A method of treating ulcers in the diabetic foot syndrome

 

(57) Abstract:

The invention relates to medicine, namely to the treatment of ulcers in the diabetic foot syndrome. A method of treatment involving the use of napkins "Al" with different active substances in a certain sequence. The method speeds up the healing process. table 1.

The invention relates to medicine, namely to conservative methods of treatment of ulcers with the disease of diabetes, namely when the diabetic foot syndrome.

There is a method of treatment of a model of diabetic ulcers, conducted on laboratory animals, where the ulcer surface was superimposed cloth with a water-soluble ointments "Levocin" and the vegetable "levomekol. Epithelialization in the treatment in a known manner were observed at 15-18 days (E. C. Kuleshov, S. E. Kuleshov "Surgical diseases and diabetes", Izdat. "High school", 1996 ). However, this method has been implemented only in laboratory conditions on a group of animals.

There is a method of traditional treatment of trophic ulcers, consisting in the fact that the ulcer dressings with a water-soluble ointment "Levocin" and the vegetable "levomekol 20-Tami and parallel appointment of physiotherapy (Great medical encyclopedia, M , Izdat. "Soviet encyclopedia", 1985, T. 25, page 374 - 348). However, this treatment is ineffective in the treatment of diabetes because the disease is protracted (up to years), while the weights for the underlying disease and progresses to other complications.

The disease of diabetes, leads to the formation of ulcers, which aggravate the course of the main disease decompensation of diabetes mellitus. In terms of decompensated diabetes healing of ulcers is significantly slowed down. In most cases, the healing of ulcers complicated by the presence of resistant pathogenic microorganisms (Staphylococcus aureus, Staphylococcus epidermidis, Enterococci, Escherichia coli, Proteus subspicious, Klebsiella pneumoniae, Pseudomonas subspicious), which is sensitive to the antimicrobial, antiseptic and bacteriostatic drugs.

A characteristic feature of ulcers in the diabetic foot syndrome is an extremely difficult and long (up to several months) the process of healing of the defect. In addition, in many cases, to close this defect cannot in General that leads to amputation, for example, fingers and full or partial disability of the patient. This severe course of the disease due to low soprabolzano water-soluble ointments "Levocin" and the vegetable "levomekol, containing the antibiotic chloramphenicol, leads to a significant increase in the resistance of the microbial flora, and often has no effect.

The problem of suppression of resistant microbial flora can be realized by applying different antiseptics, antimicrobial substances, ensure their prolonged action and interleaving in the treatment process.

The invention solves the problem by simplifying the way treatment ulcers diabetes, increases the effectiveness of the treatment and reduces its terms.

The problem is solved due to the fact that as a dressing material used napkins "Al" with prolonged therapeutic effect, representing textile knitted base containing medicines in combination with polymer-polysaccharide, one course of treatment lasts for 12 days, every two days produce replacement tissues and simultaneously shift of drugs, with a bandage periodically moisturize.

For maximum suppression of resistant microbial flora treatment of ulcers in the diabetic foot syndrome is carried out using alternating drugs, inbound m antiseptic and antioxidant action (contains chlorhexidine, -tocopherol and ascorbic acid),

- "Don't HVIT-complex (contains chlorhexidine, rutin and ascorbic acid, combined with antiseptic, antioxidant, additionally stimulating the blood circulation in the tissues;

- antiseptic agents "don't X" (contains chlorhexidine);

with antimicrobial activity "Al f" (furagin);

- spread spectrum suppress microbial flora - "Al HF (containing chlorhexidine and furagin);

- combined antiseptic antimicrobial and wound - healing action - "don't FHF" (contains furagin and charpillet).

After admission of the patient to the hospital conducted toilet ulcer 3% solution of hydrogen peroxide, necrectomy and put the napkin "don't HVIT" with antioxidant action, moistened with sterile water, saline or hydrogen peroxide, top impose the absorbent material and the bandage is fixed in the usual way. The cloth periodically moisturize, and the dressing is not changed. Hydration increases the efficiency of drug contained in a napkin, and prolong their therapeutic effect. Moist cloth is a surface defect.

Two days dressing change, the cloth is removed and the testimony is a surgical treatment of a surface defect (necrectomy), and subsequent treatment with 3% hydrogen peroxide solution. Then applied a new bandage cloth "don't HVIT-complex", which is also moistened and held for two days.

Through the following two days removed the bandages from cloth "don't HVIT-complex". After that dressings with an antiseptic wipe "Al-X", which is also moistened and held for two days.

Next consecutively for two days impose napkins "don't f", then "Al HF", and then "don't FHF".

Change the bandage on the testimony spend processing ulcer surface defect.

The entire course of treatment is 12 days and is repeated in the treatment of PIF before the closure of the ulcer.

The proposed method is based on the alternation in the sequence of drugs that provide suppression of the entire spectrum present in the wound microbial flora, reduce the pain of the wound and accelerate healing.

The invention illustrates the example.

When viewed from the left foot strain. Palpation moderate swelling. On metatarsal surface of the sole of the left foot - ulcer size 2,h,2x0,2 cm, with serous-purulent wound discharge.

After examining the bodies of the diagnosis of the disease: diabetes type 1, heavy flow (the tendency to hypoglycemia), in the phase of decompensation. Diabetic proliferative angiopathy of the retina of both eyes. State after laser coagulation in 1997, Diabetic neuropathy, distal type, sensorimotor form. Diabetic foot syndrome, neuropathic form. Ulcerative defect 2 degrees of the sole of the left foot. Diabetic autonomic neuropathy (cardiopathy, enteropathy). Diabetic nephropathy, ESRD 1 degree.

Immediately after admission to the hospital made toilet ulcer surface of a 3% solution of hydrogen peroxide, necrectomy, and then the ulcer was covered in bandages with wipes "don't HWIT", which was periodically moistened. Two days later the bandage was removed, the second bandage cloth "don't HVIT complex", which was also wet and was charged two days. Ulcers were cleansed from purulent and necrotic masses on the fourth day. Ulcer surface was treated with 3% hydrogen peroxide solution and was applied a new bandage cloth "Al-X", which was periodically moistened and was charged two days. On the sixth day appeared healthy juicy granulation. Next consecutively for two days ligation was carried out with wipes "don't f" "Al HF" "don't FHF". After 12 days of treatment course was started again and on the 15th day of the defect completely epithelials.

To illustrate the high efficiency of the proposed method of treatment was undertaken to compare the results of treatment of diabetic foot syndrome in patients with diabetes mellitus type 1 and 2 in a known manner and proposed (table).

In the group of patients (20 people ), treated by the proposed method, the complete closure of the defect by the 20th day was observed in 20% of cases, a significant improvement in 60% of cases (reduction of the defect area by more than 3.5 times), in 15% of cases there was a reduction in the area of the defect in 1,5-2,5 times, and in one case (5%) treatment gave no effect.

The advantage of the proposed method is in a gel base with drugs does not damage the newly formed granulation and epithelium. Material before removing enough to moisten, it is easily removed, the replacement is not painful.

A method of treating ulcers in the diabetic foot syndrome, including pre-treatment of the wound and the use of the dressing material, characterized in that as a dressing material used napkins "Al", periodically moisturize and changed every two days in the following sequence: first, put the napkin "don't HWIT", then "don't HVIT complex, next in series: "don't X", "don't f", "Al HF" and "don't FHF", with one course of treatment lasts 12 days and is repeated until healing of the defect.

 

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