A method for the treatment of nonhealing wounds and trophic ulcers

 

(57) Abstract:

The invention relates to medicine, namely to surgery, and is intended for the treatment of nonhealing wounds and trophic ulcers. The pre-wound covered with a napkin from dialdehydes, copper-containing, saturated aqueous solution of photosensitizer "photosense", and after keeping the cloth on the wound within 24 h conduct irradiation of wounds with light with a wavelength of 670 nm. After autodermoplastiki free split dermal flap operating and donor wound covered with a napkin from dialdehydes containing antioxidant of plant origin "Tykveol". The method allows to increase the efficiency and reduce the time of treatment.

The invention relates to medicine, specifically to surgery, namely a method for the treatment of nonhealing wounds and trophic ulcers.

In the treatment of nonhealing wounds and trophic ulcers widespread dermatone skin plastic split calibrated, i.e., the predetermined thickness transplant.

When dermatomes thin skin grafting skin grafts placed on pre-podgotovlennoe the bandage in order to avoid displacement of the graft dried up bandage.

Donor skin area that is used for the plastic cover with a sterile bandage. Bandage impregnated with potassium permanganate solution, and after drying the bandage is removed, and again impregnated with the same solution where it is getting wet. In this state it is wound to her self "dropout" at 18-21 days after surgery. ("Great medical encyclopedia, M.: Soviet encyclopedia, 1979, T. 11, S. 50)

The disadvantage of the traditional method of treatment of wounds after surgery skin plasty is easy, the number of wounds and secondary infections.

There is a method of treatment of nonhealing wounds and trophic ulcers using the method of skin plasty free transversely split dermal flap. Epithelialization of the graft occurs on the 10th day. Closing wounds produce traditional materials. (USSR author's certificate N 1000023, MKI A 61 B 17/322, 1981.)

The disadvantages of this method are easy secondary infiniroute wounds and the possibility of injury during bandaging.

The invention solves the problem of increasing efficiency and reducing time to treatment of nonhealing wounds and trophic ulcers.

"Photosense" is a sulfonated aluminum phthalocyanine and is a domestic photosensitizer developed at the State research center "NIOPIK". Permission for clinical trials is given by Farmkomiteta of the Russian Federation in 1994 ("Photodynamic therapy of malignant tumors", the Second all-Russian Symposium with international participation, M., 1997, S. 21)

"Tykveol" - product of plant origin, wyo release MZ RF, 30.12.1994 registration number N 94/302/9.

Napkins from dialdehydes containing copper, are dressing material, obtained by treating cellulose matrix containing 1-5% of the aldehyde groups of 1.5 to 2.5% aqueous solution of the complex of copper(II) Tris(oxymethyl)aminomethane when the mass ratio of the cellulose matrix and the complex is 1:0.05 to 0.15. (Application N 94028220/14 from 26.07.94, MKI A 61 L 15/44, published. 27.10.96 BI N 30).

The method is as follows.

On the purulent wound or trophic ulcers impose sterile towel from dialdehydes containing the photosensitizer "photosense", and after keeping wipes the wound within 24 hours additionally carry out the irradiation of wounds red light emitted from the solid-state laser yttrium aluminate with twice the frequency and wavelength of 670 nm or non-laser light source wide emission band 600-700 nm with a wavelength of 670 nm for 20 min on 1 cm2. The distance from the working end of the fiber to the wound surface 3-5 mm. the Number of radiation sessions 1-3 depending on the severity of inflammation and wound exudate. Surgery plastic skin free split flap on Tirso. Func is m Tykveol".

When the dressings dressings are easily removed, transplanted patches are not injured, say 100% engraftment of the transplant, the donor wound kapitalizirovana 50%. Signs of inflammation are not marked.

The invention is illustrated by examples.

Example 1.

Patient K., aged 69 years, was admitted to the hospital with a diagnosis of carbuncle back.

Had surgery excision of carbuncle. In the postoperative period were antibiotic therapy.

After treatment of the wounds with hydrogen peroxide solution held applique napkins from dialdehydes, copper-containing, saturated aqueous solution of photosensitizer "photosense" with a concentration of 250 µg/ml After 24 h held the first session of photodynamic therapy wound non-laser light source wide emission band 600-700 nm with a wavelength of 670 nm. The exposure time 20 min on 1 cm2when the distance from the working end of the fiber to the wound surface 3-5 mm

In a day marked dehydration effect, the wound without purulent plaque, bright, vibrant granulation.

Wound treatment with a solution of hydrogen peroxide on the wound again imposed napkin from dialdehydes with drugs the East, made of bright red living granulations appeared marginal epithelization. The bandage was applied with chlorhexidine. Preparing to autodermoplasty free split graft on Tirso.

An operation of autodermoplastiki on Tirso transplanted available split flaps from the hip, the size of the flaps 2,h,0 see the Transplanted flap and the donor site after taking grafts covered with a napkin from dialdehydes containing the drug "Tykveol".

5 days after transplantation was bandaging. Marked 100% engraftment of the graft, the emergence of epithelialization of skin flaps. Donor wound kapitalizirovana 50%. The patient was discharged for outpatient monitoring surgeon's clinic.

For 12 hours the wound completely epithelisation. With donor site removed the bandage.

Example 2.

Patient X., aged 60 years. Admitted to the hospital with a diagnosis of venous ulcer of the right tibia. Atherosclerosis of the lower limbs. A state of moderate severity. Right tibia swollen, hyperemic, trophic ulcers in size from 1.0 to 3.0 cm in diameter with purulent-necrotic plaque. Conducted infusion detoxification therapy, ulcers impose a napkin from dialdehydes, copper-containing, saturated aqueous solution of photosensitizer "photosense" with a concentration of 125 μg/ml, incubated for 24 hours and conduct a session of photodynamic therapy by irradiation with red light emitted from the solid-state laser yttrium aluminate with twice the frequency of the pole 2 and a wavelength of 670 nm. After the session wrapped up in bandages with chlorhexidine.

On the 5th day after a session of photodynamic therapy (PDT) has decreased hyperemia and edema of the right leg, the wound was cleansed, significantly decreased exudation of the wound surface, appeared granulation, there are few dry necrosis at the edges of ulcers.

Surgery how agressively to debride, excised dry necrosis in the wounds.

Ulcer surface clean, granulation in the wound.

An operation of autodermoplastiki on Tirso in example 1.

10 days after autodermoplastiki engraftment of the graft 90%, marginal epithelization grafts, donor wound kapitalizirovana 50%, the patient was discharged for outpatient monitoring surgeon's clinic.

Example 3.

Patient G. , aged 45 years, was admitted to the hospital with a diagnosis of venous ulcer of left tibia, chronic venous nedostatocnost is rnost ulcerative defect 8,h,0 cm, on the rear surface 8,h,0 cm, bottom is covered with purulent discharge.

On ulcers imposed napkin from dialdehydes, copper-containing, saturated aqueous solution of the drug "photosense" with a concentration of 500 μg/ml After 24 hours, conducted the session photodynamic therapy according to example 2.

The bandage was applied with chlorhexidine. A day after photodynamic therapy the surface of the ulcers was purified, separated slightly, there are lots of live bright red granulation, deposits of fibrin.

Re-imposed on the wound tissue with the drug "photosense" above, and after 24 hours, conducted the session of photodynamic therapy as described above.

The bandage was applied with chlorhexidine. Through the night ulcer defects cleansed, granulation juicy perform all of ulcerative defect, the bottom of the "rose", is a minor purulent discharge.

Held the third session of photodynamic therapy as described above. The bandage was applied with chlorhexidine, ulcerative defects cleansed, granulation juicy, perform all of ulcerative defect, the bottom of the "rose" there has been a marginal epithelization.

The bandage was applied with chlorhexidine were trained to autodermoplasty free RA is ereality free split flaps with hips, the size of the flaps 2,h,0 cm, a transplanted flap and the donor site after taking grafts covered with napkins from dialdehydes containing copper impregnated drug "Tykveol".

5 days after transplantation was bandaging marked 100% engraftment of the graft, the emergence of epithelialization of skin flaps. Headbands are easily removed, the wound at the crime scene grafts kapitalizirovana 50%.

On the 10th day after the operation, the wound flaps and consistently marked epithelialization flaps, bright living granulation on reepithelization mesoscutum areas. Donor wound without signs of inflammation.

The patient was discharged for outpatient monitoring surgeon clinic 10 days after autodermoplastiki.

At 18 days the wound is completely epithelisation. With donor site removed the bandage for 12 hours, the wound completely epithelisation.

A method for the treatment of nonhealing wounds and trophic ulcers, including operation of skin plasty free split dermal flap closure operating and donor wounds with a sterile dressing, wherein the wound is pre-covered with a cloth of which UDERZhIVANIYa cloth on the wound within 24 h conduct irradiation of wounds with light with a wavelength of 670 nm, and after autodermoplastiki operating and donor wound covered with a napkin from dialdehydes containing antioxidant of plant origin "Tykveol".

 

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FIELD: medicine, therapy.

SUBSTANCE: simultaneously for 20 d one should prescribe calcium D3 two times daily in the morning and in the evening per 1 tablet or Beresh Plus drops. The quantity of drops for daily intake is equal to patients body weight in kg and they should be introduced in three stages during meals by drinking them up with sufficient amount of water. Application of the suggested method optimizes calcium exchange in patients with osteoporosis, enables to achieve earlier and more stable results in normalization of calcium content in bones by preventing, thus, osteoporotic fractures.

EFFECT: higher efficiency of pharmacological correction.

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