A method for the treatment of neurotrophic necrotic tissue defects


(57) Abstract:

The invention relates to medicine, in particular to surgery, and can be used for the treatment of neurotrophic necrotic tissue defects. Transplantation of the patient and electrophoresis of the medicinal product. As a medicinal drug used by 0.1% of water or isotonic solution of Ximena. Electrophoresis is carried out for 15 min to 20 days in pre - and post-transplantation period, directly in the field as tissue damage, and the donor area. The positive electrode include proximal to the lesion and the donor area along the main trunk of the nerve, Innervate this region. Electrophoresis donor site spend 3-4 days before autodermoplastiki and after it within 7-8 days. The method allows to increase the effectiveness of treatment neurotrophic necrotic tissue defects. 1 C. p. F.-ly, 1 table.

The invention relates to medicine, namely to method of treatment, and may be used in the treatment of necrotic tissue defects, such as pressure ulcers, especially in patients with torpid during the reparative process, for example, in the damaged nervous trophism.

In order to optimize therapeutic actions in recent years in the treatment of wounds with a positive effect using laser, ultrasound, fluctuorization, UHF-inductothermy, UHF and magnetobacteria and other methods individually and in combination (vacuumcalibrators, galvanometers and others). Special attention is given to combined methods of exposure to electric and monotherapie.

The study of nerve fibers and their beams in the dissected tissues of the wound defect revealed degeneration of Schwann entities, demyelinization myakotnih fibers and varicose swellings of axons. Under the influence of aggressive factors of wound contents nerve is office tissues (Protopopov S. P. Pathogenesis and treatment of long-term healing of wounds. - M.: Publishing house of the Academy of medical Sciences of the USSR, 1950, - 185 C.; Brusilovsky L. Decubitus // bed. - M.: Gosizdat, 1962. - S. 922-927).

Pathogenetically substantiated beneficial effect in the treatment of topical application of various drugs and physical procedures, including the method of forced escrow drugs drugs physico-chemical diffusion in tissues by exposure to continuous direct current (overgrown A. N. Reference practitioner in physiotherapy. - M.: Medgiz, 1957, - 376 S.; Parfenov A. P. Electrophoresis of drugs. - L.: Medicine, 1973, - 290 C.; Bogolyubov C. M. Technique and methods of physiotherapeutic procedures. - M.: Medicine, 1983, - 352 C.). If there is a unity of views of the vast majority of authors in relation to the evidence and the effectiveness of various physical factors (ultrasound, laser, direct galvanic current, and others), there are still contradictions in the use of this or other medicines for effects on the body (Kurmangaliev S. M. Purulent infection in surgery. - M.: Medicine, 1985, - 271 C.).

At the present time to improve the processes of repairing the reg is Aut connection similar in its chemical structure to natural metabolites. These stimulants regeneration include purine and pyrimidine bases (Pods Century. And. et al. Guide purulent surgery. - M.: Medicine, 1987. - S. 109). Know the use of 0.1% methyluracil for the treatment of tissue defects by iontophoresis ("Clinical physical therapy", edited by Sosina I. N. Kiev: Health, 1996, - 194, 245 C.). Of particular interest from them is ksimedon - new pyrimidine derivative with local application of antiseptic and wound healing ability (Izmailov, S. Antimicrobial activity of Ximena // Pharmacology and toxicology of organophosphorus and other biologically active substances. - Kazan, 1996. - S. 73; Patent 2063752 (RF). A 61 K 31/505, 9/06, 9/14. Bull. - 1996. - 20).

However, the use of the drug in traditional lekforma - in the form of ointments or powders causes:

- low therapeutic efficacy in individuals with impaired nervous trophism;

long - term use of ointments on lanoline-vaseline basis leads to maceration of the skin, to the possible development of eczematous dermatitis;

- increased duration of treatment, which reaches 5-6 months with frequent occurrence of sepsis;

- low the ISIS transplant) was observed for each 6-th patient, causing the need to re-transplantations;

- difficult healing of the donor site.

The purpose of the invention is a new method for the treatment of neurotrophic necrotic tissue defects that reduce the treatment time and to prevent the development of complications in patients with purulent-necrotic tissue defects, long-term healing of purulent wounds and ulcers with impaired nervous trophism.

Task is the fact that after a thorough and radical conducted mechanical antiseptics in the complex of therapeutic measures used electric field DC phoresis of Ximena through the tissue defect and the area of the donor area in the pre - and post-transplantation periods. Abdominal electrophoresis of the drug at which the galvanization of the affected area is carried out after the introduction of Ximena directly into the cavity of the tissue defect and along the main nerve that Innervate the affected area of tissue.

Electrophoresis of ximedona carried out in the following sequence. Fabric defect thoroughly washed with an antiseptic solution, oosevelt. Sterile gauze there is 6-dimethylpyrimidin-2) in 100 ml of physiological sodium chloride solution - 0,85% or water and injected into the defective tissue. Top impose moistened with 0.1% solution of Ximena 2-3 layers of sterile cheesecloth, which extends over the edges of the defect by 0.5-1 cm Then the gauze moistened with the above solution of a medicinal substance and impose on it the electrode larger than gauze, so that it protrudes beyond the edges of the defect at 4-5 cm on each side, and connect to the negative pole (cathode). The other electrode (anode) is placed, strengthen in the proximal (30-40 cm) position along the main nerve that Innervate the region of the defect (for example, the sciatic nerve when the defect of the lower extremities, buttocks, hips and other). The calculation of the current produced by the current density of 0.05-0.1 mA/cm2) by multiplying by the area of the wound surface with the exposure time 15 min daily for the treatment of 20 procedures. Each ligation (12-24 h) provide mandatory reorganization of the defect with the change previously entered tampons and superimposed over the wipes, impregnated with fresh 0.1% solution of Ximena.

3-4 days before aytodermoplastics and after its implementation for 7-8 days produce the gel-ximedona (0.1% aqueous solution) of the donor area, which is expected to Zab is raspolozheniem electrodes similarly affected areas.

Ksimedon method interstitial medicinal electrophoresis through a defect and donor site used in 7 patients at the age from 21 to 48 years as the basis for the local treatment of pressure sores in different locations (lower limbs, buttocks, hip and sacral area) with disorder of the nervous trophism (distal polyneuropathy of different Genesis, injuries and diseases of the Central nervous system and peripheral nerves. The patients had complete or partial loss of sensation in the area of tissue defect. The disease duration ranged from 8 months to 2.3 years (experimental group).

All observations in the dynamics (3, 7, 12 and 19 days) was conducted microbiological study of traumatic content. In 5 cases selected for admission aureus (S. aureus and S. epidermidi), rarely Escherichia and Pseudomonas aeruginosa. The Association of pathogens detected in 1 patient and 1 - registered no growth of microorganisms. The sensitivity of microflora were more likely to levomicetinu, kanamycin and oxacillin. Cytological examination of exudate method prints and M. P. intercession and M. S. Makarov pointed to the predominance of degenerative modified phagocytes. Each patient Consul shall conduct x-ray, Ultrasound, reovasographiya, the definition of a number of biochemical constants. Controlled changes in total protein and C-reactive protein, blood urea, bilirubin, sugar, prothrombin, hemoglobin, blood clotting, transaminase activity (ACT and ALT). Histological study of the nerve fibers and their beams in tissues dissected defect was discovered an apparent degeneration of Schwann entities, demyelinization myakotnih fibers and varicose swellings thicker axons. Persistent morphological changes in tissues and degenerative changes in the nerves with functional changes in the nervous system determines the time factor.

To compare the clinical effectiveness of the proposed method under our supervision there were 6 patients (control group) with similar diseases treated with known therapeutic methods, including gel methyluracil (Clinical physiotherapy. Edited Sosina I. N., Kiev: Health. - 1996. - 194, 245 C.) (prototype).

After 4-5 sessions in the experimental group significantly decreased the area of inflammatory infiltration, discharge and swelling of the surrounding tissue. 5-6 days a tissue defect was purified from purulent-necrotic content appeared shallow well Cesky data adequately decreased pathogenicity wound microflora content, and cytologically decreased the number of polymorphonuclear neutrophilic granulocytes. If the phagocytic activity of leukocytes at admission was 60-64% in 5 patients, the 4-5 days it had risen to 78-82%, and by 6-7 days revealed a decrease, indicating the reduction of inflammatory process. Laboratory parameters were close to normal. In 3 cases we observed a distinct improvement in sensitivity. For 8-10 days in 5 patients it was observed a good adhesion of the dressing to the granulations, which indicated their willingness to kozhnoplasticescoy closure. Ongoing curative measure aimed at using the potential of neural elements, improved trophic conditions in the tissues, causing the appearance of healthy granulation and epithelialization. Created a favorable environment for active surgical interventions. So, these changes allowed 4 patients to produce successful kozhnoplasticescoy operations, and 2 came spontaneous epithelization (table).

The average duration of hospitalization of patients treated by the proposed method, amounted to 42 days. Complications during treatment were observed. Disease recurrence occurred in 2 Bo
Sick Oh, 22 years old, was admitted to the Department of purulent-septic surgery 10.04.99 was diagnosed with neurotrophic ulcers plantar surface of the right foot. Disease associates with childhood-operation concerning "clubfoot". Ulcer 33 cm with callous edges, flat bottom, which made pale granulations. On radiographs of the foot marked osteoporosis. When rheovasography legs violations of arterial blood flow is not detected. All kinds of sensitivity in the foot is sharply reduced. Examined by a neurologist. Assigned to combined therapy, including electrophoresis Ximena on our proposed methodology. On the 18th day of the ulcer healed completely. Home was discharged in satisfactory condition. After 8 months surveyed - recurrence of the ulcer was not found.

Objective evaluation of the effectiveness of the developed method in comparison with the control group showed that in the control positive dynamics of clinical and biochemical parameters observed in only 2 patients. Plastic surgery of the skin was unsuccessful in 4 cases. Length of stay of patients in hospital was 64 days. 2 observations noted the generalization of infection with one fatal outcome from sepsis. Through different periods of time (from 4 months to a year) it is possible these patients (5), the traditional summer residence of Ximena inside of 0.5 g to 2 g per day, as well as in patients receiving phoresis methyluracil (0,8% aqueous solution). It should be noted that plastic surgery has a low solubility (not more than 0.85%) and the ability to loss of pharmacological activity when it is sterilized. It is not possible to obtain its highly concentrated solutions for effective treatment gel. On the contrary, ksimedon is highly soluble and does not lose therapeutic activity when sterilization. The duration of treatment duration was equal to the control group.

Thus, the method of treatment of tissue defects, for example, in patients with impaired nervous trophism by medicinal electrophoresis through tissue defect using a 0.1% solution of Ximena applied in the clinic as the basis of local treatment, manifested in the intensification of necrolysis and stimulation of reparative regeneration, which ultimately compared with the prototype leads to a reduction in the duration of treatment and prevent complications. Electropharmacological impact galvanization of Ximena at the tissue defect is an effective and safe treatment method. Any complications during its clinical use was not recorded.

Proceeding from the known lipotropina necrotic tissue defects. Described is a method of treatment is new.

1. A method for the treatment of neurotrophic necrotic tissue defects, including transplantation and electrophoresis of a drug, characterized in that as a drug used by 0.1% solution of Ximena, electrophoresis carried out for 15 min to 20 days in pre - and post-transplantation period directly as in the area of tissue damage, and donor site with the location of the positive electrode proximal to the lesion and the donor area along the main trunk of the nerve, Innervate this region, and electrophoresis donor site spend 3 - 4 days before autodermoplastiki and after it within 7-8 days.

2. The method according to p. 1, characterized in that the solvent of Ximena use water or isotonic NaCl solution.


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