RU95996U1 - DEVICE FOR STIMULATION OF HEALING OF THE RAS OF THE PERIANAL AND SACRICOSCOPIC REGION - Google Patents

Abstract

 1. A device for stimulating wound healing in the perianal and sacrococcygeal region in the postoperative period in patients operated on for rectal fistula of various localization, as well as for treating chronic inflammation of the epithelial coccygeal passage containing a generator of high-frequency electric pulses, a modulator that provides the required duty cycle of high-frequency current pulses , timer, electronic control unit for the metering movement of the needle electrode, electromechanical dose module movement of the needle electrode with a needle electrode. ! 2. The device according to claim 1, characterized in that it further comprises a pedal, when pressed, an electrical signal is supplied to the timer, from which a signal is supplied to the electronic control unit of the needle electrode moving device; from the electronic control unit of the needle electrode moving device, an electric signal is supplied to the electromechanical module of the dosed movement of the needle electrode, causing the needle electrode to translate; the latter extends from the unit of the metered movement device. ! 3. The device according to claim 2, characterized in that after the needle electrode is extended from the unit of the dosed movement device to a length corresponding to the insertion depth of said needle electrode, a signal is sent from the timer to start the high-frequency current generator. ! 4. The device according to claim 3, characterized in that the high-frequency current from the high-frequency current generator, modulated by the modulator, is supplied to the needle electrode. ! 5. U

Description

The utility model relates to medicine, namely to colorectal surgery, and can be used to treat postoperative wounds of the perianal and sacrococcygeal region.

A known method of treating wounds of the perianal and sacrococcygeal regions in the postoperative period, based on local antibacterial and stimulating wound healing therapy. It is carried out by washing the wounds with antiseptic solutions (a solution of chlorgesidine, betadine, etc.), as well as applying dressings with water and fat-soluble ointments (levomekol, methyluracil ointment, etc.) on the wound surface (Kuzin M.I., Kostyuchenko B.M. Wounds and wound infection. - M., 1990 [1] and Datsenko BM Theory and practice of local treatment of purulent wounds. - Kiev, 1995 [2]).

The disadvantages of this method are:

- the prevalence of multi-resistant strains among potential pathogens of infectious wound complications, which significantly reduces the effectiveness of local antiseptic therapy;

- a decrease in the activity of antibacterial and stimulating agents due to their partial inactivation in the wound due to binding to proteins;

- treatment using traditional dressings is long, lingering, dressings are painful due to the drying of the dressing to the wound.

A known method of surgical treatment of epithelial coccygeal passage [RU 2283632, publ. 09/20/2006], which is the prototype of the proposed method for the treatment of purulent wounds of the perianal and sacrococcygeal regions, which consists in laser treatment of the cavity of pockets and fistulous passages with purification and evaporation of devitalized and altered biological tissues. Processing is carried out by means of a 2-3-fold intra-tissue laser thermotherapy with a laser operating in a continuous mode with a wavelength of 970 nm and a power of 2.5 W. As a means of delivering laser radiation to the irradiation site, a flexible monofilament fiber is used, the distal end of which is immersed in the fistulous passage through the primary openings or transcutaneously. The immersion depth of the distal end of the fiber is controlled by ultrasound. The duration of laser exposure is in the range of 30-180 s,

The disadvantages of this method are:

- the complexity of processing a large area of the wound surface;

- the need for a large number of radiation sessions;

- individual patient sensitivity to the procedure;

- the impossibility of visual control of the irradiation zone during thermal exposure;

- the difficulty of optimizing the radiation dose both in time and in area and depth of exposure for a particular patient;

- the reserve capabilities of his body are not taken into account.

All this reduces the effectiveness of the treatment process, increases the healing time of wounds in the postoperative period.

The purpose of the utility model is to reduce the healing time of wounds of the perianal and sacrococcygeal region in the postoperative period in patients operated on for rectal fistula of various localization, as well as chronic inflammation of the epithelial coccygeal passage.

The specified goal is achieved in the following way. In the proposed device that implements a method of stimulating wound healing of the perianal and sacrococcygeal region in the postoperative period in patients operated on for rectal fistula of various localization, as well as treating chronic inflammation of the epithelial coccygeal passage after treating the surgical field with an antiseptic agent, a needle electrode is inserted into the biological tissue, a pulsed high-frequency voltage is supplied to the electrode for a period of 3 to 10 seconds, that is, the pocket cavity is heat treated s and fistulous passages in the wound. The introduction of a needle electrode into the biological tissue is carried out to a depth of 5-15 mm. The depth of introduction of the needle electrode into the biological tissue is determined by the nature of the pathomorphological process and is 5-15 mm.

It should be noted that the pulse high-frequency voltage is supplied to the needle electrode only after it is introduced into the biological tissue to the mentioned depth, and the needle electrode is removed from the biological tissue only after the pulse high-frequency voltage is stopped.

By moving the electrode in a checkerboard pattern with a step of 5-15 mm and, each time after injection, applying a pulsed high-frequency voltage to the needle electrode introduced to the given depth into the biological tissue, the entire wound surface is treated in this way.

The frequency of the high-frequency current of the above-mentioned pulsed high-frequency voltage is in the range of 2-6 MHz, the duty cycle of the pulses is 6-10, the pulse repetition rate, which ensures the high efficiency of the method, lies in the range of 1-10 kHz, the voltage amplitude is (160-200) V, the average exposure power (3-5) W. As a rule, the procedure is prescribed once for 2 days after surgery. In difficult cases, the procedure is repeated up to 3 times with an interval of 3-4 days.

Figure 1 shows a device for implementing the proposed method, which contains a generator (1) of high-frequency electric pulses (high-frequency current generator), a modulator (2) that provides the required duty cycle of high-frequency current pulses, a timer (3), a pedal (5), an electronic unit (4) controlling the metering movement of the needle electrode, an electro-mechanical module (6) metering the movement of the needle electrode with the needle electrode (7).

The device operates as follows. The electromechanical module (6) of the metered movement of the needle electrode (7) is installed on the wound surface. Set the duty cycle of pulses 6-8, the exposure time of the high-frequency current in the range of 3-10 seconds. Press the pedal (5), the signal from which is fed to the timer (3). From the timer, the signal enters the electronic unit (4) for controlling the dosed movement of the needle electrode, from which a signal is supplied to start the electro-mechanical module (6) of the dosed movement of the needle electrode (7). The movement (translational movement) of the needle electrode begins, which is introduced into the biological tissue perpendicular to the wound surface to a predetermined depth of 5 to 15 mm.

After the needle electrode (7) is pulled out from the unit of the dosed movement device to a length corresponding to the insertion depth of the mentioned needle electrode, a signal is supplied from the timer to start the high-frequency current generator, the current of which is modulated by the modulator (2), and is supplied to the needle electrode (7).

After the high-frequency current is supplied to the needle electrode from the electronic control unit of the metering device for the needle electrode (after a set time, of the order of 3-10 seconds), a signal is triggered to this unit, which starts the procedure of moving the needle electrode (7) inside the unit.

It should be noted that the voltage from the high-frequency generator (1) is sequentially supplied only to the extended needle electrodes (7).

Next, the electromechanical module (6) of the dosed movement of the needle electrode (7) is moved to a new place and the previously described procedure is repeated until the wound surface is completely treated.

To accelerate the treatment of the wound surface, the needle electrode (7) can contain from one to four needles, each of which is supplied with a high-frequency current strictly in a given sequence, the needle electrodes (7) are advanced from the electro-mechanical module (6) of the dosed movement of the needle electrodes (7) ) independently from each other, both individually and all at the same time, which is set by the operating staff.

This design of a multi-needle electrode can significantly reduce the time of the electrotherapeutic procedure and eliminates the mutual influence of the needle electrodes.

Clinical example:

Patient A., 47 years old, IS No. 482-09, was admitted with complaints of purulent discharge from the anus, pain in the anal canal during defecation.

With an external examination of the perianal region, the anus is closed, the perianal reflex is alive. At 6 hours, a funnel-shaped retraction-external fistulous opening of about 2 mm in diameter is determined. With a digital examination of the rectum, the sphincter tone and volitional efforts are satisfactory. At 6 o’clock in the area of the posterior crypt, a scar-modified internal fistulous opening up to 2 mm in diameter is determined. When examining with a button probe, the course of the fistula is transfinkter.

The patient was diagnosed with a posterior transsphincter fistula of the rectum.

02/12/09, the patient underwent surgery in the amount of excision of the fistula, opening and drainage of the intersphincter flow. On the second day after surgery, the patient underwent the procedure of electropulse stimulation of the wound by the proposed method. A multi-needle electrode (7) with two needle electrodes was used. The frequency of the RF current is 2.64 MHz, the duty cycle of pulses is 8, the voltage is 160 V, the average power is 5 W, the exposure time for each injection was 6 seconds. Using this method, a 5 cm ² surface was treated.

The postoperative period was uneventful. The appearance of marginal epithelization was recorded on the third day after the procedure, by the ninth day after the operation, wound cleansing with the most complete formation of granulation tissue was observed, by the fourteenth day a decrease in the size of the postoperative wound was observed, and on the twentieth day the complete epithelization of the wound with the formation of a postoperative scar was determined macroscopically.

Thus, the proposed device that implements the aforementioned method, in comparison with known devices makes it possible:

- reduce the time of wound healing after surgery for rectal fistula and chronic inflammation of the epithelial coccygeal passage due to the acceleration and simultaneous occurrence of phases of the wound process;

- reduce postoperative bed day;

- reduce the time of social and labor rehabilitation.

Claims (8)

1. A device for stimulating wound healing in the perianal and sacrococcygeal region in the postoperative period in patients operated on for rectal fistula of various localization, as well as for treating chronic inflammation of the epithelial coccygeal passage containing a generator of high-frequency electric pulses, a modulator that provides the required duty cycle of high-frequency current pulses , timer, electronic control unit for the metering movement of the needle electrode, electromechanical dose module movement of the needle electrode with a needle electrode. 2. The device according to claim 1, characterized in that it further comprises a pedal, when pressed, an electrical signal is supplied to the timer, from which a signal is supplied to the electronic control unit of the needle electrode moving device; from the electronic control unit of the needle electrode moving device, an electric signal is supplied to the electromechanical module of the dosed movement of the needle electrode, causing the needle electrode to translate; the latter extends from the unit of the metered movement device. 3. The device according to claim 2, characterized in that after the needle electrode is extended from the unit of the dosed movement device to a length corresponding to the insertion depth of said needle electrode, a signal is sent from the timer to start the high-frequency current generator. 4. The device according to claim 3, characterized in that the high-frequency current from the high-frequency current generator, modulated by the modulator, is supplied to the needle electrode. 5. The device according to claim 4, characterized in that after the high-frequency current is supplied to the needle electrode from the electronic control unit of the metering device for the needle electrode, a signal is sent to this unit, which starts the procedure of moving the needle electrode inside the block. 6. The device according to any one of claims 1 to 5, characterized in that the needle electrode contains from one to four needles. 7. The device according to claim 6, characterized in that the aforementioned from one to four needles of the needle electrode are pushed out of the unit of the dosed movement of the needle electrodes independently of each other, either individually or all at once. 8. The device according to claim 4, characterized in that the voltage from the high-frequency generator is sequentially supplied only to the extended needle electrodes.