Method for treating skin lipodermosclerosis

FIELD: medicine.

SUBSTANCE: method involves making muscle tissue and subcutaneous fat forage at a place located under pathologic skin region. The operation starts and ends in healthy tissues adjacent to the skin region. Then, skin defect surface is treated so that both forage and skin defect surface treatment are done with high intensity laser radiation having wavelength of 805-1064 nm. Forage is carried out with laser radiation power of 4-10 W, light guide of 4-6 mm in pulsating or continuous mode. The skin defect is treated with radiation power of 2-8 W daily during 7-10 days in remote mode with scanning movements in the direction set in perpendicular to the accomplished forage with light guide movement speed equal to 0.5-1.0 mm/s and distance between the light guide and surface under treatment being equal to 5-50 mm.

EFFECT: enhanced effectiveness of treatment.

 

The invention relates to medicine, more specifically to dermatology, and can be widely used in the treatment of specific diabetes skin lesions - lipodermatosclerosis.

Widely known methods of treatment of skin lesions developing in patients with diabetes mellitus - diabetic lipidrich of necrobiosis, providing the impact on the affected skin helium-neon laser with a power flux-density of 0.25 to 5.0 mW/cm2with exposure 3-10 minutes, daily for the treatment of at least 20 sessions (see Weerapana, Sampedro, Vasulka "Application of low-intensity laser radiation in dermatology" (a Practical guide). M., 1996, p.27).

However, this method is not sufficiently effective as external beam radiation lesions, and low-intensity laser radiation power and exposure leads to insufficient penetration of laser radiation into the lower layers of the dermis and blood vessels of the skin.

In addition, this method has limited application, as recommended to ensure only specific to diabetes skin lesions - lipoid necrobiosis.

There is a method of treatment of severe pathology of tissues, including skin, is selected as the closest analogue, providing for pre-heating pathologic the maternal tissue with the fixing temperature, and after reaching the cloth to the desired temperature, the effect on the surface of pathological tissues violet radiation vapor laser strontium (see application RU # 93009010/14, IPC And 61 N 5/067, publ. 09.07.1995 year).

According to the creators of this method it provides maximum selective effect on pathologically changed skin and minimally affects adjacent to the pathological section of healthy tissue.

However, this method is not effective enough, because it does not provide sufficient impact on the lower layers of the dermis, which is especially important when such skin diseases as lipodermatosclerosis.

Thus, the technical result for the solution of which this invention is directed, is to increase the effectiveness of treatment of lipodermatosclerosis.

This technical result is achieved by the fact that in the known method of treatment of lipodermatosclerosis skin, providing the impact on the surface of pathological tissue by laser radiation, according to the invention, prior to exposure to laser radiation additionally perform channelization muscle tissue and subcutaneous fat at the site, located under the skin defect, starting and ending with the implementation of healthy tissues surrounding tissue, while channelization and impacts is established on the surface of pathological skin area is carried out using high-intensity laser radiation with a wavelength of 805-1064 nm, moreover, channelization carry out laser radiation power 4-10 W, led diameter 4-6 mm in pulsed or continuous mode, and the effect on the surface of pathological skin area carry out laser radiation power 2-8 W, daily for 7-10 days remotely scanning motion over the surface of pathological skin area in the direction perpendicular performed tunnelization, with a speed of movement of the fiber 0.5-1.0 mm/sec, when the distance between the fiber and the surface 5-50 mm

Additional implementation, prior to exposure to laser radiation on the surface of pathological skin area, tunnelization muscle tissue and subcutaneous fat at the site, located under the skin defect, starting and ending its run with a healthy, adjacent to the defect, tissues, can significantly improve the clinical efficacy of the method.

This is achieved through education in the muscle tissue, in locations around made tunnels, and healthy, adjacent to this pathological site, tissues additional network of small arteries, which increases blood flow to pathological skin area and surrounding areas of healthy skin.

While the authors experimentally found that the best results to tigalda in the implementation of tunnelization and impact on the surface of pathological skin area exactly high-intensity laser radiation with a wavelength of 805-1064 nm, and with the implementation of tunnelization laser radiation power 4-10 W, a fiber with a diameter of 4-6 mm in continuous or pulse modes, and effects on the surface of pathological skin laser radiation power 2-8 W, daily for 7-10 days remotely.

This is ensured by the fact that high-intensity laser radiation is characterized by a short, painless, aseptically and very importantly, well tolerated by the proposed categories of patients.

In addition, the mechanism of high-intensity laser radiation must be noted is its ability to enhance the body resistance, to enhance tissue regeneration and to increase the resistance to the pathogenic action of various factors immunodeficiency, which is also especially important for the claimed category of patients.

Thanks to the implementation of the tunnels high-intensity laser radiation is provided by its impact on a larger volume of tissue, and longer data retention tunnels in muscle tissue, which eventually leads to the formation under the skin defect and surrounding healthy tissues more powerful additional network of small arteries, which contributes to more powerful blood flow to pathological skin area.

In addition, the authors of the experimental the quarterly set, the best results are achieved when performing the action of laser radiation on pathological skin it remotely scanning movements on the surface of the pathological tissue in a direction perpendicular performed tunnelization.

According to the authors this is ensured by the fact that in this case the overall effect of the laser radiation (if tunnelization, and then the surface action) is subjected to the maximum amount of pathological skin area.

The method is as follows.

Under General anesthesia are channelization muscle tissue and subcutaneous fat areas affected limb, located under pathological skin area, starting and ending its run with a healthy, adjacent to this site, fabrics.

The formation of tunnels is as follows. Using the original instrument of their own design under pathological skin area affected limb is drawn fiber with a diameter of 4-6 mm and under the skin defect is performing up to 6-8 tunnels as in the muscle layer and in the layer of subcutaneous fat.

The introduction and removal of the fiber at each of the tunnels is within the healthy tissues of the skin adjacent to the given pathology is a mini-site, i.e. the beginning and the end of the tunnel falls on the area of healthy skin adjacent to the skin defect.

When turning on the laser light source light guide, starting with healthy skin area, adjacent to a skin defect, moving along pathological area muscles at a distance of from 5 to 15 cm (depending on the size of the skin defect). The removal of the fiber after completing each tunnel is also carried out within the healthy tissues of the skin adjacent to the skin defect. The distance between the places of insertion of the optical fiber is 2-5 see

Manipulation perform high-intensity laser radiation with a wavelength of 805-1064 nm capacity 4-10 watts in pulsed or continuous mode fiber with a diameter of 4-6 mm

The impact on the surface of pathological skin area carry out high-intensity laser radiation with a wavelength of 805-1064 nm radiation power 2-8 watts. Effects on skin defect perform daily for 7-10 days. This effect carried out remotely scanning motion over the surface of pathological skin area in the direction perpendicular performed tunnelization. The speed of travel of the light guide when performing this impact is 0.5-1.0 mm/sec. The distance between the light guide and the workpiece surface when you follow what this impact is 5-50 mm

The method is confirmed by examples of specific performance.

Example No. 1. Patient W. - 52, Diagnosis: varicose disease with chronic lymphovenous insufficiency right limb IV class CEAR. On the bottom third of the inner surface of the right tibia two pathological skin area, one with a diameter of 6 cm, the other with a diameter of 5 cm

The fiber diameter of 4 mm, built-in special instrument of his own design is applied to the first pathological skin area (diameter 6 cm). After summing up the fiber to the starting point of impact includes the laser light source and with the help of this tool, the fiber is pushed under pathological skin along his muscles at a distance of 8 see the Input optical fiber to perform each of the tunnels and its output is within healthy tissues adjacent to this skin defect.

Under the first skin defect made 3 of the tunnel. The distance between the seats of the input optical fibers - 2 see

Manipulation of tunnelization muscle tissue and subcutaneous fat were performed high-intensity laser radiation from a diode laser with a wavelength of 805 nm with power of 10 watts in continuous mode.

After tunnelization muscle tissue and subcutaneous fat below the first pathological skin fulfilled tunnelization under the second skin is the effect. Used modes of laser radiation used for tunnelization first pathological area. Under the second pathological section of the light guide advanced along the muscles at a distance of 7 see the Number of tunnels - 2. The distance between places, the introduction of fiber - 2,5 see

After the implementation of tunnelization under the first and second skin defects fulfilled remote effect of high-intensity laser radiation on the surface of each skin defects. Exposure was performed on the surface of each of the sites daily for 10 days scanning movements on the surface in the direction perpendicular performed tunnelization. Exposure was performed using a diode laser with a wavelength of 805 nm 8 watts. Used a fiber diameter of 6 mm, the Fiber was moved at a rate of 0.5 mm/sec. The distance between the fiber and the surface - 5,0 mm

Upon completion of the course of treatment, the patient, lipodermatosclerosis completely cured. The patient was discharged with recovery. At follow-up at 6 months of disease recurrence was not detected.

Example No. 2. Patient U. 47 years. Diagnosis: posttromboflebichesky disease with chronic lymphovenous insufficiency of the left limb VI class CEAR. On the lower third of the left limb two pathological skin area, tindomerel 10 cm, the other 5 see

The sequence of manipulations to example No. 1. When performing manipulations using the following modes:

- channelizate first section: radiation of YAG-neodymium laser with a wavelength of 1064 nm 4 W in pulsed mode;

the fiber diameter of 6 mm;

- the number of completed tunnels - 4;

- the distance that promoted the fiber when tunnelization -15 cm;

- the distance between the places of insertion of the optical fibers is 2.5, see

Channelizate second section is carried out with the following modes:

- channelization performed high-intensity YAG-neodymium laser with a wavelength of 1064 nm, the radiation power of 4 watts;

the fiber diameter of 6 mm;

- the number of completed tunnels - 2;

- the distance that promoted the fiber 7 mm;

- the distance between the seats of the input optical fibers - 2.5 mm

Remote impact on the first pathological skin area is carried out according to example No. 1 daily for 7 days by radiation of YAG-neodymium laser with a wavelength of 1064 nm radiation power of 2 watts. The speed of travel of the fiber - 1.0 mm/sec. The distance between the fiber and the surface - 50 mm

Remote impact on the second pathological skin made according to example No. 1 (second pathological section).

Lipodermatosclerosis at blogopolis cured after 7 sessions. The patient was discharged with recovery. At the control examination after 7 months of aggravation of the disease was not detected.

A method of treating lipodermatosclerosis skin, providing the impact on the surface of pathological skin laser radiation, characterized in that prior to exposure to laser radiation additionally perform channelization muscle tissue and subcutaneous fat at the site, located under the skin defect, beginning and ending with her exercise with a healthy, surrounding tissue, while channelization and impact on the surface of pathological skin area is carried out using high-intensity laser radiation with a wavelength of 805-1064 nm, and channelization carry out laser radiation power 4-10 W, a fiber with a diameter of 4-6 mm in pulsed or continuous mode, and the effect on the surface of pathological skin - laser radiation power 2-8 W, daily for 7-10 days remotely scanning motion over the surface of pathological skin area in the direction perpendicular performed tunnelization with the speed of movement of the fiber 0.5-1.0 mm/s when the distance between the fiber and the surface from 5 to 50 mm



 

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