreases, usually patients do not present complaints.

Dressings are changed every day twice a day.

After 6-8, and then 18-21 days after surgery, the procedure for the introduction of plasma is repeated similarly to the above.

Within 3-6 weeks after surgery, 2 times a day: first in a hospital, and then on his own, the patient conducts treatment of the postoperative area with Zeroxin gel.

Efficiency in such patients is restored depending on the volume spent from 1 day to 3-5. Within 7 days, the patient is restored to his normal working mode.

Example 1

Patient O. 36 years old was diagnosed with Post-traumatic cicatricial deformity of the buccal region on the right. Condition after a burn of 2 degrees. From the anamnesis: it suffered as a result of an injury in everyday life due to a burn with boiling water during careless use of the kettle 1 year ago. Complaints: the presence of retraction and gross scars in the buccal region on the left, pain and a feeling of tightness in the scar area, about which the patient experiences psychological discomfort. Upon external examination, the configuration of the face was changed due to the presence of a scar in the left buccal region 5 cm long with a width of 2 cm and a height above the skin surface of 0.4 mm, bright pink, dense with deformation of surrounding tissues, and moderately painful on palpation. After a clinical and laboratory examination and collection of anamnestic data, there were no contraindications to the operation in the patient.

Under operating conditions under local anesthesia, an operation was performed similarly to the above.

Further, 3 ml of blood was taken from peripheral blood (into a 2 vacuum tube with a volume of 3 ml). 3.8% sodium citrate solution was used as an anticoagulant. Next, the blood was centrifuged for 5 min with a centrifuge speed of 3000 rpm. Received 3 ml of plasma. All of the obtained plasma enriched with growth factors was collected in insulin syringes.

Immediately after centrifugation is completed, plasma enriched with growth factors at the rate of 0.2 ml per 1 cm in a total volume of 1 ml was injected transdermally under the suture along the entire length of the centrifugation, and then the Zeroxin gel was applied to the wound area directly on the line with a thin layer seam. The operation ended with the application of a strip of Steri-strip on the wound.

In the postoperative period, a similar injection of plasma was carried out on the 8th and 18th day after surgery.

In the postoperative period, perioperative anti-inflammatory, analgesic therapy and protective regimen are prescribed. Dressings were changed every day twice a day. After changing the dressing, the patient independently treated the wound surgical area with Ceroxin gel for 3 weeks.

2 weeks after surgery, the patient was aesthetically satisfied with a scar. When observed on the 1st, 3rd, 6th months after the operation and a year later, a normotrophic scar was formed that absolutely suits the patient cosmetically. The patient with the result of treatment is satisfactory.

Example 2

Patient J., 29 years old, was diagnosed with a keloid scar of the anterior chest wall. From the anamnesis: suffered as a result of removal of the nevus of the above region 3 months ago. Complaints: for the presence of a rough scar, a bright red color, soreness and a burning sensation, about which the patient experiences psychological and functional discomfort. Upon external examination, the skin of the anterior chest wall has a keloid scar with dimensions: 4.0 × 2.0 × 0.5 cm, bright pink in color, dense, moderately painful on palpation. After a clinical and laboratory examination and collection of anamnestic data, there were no contraindications to surgery for the patient.

In the operating room under local anesthesia, the skin-subcutaneous fat layer was infiltrated according to the previously applied markings in the buccal region on the left with the volume of injected anesthesia, and the operation and postoperative treatment were performed according to the proposed method.

To obtain plasma from peripheral blood, 1 ml of blood was taken (in 1 vacuum tube). 3.8% sodium citrate solution was used as an anticoagulant. Next, the blood was centrifuged for 5 min with a centrifuge speed of 3000 rpm. Then, using the laboratory dispenser, the upper plasma layer was removed into a separate tube. Received 0.5 ml of plasma.

Immediately after centrifugation was completed, a plasma enriched along the entire length of the percutaneous suture was injected with plasma enriched with growth factors at the rate of 0.1 ml per 1 cm, in a total volume of 0.4 ml (taking into account the scar length of 4 cm), and after that to the area wounds were applied with Zeroxin gel in a thin layer directly on the wound area. The operation ended with the application of a strip of the Steri-strip patch on the wound, while the size of the patch was chosen with an excess of the size of the wound by 1 cm on each side.

In the postoperative period, a similar injection of plasma was carried out on the 6th and 21st day after surgery.

In the postoperative period, perioperative anti-inflammatory, analgesic therapy and protective regimen were prescribed. Within 7 days, moderate swelling was observed in the postoperative area, after which the swelling decreased.

Dressings were changed every day twice a day. After changing the dressing, the patient independently treated the surgical area of the wound and suture with Zeroxin gel for 6 weeks.

2 weeks after surgery, the patient was aesthetically satisfied with a scar.

After 6 and 12 months, a normotrophic scar was formed on the control examination, which absolutely suits the patient cosmetically. The patient considers the treatment result satisfactory.

A method of treating patients with various types of cicatricial lesions of the skin, including combined methods of surgical treatment followed by the introduction of plasma enriched with growth factors and the use of Ceroxin gel in all 100% of cases was successful in treating 28 patients with keloid scars, 32 hypertrophic scars, and 20 patients with burns, without complications and adverse reactions.

The application of the method showed its activating effect on the regenerative processes of connective tissue and epithelium, which indicates the biostimulating effect of plasma and gel in the postoperative period and was confirmed by a reduction in the healing time of wounds without scar formation at the end of treatment, with a good and uniform distribution on skin surfaces and ease of use this method.

Claims (1)

A method for treating patients with cicatricial lesions of the skin, including surgical excision of the scar with the subsequent approach of the wound edges with a continuous removed suture, suturing in the subcutaneous fat layer with immobilization of wound tissue, applying a strip of Steri-strip patch to the wound, characterized in that after tissue immobilization and overlay the tunnel along the entire length of the suture inject plasma, enriched with growth factors at the rate of 0.1-0.2 ml per 1 cm of suture, and then a thin layer of Zeroxin gel is applied to the wound area, in the postoperative period ary introduction of plasma is carried out at 6-8 and 18-21 days after surgery, the gel "Tseroksin" is applied to the wound within 3-6 weeks, twice a day.