The method of local treatment of fistulous dermatitis

 

(57) Abstract:

The invention relates to medicine, to surgery, to a method of treatment of fistulous dermatitis. The skin around the fistulous openings cause Tizol mixed with an antioxidant, or analgesic or nonsteroidal anti-inflammatory drugs in therapeutic dosages for outdoor applications with an interval of 12-24 hours. This method reduces the frequency of dressing changes, increase therapeutic efficacy of drugs to reduce the duration of clinical effect.

The method relates to medicine, specifically to surgery, can be used for the treatment of fistulous dermatitis occurring as a complication of external fistula of stomach, intestines, pancreas.

Known methods of local treatment of fistulous dermatitis, aimed at neutralizing the alkaline environment and inactivation of the enzymatic activity of the intestinal content appearing on the skin in the area of the fistula permanent irrigation or bandages from 0.47% lactic acid with a pH of 4.7; H 0,1 hydrochloric acid; 0,9% solution of 100 thousand UNITS of trasilol [s tobiko. The treatment of external fistula of intestine. - M., Honey-on - 1977. - S. 30-33]. The disadvantage of all these methods is their NAP is specialnogo process in comparison with the skin, for effective mitigation of the symptoms of dermatitis in need of constant and prolonged use of drugs, limit physical activity of the patient.

Known use in the local treatment of dermatitis of different origin solution of dimethyl sulfoxide (DMSO) [M. D. Mashkovsky. Medicinal product. H. 1. - Tashkent. - Honey-on. - 1988. - S. 202-203], with its own anti-inflammatory, analgesic action expressed by the ability to enhance percutaneous penetration mixed with it in a solution of a medicinal substance. However, the use of solutions based on the dimethyl sulfoxide in the treatment of fistulous dermatitis is limited to its own local irritant effect on the skin, a wide range of possible complications and a high frequency of reactions of individual intolerance of the drug.

There are also known methods of local treatment of fistulous dermatitis, aimed at creating a protective layer of a sorbent, or a film coating on the skin around the fistula, preventing her aggressive intestinal contents - 2, 5, and 15% polysiloxane paste, powder, gypsum, kaolin, tannin [s tobiko. The treatment of external fistula of intestine. - M., Honey-on - 1977. - C. 32]. The disadvantages of these STRs is dry, the absence of active influence of the protective layer on the inflammatory process in the skin.

Closest to the claimed is used for the local treatment of fistulous dermatitis ointments and pastes based jelly (liquid paraffin), refined naphthalene oil, solid (heated) paraffin containing anti-inflammatory, analgesic, antioxidant tools - for example, 10% ointment "dermatol" [M. D. Mashkovsky. Medicinal product. H. 1. - Tashkent. - Honey-on. - 1988. - S. 344], some pastes - salicylic-zinc (salicylic acid 2 parts of zinc oxide, 25 parts of wheat starch to 25 parts, vaseline 48 parts) [M. D. Mashkovsky. Medicinal product. 4.2. - Tashkent. - Honey-on. - 1988. - S. 403], zinc-Ichthyol (zinc oxide 24.4 g, Ichthyol 2.5 g, starch 24.4 g, vaseline of 48.7 g) [so 2. M. D. Mashkovsky. Medicinal product. 4.2. - Tashkent. - Honey-on. - 1988. - S. 403]; ointments naftalannoy (naphthalene oil 70, paraffin 18, petrolatum 12 parts) [M. D. Mashkovsky. Medicines - 2 Hours. - Tashkent. - Honey-on. - 1988. - S. 415], zinc-naftalannoy with benzocaine (ointment naftalina to 15.8 parts, zinc ointment 79,2 part, benzocaine 5 parts) [M. D. Mashkovsky. Medicines, including 2. - Tashkent. - Honey-on. - 1988 - S. 415], applied to the skin around the intestinal Saint who icin. External intestinal fistulas. - Novosibirsk. - Zap. Sib. ed. - S. 127].

The disadvantages of these methods of treatment of fistulous dermatitis ointments and pastes are not integrated therapeutic effect on inflammatory process in the skin, weak therapeutic effect was included in the composition of ointments and pastes medicines, absence of own therapeutic effect of ointment bases, the need for frequent change of dressings and long (up to 5-6 days) applications to achieve clinical effect.

Objectives of the invention are the creation of a comprehensive therapeutic effects on inflammatory process in the skin, increasing therapeutic efficacy of drugs, giving the ointment the basis of its own pronounced therapeutic effect, reducing the frequency of dressing changes and the reduction of the duration of clinical effect.

These goals, the proposed method is achieved by the fact that the skin around the external opening of the intestinal fistula with an interval of 12-24 hours put antioxidant, analgesic and non-steroidal anti-inflammatory drugs in therapeutic doses for external use, in a mixture with etizolam (Xiamen happy valley water Park of glycerol the ing the skin at the circumference of the intestinal fistula gauze pad with a thin layer put cooked before using drugstore by way of a medicinal mixture in the form of a gel, containing, for example, 6% of tocopherol acetate, 3% mefenamovoy acid, 1% lidocaine, 90% of aquacomplexes of glitzerofosfata titanium (title). Place dry gauze bandage on the skin. Within 12-24 hours of the application mixture, repeat.

The disappearance or reduction of subjective symptoms fistulous dermatitis - dermatomal pain, itching, burning occurs through 20-45 minutes. The elimination of local clinical manifestations fistulous dermatitis occurs within 24-48 hours, after which it becomes possible regular preventive drawing on the skin with a protective film coating. With insufficient protective effect of the latter, the recurrence of clinical symptoms of dermatitis, applying the mixture on the new evidence, I repeat.

This method is used by us in 1998-99 In the clinic purulent surgery Sverdlovsk regional clinical hospital 1 in the treatment of 4 patients with fistulous dermatitis, a complication for high fistula jejunum. Clinical effect in all cases was good and helped to prepare the patients for elective surgical treatment. Complications associated with the use of method not found.

Example: Patient G s H. A., 1959 g/R IB N 797, received 11.01.99 1 surgical is the main disease of the abdominal cavity. Chronic adhesive small bowel obstruction. Ligature fistula abdominal wall. Fistulous dermatitis II Art.

During the preoperative examination for edema fistulous dermatitis used the dressing with the pasta of Lassara. However, with 12.01.99 on 27.01.99 phenomenon dermatitis decreased slightly, the patient continued to bother constant, moderate intensity, pain expressed the burning and itching of the skin around the fistulous openings. With 27.01.99 treatment of fistulous dermatitis proposed method on the dried surface of the skin around intestinal fistula caused by a thin layer of the medicinal mixture in the form of a gel, containing 6% of tocopherol acetate, 3% mefenamovoy acid, 1% lidocaine, 90% of aquacomplexes of glitzerofosfata titanium (title). In the first 20 minutes after application of the mixture, the patient noted a sense of light amplification burning perifocal to suishu skin. Complete disappearance of pain in the area of the fistula occurred in 30-40 minutes and remained until the next application of the mixture after 24 hours. Next bandaging 28.01.99 found the almost complete disappearance of redness, swelling of the skin in the area of the fistula, despite continued, due to not fully effective obturation, skin intestinal ralom in 24 hours phenomena dermatitis no longer resumed.

01.02.99 patient was operated in a planned manner: Laparotomy with excision of external fistulous openings (through the zone pre-existing dermatitis!). Excision ligature fistula abdominal wall. Dissection of adhesions of the abdominal cavity with the elimination of chronic spaece-obstructive small bowel obstruction. Resection of the jejunum with fistula and anastomosis side-to-side. Suturing the perforation of the middle segment of the small intestine. The outer protection of intestinal sutures, collagen Explant on Levchik et al. (1995). Auxiliary transplantation improves abdominal wall combined antibacterial allograft for Levchik et al. (1997). The drainage of the abdominal cavity, hollow suture the wound with her vacuum drainage by Subbotin-Redon.

Nearest postoperative period was complicated by prolonged paralysis of the intestine, kupirovannom conservative methods. 6.02.99 drained deep peripeteia hematoma of the abdominal wall. The healing of the wound by first intention over drainage, infiltration seams were absent, despite the massive infection of the wound during surgery. 15.01.99 removed skin sutures. After completing the course the Oia fistulous dermatitis, including applique on the skin around the fistula with an interval of 12-24 hours of drug compound in the form of a gel, antioxidant, analgesic and non-steroidal anti-inflammatory drugs in therapeutic doses for topical use, characterized in that the said drug substance is first mixed with etizolam.

 

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