Method of preparation of extensive difficult-to-heal wounds to dermanaplasty

FIELD: medicine.

SUBSTANCE: invention relates to medicine, more specifically the preparation of extensive long-term non-healing wounds to dermanaplasty requiring the use of plastic split-skin graft. The method consists of applying hemostatic dressings are applied Gemoteks on the wound for 2-3 minutes immediately after surgical treatment on the, in the first stage of wound healing process dressings are used (3-4 days) with the alternation of Atraumatic Tissue Activetex HL, Activetex HF and Activetex HVIT-complex, while on the second stage of wound healing process (2-3 days) tissues Activetex FOM and Activetex FHF are alternated. After the appearance of the boundary epithelialisation and wound cleansing free skin grafting with split-skin graft is performed in accordance with traditional techniques.

EFFECT: invention solves the problem of easier and cheaper method of treatment of extensive long-term non-healing wounds by reducing the time of preparation of the wound surface to dermanaplasty.

2 tbl

 

The invention relates to medicine, namely to prepare extensive nonhealing wounds to dermoplastic, requiring the use of plastics wounds split skin graft.

It is known that when a large wound closure by epithelialization takes a long time - up to several months. It is therefore necessary to timely surgical intervention was the implementation of skin plasty.

However, conducting termoplastici often unsuccessful (does not catch on flap) primarily because of the closure of poorly prepared wound. But the preparation of a wound to the skin plasty takes a long time and is very costly. Thus, the average time of preparation of the wound to the plastic even in the absence of clinically significant disturbances of microcirculation in the area of the wound to take 21-23 days.

There is a method of traditional extensive training nonhealing wounds, consisting in the fact that to prepare for the plastic used bandage with ointment the vegetable "levomekol. Treatment with the use of these dressings also is of long standing (average of 16.7 days) and thereby slows active surgical treatment of such wounds.

Closest to the claimed method is a method of treatment of trophic ulcers of venous origin using bandages "Activte the prolonged therapeutic effect (patent of Russia 2178311, class A61L 15/20, 15/28, 15/22, 15/38).

How is that as a dressing material used napkins "Al" with prolonged therapeutic effect, which accelerates the healing process of ulcers of venous origin, simplifies its implementation. In the first stage of wound healing on average within 4 days used napkins "don't HVIT - tocopherol, vitamin C and chlorhexidine, and "don't HVIT-complex - with rutin, vitamin C and chlorhexidine, and the second stage treatment continue napkins "Al FOM - furagin and sea buckthorn oil and "don't math - furagin and rosehip oil.

However, this method was effectively used by the authors for the treatment of venous ulcers limited area - up to 10 cm2and in comparison with the proposed proved to be less effective (see Tab. 1 and 2).

The present invention is intended to treat a much wider range of nonhealing wounds of a large area up to 600-750 cm2including for example, frostbite and burns.

The present invention solves the problem of simple and inexpensive method of treatment of extensive nonhealing wounds by reducing the preparation time of the wound surface to free skin grafting split flap.

The problem is solved by using as a dressing Mat is the real hemostatic bandages "Remotex" (patent of Russia 2200583) and napkins "Al" with prolonged therapeutic effect (patent of Russia № 2101033).

The method is performed in the following sequence.

After admission of the patient to the hospital are preparing the patient for surgical treatment.

Immediately after surgical treatment for 2 - 3 minutes on the wound superimposed hemostatic bandage "Gumotex with iron gluconate and dioksidin for emergency stopping capillary, diffuse and erosive bleeding.

In the first stage of wound process produced ligation (3-4 days) with alternating atraumatic wipes "Al PI" with chlorhexidine and lidocaine with antimicrobial and local anesthetic action, napkins "Al HF" with chlorhexidine and furagin, with an expanded range of antimicrobial action and napkins "don't HVIT-complex - with rutin, vitamin C and chlorhexidine to provide antiseptic, antioxidant, cytoprotective effect and stimulate microcirculation in the wound.

In the second stage of the wound healing process (2-3 days) is the alternation of napkins Al FOM" furagin and sea buckthorn oil and "don't FHF" furagin and eucalyptus oil, which contain natural healing complexes with Tocopherols, carotenoids and flavonoids and possess wound healing properties. After the appearance of signs of epithelialization and cleansing of the wound is done free plastic surgery of the skin split graft according to traditional methods.

When the treatment by the proposed method, the average time for preparation of the wound to the skin plasty an average 7.5 days (from 4 to 11 days). The use of bandages "Gumotex and napkins "Al" in the proposed method provides a significant increase in the efficiency of preparation of the RAS to dermoplastic due to the intensification of the processes of reparation. The effect is realized due to early and comprehensive debridement and the use of hemostatic, anti-oxidant and antimicrobial action of medicines, immobilized in dressing tools that provides accelerated preparation of a wound to the skin plasty.

To illustrate the effectiveness of the proposed method of preparing the RAS for dermoplastic was undertaken to compare the results of the extensive wounds of the lower extremities in the traditional way (bandage with ointment the vegetable "levomekol), closest to the claimed method (patent of Russia 2178311) and the proposed method.

The results are shown in tables 1 and 2. Patients had no clinically significant ischemia in the area of the wound, were comparable in the main clinical criteria: the size of the RAS, duration wounds, had no concomitant diseases in decompensation stage. From review excluded patients with diabetes and other viragen the violations of metabolism, allergic reactions to components of treatment.

Table 1
The results of autodermotransplantat depending on the form used wound dressings in patients with extensive nonhealing wounds
The group of patientsJust sickComplete epithelialization, %Partial epithelialization, %Epithelialization is less than 10% of the area of the wound, %The duration of treatment patients who achieved complete epithelization of wounds (including outpatient phase, days)
The traditional method185027,841,756,6
The known method185834,822,842,7
The proposed method22100--28,3

Table 2
The results of autodermotransplantat depending on the form used wound dressings in patients with infected wounds
The group of patientsJust sickOnly patients who were autodermotransplantatThe time from the beginning of the treatment, which was carried out autodermotransplantat (average days)The degree of engraftment autograft average, % of the area of transplant
The traditional method18916,746,3
The known method181212,258,5
The proposed method22227,588,5

Thus, the treatment of 22 patients using the proposed method, complications were noted. Thus, the term proposed method of treatment was reduced by 60%, and area of residence of the autograft is increased by 66%.

The method of preparation of extensive nonhealing wounds to dermoplastic, including the use of early surgical treatment, characterized in that in order to accelerate the process of preparing extensive nonhealing wounds to dermoplastic as dressing material used hemostatic bandage "Remotex" and atraumatic napkins "Al" with prolonged therapeutic effect after surgical treatment for 2-3 min, the wound is closed hemostatic bandages "Remotex", in the first stage of wound process in the next 3 to 4 days using the interleaved wipes "Al-holdem", "Al HF", "Al HVIT-complex, and in the second stage of preparing the RAS for dermoplastic continue napkins "FOM Al", "Al FHF" before the advent of the indications for free skin grafting split flap within 2-3 days.



 

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