The method of treatment of purulent wounds

 

(57) Abstract:

The invention relates to medicine, in particular to surgery, and can be used for the treatment of purulent wounds. The method includes necrectomy, washing the surface wounds or cavities ozonated distilled water obtained by passing through it of ozone-oxygen mixture at a concentration of 200 g/l for 60 minutes. Then carry out air ozonation ozone-oxygen mixture at a concentration of 50 g/l for 20-30 min, then neutralized with 1% sodium bicarbonate solution, then treated with a solution of powergra in a concentration of from 0.1 to 0.3% and dressings. The method allows for readjustment of purulent wounds to avoid the application of high concentrations of ozone, antibiotic therapy, and the treatment process to make more physiological. 1 C.p. f-crystals.

The invention relates to medicine and can be used in surgery, traumatology and orthopedics, and is intended for the treatment of purulent, nonhealing chronic wounds, ulcers and sores, as well as for the prevention of suppurative complications in traumatic injuries, degenerative lesions and planned operational interventions on the musculoskeletal system.

2the area of the wound daily until the appearance of granules, after which irrigate granulation fine stream of ozonized solution at a pressure of 10-15 ATM daily until complete epithelialization of the wound.

The disadvantages of this method are:

the possibility of damage to healthy cells and spread infection into the deeper layers of the wound as a result of pressure of the ozonated liquid stream;

the harmful effects of ozone on the patient's body during ozonation without special selection harmless to ozone;

the continuing risk of bacterial pollution (operational, dressing) microdisplay.

There is a method of treatment of purulent wounds (U.S. Pat. EN 2142279 AND 61 TO 33/38 // A 61 N 7/00 from 07.06.95, publ. B. I. 34 1999 from 10.12.99) by washing them with a solution of silver-containing antiseptic detergent of powergra in concentrations of 0.1-0.3%, treated with ultrasound.

The disadvantages of this method are:

the presence of the acidic environment of purulent wounds, promoting the development of pathogenic microflora; what about the pollution and contamination of the external environment (operating, dressing);

the need for additional costs when conducting remediation of indoor air dressing.

The closest in purpose and essential features is a method of treatment of purulent wounds (application EN 99112290, from 09.06.99, a 61 K 33/00, 33/38, publ. in BI 11 for 2001, from 20.04.2001) by treating them with antiseptic aqueous solution containing ozone or poviargol, and washing the Russian Academy of Sciences carried out with a mixture prepared ex tempore of ozonoterapia solution at a concentration less than 4 mg/l and solution powergra in low concentrations, before which conduct air ozonation environment and wounds.

The disadvantages of this method are:

the possibility of adverse systemic effects of ozone on the patient's body when disinfecting the ozonation environment, because it is usually carried out without special selection harmless to ozone;

the presence of the acidic environment of purulent wounds, favouring the development of pathogenic microflora;

the slow process of rehabilitation, reparative regeneration and, as a consequence, the slow reduction of endogenous intoxication and normalize immune system.

Objectives of the invention

the creation of newsasia bactericidal action of powergel, used in low concentrations,

creating conditions exceptions immune suppression and the development of endogenous intoxication.

The task is solved by the fact that in the proposed method of treatment of purulent wounds, first, in the presence of necrotic foci, produce necrectomy (i.e., excision of dead tissue and removal of necrotic lesions not involving viable tissue, because the removal of necrotic tissue and necrotic foci is a prerequisite for any method of treatment of purulent wounds, but not in all cases of purulent wound contains dead necrotic tissue);

then produce conservative treatment of surface wounds and/or generated (trauma, including post-operative) cavities: washed with ozonated distilled water, prepared immediately before use by passing through it an ozone-oxygen mixture at a concentration of 200 g/l for 60 min, followed by their air ozonation ozone-oxygen mixture at a concentration of 50 g/l for 20-30 min, then neutralized with 1% aqueous solution of sodium bicarbonate, treated with a solution of powergra in a concentration of 0.1-0.3% and ele neutralization, washed with 0.1 to 0.3% aqueous solution of powergra (GOS. reg. 97/167/27; Pharm. senior 42-2845-97, appr. 27.05.1997) and dressings with ozonized water with a concentration of 200 g/l, and in the case of gram-negative infection - treatment and bandaging spend solution powergra concentration of 0.3%.

The proposed method of treatment differs from prototype

- addition of the treatment process, if necessary, surgery how agressively to debride;

- conducting air ozonation locally, without ozonation environment, by treating the surface of a wound and/or generated (trauma, including post-operative) cavities after washing them ozonated distilled water;

- introduction operations neutralization of surface wounds and the resulting (post-traumatic, including postoperative) cavities 1% sodium bicarbonate solution;

sequence receptions ways, namely, by carrying out how agressively to debride, then washing the surface of wounds and/or cavities ozonated distilled water, further air ozonation followed by neutralization of the wound surface 1% sodium bicarbonate solution and treated with a solution of powergra;

- differentiated approach to the final stages of treatment: in the allocation of wound gram-positive microflora - host processing about 0.1-0.3% aqueous solution of powergra and dressings with ozonated water at a concentration of 200 g/l, and in the case of gram-negative infection, treatment and bandaging produce a solution powergra concentration of 0.3%, etc.

The proposed method of treatment, you can go to the next level and quality of treatment of patients with purulent, nonhealing wounds, bedsores due to the use of low concentrations of ozone and powergra in combination with additional treatment of the wound surfaces with an alkaline agent to neutralize the acidic environment of purulent wounds and activation used antiseptics on one or two orders of magnitude, thereby creating conditions for inhibition of pathogenic microorganisms on the wound surface of purulent wounds and its complete renovation.

When ozonation is the penetration of ozone in the cell membrane with the destruction of the cell membrane of microorganisms due to the impact on the polypeptide chain and the protein shell of the highly reactive hydroxyl radical ozone and activated ionizirovannaya with substances cytoplasm and the transformation of the closed plasmid DNA to open circular DNA, that may reduce proliferatio bacteria. Cations of silver, which is bactericidal basis of powergel, at low concentrations without activating the ozone reacts with various organic compounds in the aqueous phase, linked to the introduction and does not penetrate cells, i.e. not overcome the membrane barrier. In turn, increased the permeability of cell membranes of microorganisms improves penetration powergra in the cell, there is an increase of bactericidal action of powergel, despite its application in low concentrations. The ozone in this case acts as a conductor of silver cations in the bacterial cell. Due to the inactivation of the reverse transcriptase enzyme happen inhibition of transcription and translation of proteins of microorganisms, and the subsequent total inactivation (loss of the ability to reproduce in the cell-master) bacteria. Is the impaired ability of bacteria to communicate with the receptors of the target cells.

At the same time proven that ozone is used in low concentrations, it has no negative effect on cell membranes of tissues of higher organisms (i.e., patient) by the action of the enzyme mechanism is gnome effects of free radicals and including activated oxygen ozone.

It is known that chronic purulent wounds are acidic (pH 5,40,11) that help support the reproduction of microorganisms and development of purulent processes. It is also known that high concentrations of ozone (50000 ug/l) change pH to the alkaline side in the wound. In the proposed method applied physiological, lower ozone concentrations, which are not able to quickly change the pH to the alkaline side, and thus can slow down the process of removing long-term healing of purulent wounds of tissue hypoxia. To neutralize the acidic wound environment in this way it is proposed to use 1% aqueous solution of sodium bicarbonate, which is also close to physiological and will not have a more traumatic and/or pathogenic action.

Currently, the frequency of complications in the treatment of purulent wounds and inflammations methods of drug therapy by systemic use of modern generations of broad-spectrum antibiotics comes to 10-14% and has been steadily increasing. This has led to the emergence of new polyetheretherketone strains of microorganisms and the formation of pathogenic microorganisms with pathogenic properties, which is ETA and a General weakening of the body. In addition, when allocating polyetheretherketone microflora use of antibiotics is not only useless, but harmful.

The application of the proposed method can effectively and quickly sanitize chronic purulent not healing wounds and sores, infected polyantibiotic microflora, it is possible to avoid the use of high cancerogenic concentrations of ozone, i.e., its toxic effects on the body of the patient, to avoid the application of antibiotic therapy, to bring the mechanism of treatment to physiologically justified, and the processes at local rehabilitation on the proposed method to the physiological processes of physiological and reparative regeneration and wound healing. This not only contributes to the normalization of the oppressed immune processes in the body, but also to the formation of semimountainous mechanism in the patient. Additionally, it helped to reduce the use of expensive antiseptic, thereby to reduce the overall cost of treatment.

The method is as follows:

with infected wound surface remove bandages and in the presence of non-viable areas of soft tissue and necrosis of product is the processing of wounds by passing through it an ozone-oxygen mixture in a concentration at the outlet of the ozonizer 200 g/l for 60 min;

then cooked ozonated distilled water washed surface wounds and/or generated (trauma, including post-operative) cavity, mechanical washing purulent discharge, thereby purifying from pus and infection;

next, carry out air ozonation open (without dressing) surface wounds and/or generated (trauma, including post-operative) cavities ozone-oxygen mixture at a concentration of 50 g/l for 30 min;

after this process the 1% aqueous solution of sodium bicarbonate to neutralize the acidic environment of purulent wounds, thereby creating unfavorable conditions for the growth of microorganisms and activation of bactericidal used antiseptics;

in the allocation of wound gram-positive microflora spend processing of 0.1-0.3% aqueous solution of powergra (GOS. reg.97/167/27; Pharm. senior 42-2845-97 appr. may 27, 1997) and dressings with ozonated distilled water to a concentration of 200 g/l, and in the case of gram-negative infection - concentration solution powergra for processing charge of 0.3% and dressings with the same solution.

This treatment is carried out daily 1 or 2 times a day on which Noah plastic.

Example 1. Patient M., aged 27 (I. B. 26), was treated in Sarnico about multiple trauma: an open fracture of the nail phalanx of the first finger of the left foot; closed fracture of metatarsal II without bias; closed fracture of the heel bone without displacement; massive bruising of the soft tissues of the middle of the lower third of the left tibia, ankle and foot with extensive necrotic skin and subcutaneous tissue; hemorrhagic blisters. At admission were performed in R-gr left lower extremity and primary surgical treatment.

3.5 weeks after unsuccessful treatment in the traditional way (3% hydrogen peroxide, furatsilin 1:5000, antibiotic therapy, ultraviolet irradiation, UHF, reopoliglyukin, gemodez, heparin) during the inspection there were extensive purulent-necrotic wound on the front outer surface of the left foot, lower leg the wrong shape, size 20h15 cm, depth up to 3.5 cm with an area of necrosis in size 3x2 cm in the area of the thumb. The bottom of the wounds appeared to be soft tissue, covered with fibrin. The peripheral blood: ESR 42 mm/h, WBC - 12,2109, erythrocytes - 3,41012. Discharge of purulent wounds, from which stood out Pseudomanas aeruginosa, resistant to 15 antibiotics.

Patient ( see Before each ligation ex tempore prepared ozonated distilled water passing through it an ozone-oxygen mixture in a concentration at the outlet of the ozonizer 200 g/l for 60 minutes

Every day spent washing the wound freshly ozonated distilled water, mechanical washing purulent discharge, thereby purifying from pus and infection; further held air ozonation open wound ozone-oxygen mixture at a concentration of 50 g/l for 30 min; after that, the wound was treated with 1% aqueous solution of sodium bicarbonate and 0.3% solution powerpole; then put a cloth soaked in 0.3% solution powergel.

On the 5th day after the start of treatment number of purulent discharge decreased there was a bright pink granulation, began marginal epithelization. Two weeks later, the wound was completely cleansed of purulent discharge, 85% of the area of the wound epithelials. The peripheral blood: erythrocyte sedimentation rate 10 mm/h, WBC - 9,8109, erythrocytes - 3,71012. After 4 weeks from the start of treatment suggested by the way the size of the wound 1x1 cm2depth of 0.1 cm, the inflammatory process was arrested. Made free skin plastic.99, about closed unjoining fracture of the left humerus with displacement of fragments. The injury was received 21.01.99, during the ice in the fall. Hospital city hospital 9, Saratov were treated for 4 months was imposed skeletal traction for 2 weeks, and then made osteosynthesis by Ilizarov. In allospecies suppuration of the soft tissues after 2 months the device was removed. Imposed cast for 1 month. Conducted treatment of septic complications in the traditional way with the use of broad-spectrum antibiotics. Adhesions in the area of the fracture has not come, remained significant displacement of bone fragments. When contacting Sarnico the patient complained of arching pain in the fracture, movement in his hand sharply limited. During the inspection it was noted swelling and hyperemia of soft tissues.

In Sarnico surgery: outdoor cervical osteosynthesis left humerus metal plate. After 15 days occurred suppuration of postoperative hematoma. This resulted in postoperative wound size h mm and a depth of 35-40 mm of the Bottom of the wound was to be the soft tissue. After emptying GE is about 40 mm. It was noted profuse purulent discharge, which was dedicated polyetheretherketone Staphylococcus aureus, sensitive to polymyxin and ciprofloxacin and yeast-like fungus Candida albicans. The peripheral blood: ESR - 75 mm/h, erythrocytes - 2,01012leukocyte - 15,8109.

The patient started the treatment by the proposed method. The daily dressings were washing freshly ozonated distilled water on the surface of the wound formed after evacuation of the hematoma cavity, mechanical washing purulent discharge. Next carried out air ozonation open surface wounds and cavities formed ozone-oxygen mixture at a concentration of 50 g/l within 30 minutes After they were treated with 1% aqueous solution of sodium bicarbonate, and then with a solution of powergel at a concentration of 0.3% and was bandaging with ozonated distilled water to a concentration of 200 g/L.

On the 4th day after the start of treatment number of purulent discharge decreased there was a bright pink granulation. One week after the start of treatment of purulent discharge changed to sero, noted the active regeneration of soft tissues, resulting OYe cavity has almost disappeared, there was also a gradual tightening of the wound. The peripheral blood: ESR - 57 mm/h, WBC - 7,5109, erythrocytes - 3,31012.

Three weeks from the start of the proposed method of treatment, the wound is completely closed, swelling and redness was almost completely absent, the inflammatory process was arrested. Bacteriologically the crop growth was not given. On the control retinogram position fixed stable fragments, secondary displacements were observed, there were signs of monolaurate.

In Sarnico, since 2000, the proposed method applied in the treatment of 10 patients with post-traumatic, postoperative purulent complications, nonhealing purulent wounds, the area of which ranged from 10 to 450 cm2and was often covered with necrotic masses. From wound stood out polyetheretherketone microorganisms. All patients continuously and unsuccessfully treated with antibiotics.

After the treatment approach after 2-5 days decreased purulent discharge occurred cleansing wounds from purulent discharge, appeared fresh granulation, began marginal epithelization.

Thus, when treating with telesale wounds.

Medico-social efficiency of the method is

reducing the risk of spread of hospital infections;

improving the quality of treatment of purulent infections without the use of expensive antibiotics;

save the costly use of a silver-containing antiseptic of powergra;

reduction of terms of treatment of patients with purulent, nonhealing wounds, bedsores.

1. The method of treatment of purulent wounds, including the treatment of wounds ozonated distilled water, prepared ex tempore, and the solution powergel, air ozonation RAS, characterized in that in the beginning, in the presence of necrotic foci produce necrectomy, then washed surface wounds or formed, including postoperative, cavity ozonated distilled water obtained by passing through it an ozone-oxygen mixture at a concentration of 200 g/l for 60 min, followed by their air ozonation ozone-oxygen mixture at a concentration of 50 g/l for 20-30 min, then neutralized with 1% a sodium bicarbonate solution, then treated with a solution of powergra in a concentration of from 0.1 to 0.3% and dressings.

2. The method according to claim what ment washed with 0.1 to 0.3% aqueous solution of powergra and dressings with ozonated distilled water to a concentration of 200 g/l, and in the case of gram-negative infections washing and soaking the blend dressings provide a solution powergra concentration of 0.3%.

 

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