A method for the treatment of venous leg ulcers

 

(57) Abstract:

The invention relates to medicine and can be used for the treatment of venous leg ulcers. Hold the contact effects on the skin colasuonno the field of IR radiation, slowly moving sensor led device on the perimeter of the ulcer within 10 minutes the wavelength of visible red light, 640 nm, invisible - 840-950 nm. Then act ozonopause mixture with ozone concentration of 50 mg/l for 15-20 minutes Close ulcerative defect plate polyacrylamide gel, saturated solutions of antiseptics and antibiotics. During the day, spend twice the exposure of vessels methodology on vessels popliteal area within 10 minutes Ozonopause mixture effect within 5-12 sessions. Rate IR is carried out before complete healing of the ulcer. The method allows to increase the effectiveness of treatment of venous leg ulcers. 4 C. p. F.-ly, 2 tab. , 1 Il.

The invention relates to the field of medicine, surgery, specifically to methods for treating venous leg ulcers.

Known methods of treatment of venous ulcers, which is to assign medicinal drugs, as well as local use of medicines and LASS="ptx2">

These methods have drawbacks:

- we offer drugs or techniques are targeted and can not cover the entire spectrum of the pathogenesis of ulcer formation,

- a large percentage of recurrence of venous ulcers,

- the use of most methods is possible only in stationary conditions.

Closest to the proposed method is a method of ozone therapy of purulent wounds and trophic ulcers proposed Muravyev A. C. in 1990 [7] . The essence of this method consists in the following: without surgical treatment of trophic ulcers before treatment the tibia is fixed local isolator, connected by pipeline with ozone. In the local insulator supported the ozone concentration of 50 mg/L. trophic ulcers of venous etiology, the treatment is supplemented with medication and compression therapy. In the result of the research, the author notes the following clinical indicators in the treatment of trophic ulcers of venous etiology with the duration of the ulcer for more than 6 months:

1. the disappearance of pain - 9,21,5 day,

2. the appearance of granulations - 3,00,3 day;

3. the emergence of epithelization 11,11,4 day;

4. the duration of treatment is 33,66,6 actuat not all links of the pathogenesis of ulcer formation;

3. without plastic skin cannot heal ulcers of the large size;

4. is not universal.

A new technical result is an increase treatment effectiveness by reducing the time of healing of the ulcer, decrease the duration of the adverse clinical manifestations course of wound process, reducing the number of infectious complications and recurrence of ulcer formation reached by applying a new method for the treatment of venous leg ulcers, including the treatment of the skin of the leg and the surface of the ulcers and the subsequent conduct of drug therapy, ozone therapy and etiology of varicose ulcers, compression therapy, and additionally spend the contact effects on the skin colasuonno the field of IR radiation, slowly moving the probe around the perimeter of the ulcer for 10 minutes, then affect the pathologic lesion ozone for 15 - 20 minutes, then cover the surface of the ulcer plate of polyacrylamide gel (plasterer), saturated solutions of antiseptics and antibiotics respectively mean microflora, prevailing in the plague, and its sensitivity to antibiotics, and then fix the plate perawat on vessels methodology on vessels popliteal region for a duration of 10 minutes each, also the treatment with ozone is from 5 to 12 sessions, and exposure to IR-radiation continue to heal the ulcer, also the saturation of the plate plasterer solutions of antiseptics and antibiotics should be performed within 48 hours, and in the case of the large size of the ulcer perform surgical treatment, corresponding to the etiology of ulcer formation and size of the ulcer, after which, repeat the treatment without exposure to ozone until complete healing of the ulcer.

The method is as follows

The treatment of ulcers produce both in-patient or outpatient basis, depending on the severity of the condition of the patient, size of ulcer, the need for surgical treatment, stage course of wound process. During the first ligation produce toilet wound with warm, soapy solution process the skin of the lower leg around the ulcer with a soft sponge. The surface of the ulcer is treated with antiseptic solutions.

After that, the apparatus for led therapy "dune-T" hold contact effects on the skin colasuonno areas with slow moving around the perimeter of the ulcer for 10 minutes. The emission spectrum of the device "dune-T" lies in the red region of the visible light is light. The device was created in medico-ecological center "Dune" in the city of Tomsk. In case of apparent changes of the skin exposed by vessels methodology in the popliteal area is also within 10 minutes [6] .

Then the lower leg is placed in a local detention facility [5] (a plastic bag with a volume of 30 liters, by means of a flexible pipe connected with ozone, for each procedure uses a new bag, sterilization which is in proformative the camera up to 1 day). The concentration of ozone in the insulator 50 mg/l at the time of the procedure is from 15 to 20 minutes.

The last stage of treatment procedures is the location on the surface of the ulcer plate dressing material with hydrophilic properties, for example, polyacrylamide gel (plasterer) (10). The plate is supplied sterile, Packed in polyethylene bags. Before use, the plate is saturated with antiseptic solution (Dioxidine Of 0.5%, Furacin 0,02%, solutions of antibiotics, antiseptic nature is determined by the type of microflora, prevailing in the plague. The plate is placed in a sterile container with a solution to saturation at 48 hours. During ligation, depending on the size and shape of the ulcer moduliruya varicose etiology of ulcer formation impose a compressive bandage.

Depending on the etiology of ulcer formation and size of the ulcer apply surgical treatment. Varicose etiology of ulcer formation perform an operation Troy - Trendelenburg - Babcoke with ligation of perforating veins in Lynton [1,2] . In case of impossibility of self-epithelialization of the ulcer perform plastic leather vintage way with the subsequent application of infrared radiation, plasterer until complete healing of the ulcer, saturating platinum of plasterer medicinal solutions, respectively, under current wound process.

After ligation during the day, the patient holds two sessions led therapy apparatus "dune-T" vessels methodology on popliteal region with a duration of 10 minutes each procedure [6] .

Justification mode

The total dose of exposure apparatus for led therapy "dune-T" based on the methodological recommendations of use of the instrument. The instructions daily dose of exposure for an adult regardless of the method of application varies from 30 to 50 minutes of total exposure. The total dose in the proposed method consists of three uniform wtru ulcers,

two subsequent exposure is carried out by patients on vessels methodology in the popliteal area during the day after ligation at equal intervals of time. Each exposure duration up to 10 minutes.

The choice of infrared radiation based on studies revealed immunomodulating properties of low-intensity laser radiation [4,6] and confirmed by the authors of the experimental work to determine the immunotropic properties of the device for led therapy "dune". It is established that the infrared radiation with a wavelength of 640 nm and 840-950 nm causes an improvement of the rheological properties of tissues (vascularization) and stimulates local immunity, which contributes to the stimulation of reparative processes in the plague and colasuonno area and accelerates the process of healing of the ulcer. The authors also selected optimum impact, and sequence effects on different areas of the body. First - contact effect on the skin colasuonno areas with slow moving around the perimeter of the ulcer to improve microcirculation in the area of the ulcer, and then on vessels methodology in the popliteal region, in the projection of the vascular bundle of the popliteal region, with the aim of IME the m treatment is sufficient for stimulation of reparative processes in the plague in this category of patients.

The closure of the ulcer dressing material with hydrophilic properties, such as Plastika, saturated solutions of antiseptics or antibiotics, respectively selected from the surface of the ulcer microflora and its sensitivity to antibiotics promotes active local antibiotic therapy reduces the trauma to the ulcer surface, and after the plastic skin trauma of the skin grafts, reduces pain, makes absolutely painless dressing that promotes more rapid cleaning of the surface of the ulcer and filling it granulation tissue. Preparation of material for bandaging chosen empirically based on the authors conducted research (see drawing). Maximum saturation bandages antiseptic solution occurs within 48 hours, in the following days, the saturation dramatically slows down and is reflected only on the physical properties of the plate.

Known bactericidal effect of ozone [3,7] , the duration of the procedure 15-20 minutes based on the clinical observation of treatment of these patients and taking into account the combined effect of various factors. Depending on the effectiveness of the treatment is about the defect of granulation tissue, the number of treatments of ozone varies from 5 to 12 for each patient with trophic ulcers of the leg.

The surgical treatment is shown in case of impossibility of self-epithelialization of the ulcer due to its large size. In the case of varicose etiology of ulcer formation perform the operation venectomy on Troyanovo - Trendelenburg - Babcoke with ligation of perforating veins in Linton, plastic skin ulcer carried out, for example, vintage method [1,2,3,8] .

Example

Patient M. aged 77, was admitted to the surgical Department plan assistance in the direction of the clinic at the place of residence. The duration of the ulcer at the time of admission was 24 months. During this time the patient was unsuccessfully treated in several surgical hospitals of the city, however, surgical treatment, given the age of the patient was not offered. The patient is significantly restricted in movement due to significant pain syndrome and ankylosis of the ankle joint. The patient's condition at admission regarded as moderate, complains of pain in his left Shin, constant fatigue and low-grade fever with episodes of increasing the arc. When viewed from the tibia increased in volume, the skin of the lower leg indurative changed and hyperpigmentation. On the inner surface of the tibia above the ankle is oval ulcerative defect with callous edges, and the plague filled with purulent-necrotic masses, emitting sweet odor and staining the bandages in greenish-dirty color. The skin around the ulcer eczema changed. On the femur and tibia are defined conglomerates varicose veins predominantly trunk type. The perimeter of the ulcer totaled 32.0 see In the General analysis of blood draws attention to the indicator of the level of erythrocyte sedimentation rate of 50 mm/h From the surface of the ulcer dedicated Ps. Aerugenosae. Made rheovasography of vessels of lower extremities, which is determined by the human peripheral blood flow at the level of the left tibia of 2 degrees. According to the results of the researches diagnosed with primary varicose veins of left lower extremity trunk type, CVI 3 tbsp. trophic ulcer of left tibia, paratravmaticheskoy eczema. From the first day of treatment appointed peace with elevated foot position. Medical therapy consisted of antibiotics, venotonic, antiplatelet and desensitizing agents. On the first of peuchen stream of warm air. Apparatus for led therapy "dune-T" held effect on the skin colasuonno region remote method (because of eczematous skin changes colasuonno area) for 10 minutes. Then the lower leg is placed in a plastic boot, which is fed into the ozone-air mixture with ozone concentration in her 50 mg/l exposure time of 15 minutes. After that the plague is superimposed plate of plasterer saturated solution of trypsin. Against the background of such treatment to 3 days clearly marked improvement in General condition with normalization temperature, reducing the pain. In the ligation disappeared weeping skin sores around (since that time the influence of infrared radiation produced by the contact method on the perimeter of the ulcer). Decreased amount of purulent discharge from the wound surface and reduced the number of necrotic tissue on the wound surface. This mode of binding was preserved in 10 days. During this time, the swelling of the leg, and the surface of the ulcer began to fill with bright granulations. Ozone therapy has stopped (11 sessions), continued led treatment on the surface of the ulcer and ligation with Plastika, rich 1% solution dioksidina. Continued preparation of the skin: once in the perimeter of the ulcer decreased to 20.5 cm (healing rate was 0.48 cm/day), the surface of the ulcer is filled with vibrant granulations, but the wound is still determined by the Ps. Aerugenosae. Significantly reduced the degree of induration of the skin of the leg. On the 25th day from the start of treatment, the operation of removal of the great saphenous vein on Troyanovo - Trendelenburg - Babcoke. Due to pronounced changes in the skin of the leg ligation of perforating veins were not carried out. The postoperative period was uneventful with the healing of surgical wounds by primary intention. Treatment of trophic ulcers continued daily dressings with Plastika, a saturated solution dioksidina 1% in combination with led irradiation. Within 15 days of the postoperative period the perimeter of the ulcer decreased to 8.5 cm (healing rate was 0.8 cm/day). The positive dynamics of the current local wound healing, despite being defined in the wound Ps. Aerugenosae allowed to perform plastic leather vintage way. In the postoperative period grafts covered with Plastika, a saturated solution dioksidina, the first ligation performed on the 3rd day. Achieved full engraftment of the graft and epithelialization of the surface of the ulcer. The patient was discharged in good condition after 52 days from the commencement of the treatment.

The duration of treatment of trophic ulcers varicose etiology in the study group was 29,00,46 day, in the same group of patients selected the prototype method, the duration of treatment was 33,66,6 day. Compared with the method of the prototype relief of pain occurred earlier 2,280,12 day against 9,21,5 days in the method prototype, the emergence of epithelialization observed 5,00,56 day difference 11,11,4 day on the prototype method (table. 2).

Thus, the advantages of the proposed method are:

the versatility of the method, it can be used with trophic ulcers of any etiology,

no negative impacts on patients, staff and the environment,

the possibility of inpatient and outpatient use,

rapid improvement in clinical indicators, relief of pain,

less trauma to the graft after skin grafting with the management of the postoperative period with Plastika,

reduction of terms of treatment of patients with varicose ulcers etiology to 29,02,71 day,

the reduction in the number of mutilating operations.

Sources of information

1. Vasudev C. J. , Protsenko N. Century Trophic ulcers of the leg and foot. M. , 1993 , 160 S.

4. Illarionov C. E. fundamentals of laser therapy. M, 1992 - 123 S.

5. Clement A. A. , Vedeno A. N. Surgical treatment of diseases of the veins of the extremities. - L. 1976 -295 C.

6. Methodical recommendations. Led phototherapy. //Novosibirsk-Tomsk. - 1997, N 1, - 27 C.

7. Ants A. C. Ozone therapy of purulent wounds and ulcers. //Abstract. dis. Kida. the honey. Sciences. - Yaroslavl, 1990, to 24 C.

8. Petrov Century. And. Free skin grafts. M - 1964 - 145 C.

9. Popov A. C. Comprehensive treatment of trophic ulcers of the lower limbs venous origin. //Dis. Caen. the honey. Sciences - N. Novgorod 1994, - S. 148.

10. Conclusion on Toxicological tests polyacrylamide gel. The scope and method of application, contact lenses. Kyiv. 1980.

1. A method for the treatment of venous leg ulcers, including the treatment of the skin of the leg and the surface of the ulcers and the subsequent conduct of drug therapy, ozone therapy, characterized in that it further conduct of the contact effects on the skin colasuonno the field of IR radiation in the visible red light with a wavelength of 640 nm and invisible infrared radiation with a wavelength of 840-950 nm, slowly the ulcer defect ozonopause mixture with ozone concentration of 50 mg/l for 15-20 min, after that cover the surface of the ulcer plate polyacrylamide gel, saturated solutions of antiseptics and antibiotics, fix the plate and in the course of the day still spend twice the exposure of vessels methodology on vessels popliteal region, with a duration of 10 min each.

2. The method according to p. 1, characterized in that act ozonopause mixture within 5-12 sessions.

3. The method according to p. 1, characterized in that the rate of IR exposure is carried out before complete healing of the ulcer.

4. The method according to p. 1, characterized in that the feeding of the plate polyacrylamide gel solutions of antiseptics and antibiotics should be performed within 48 hours

5. The method according to p. 1, characterized in that the larger size of the ulcer perform surgical treatment, corresponding to the etiology of ulcer formation and size of the ulcer, after which repeat the proposed course of treatment without exposure to ozone, until complete healing of the ulcer.

 

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