Method for post-operational treatment of donor's wounds

FIELD: medicine, surgery.

SUBSTANCE: one should apply a polycompositional film onto donor's wounds after autodermoplasty performed. This film contains the following components in weight proportions: chitosan 78.3-89.4; polyvinyl alcohol 9.8-19.8; antibiotic of aminoglycoside group 0.5-2.0; anesthetic 0.1-0.2. It is perforated at tension coefficient being 1:4. The innovation enables to decrease wound's traumatization, improves prophylaxis of suppuration and increases cosmetic effect even at a single application of the film suggested.

EFFECT: higher efficiency of therapy.

2 ex

 

The present invention relates to medicine, namely to surgery, and can be used in surgical wards and in the outpatient network.

The treatment of burn wounds remain. Used for these purposes, new drugs and tools must meet the following requirements: to isolate the wound from infection; and to protect it from dehydration, reduce the heat, have some antibacterial properties, contribute to early epithelization. In recent time there are many samples of wound coverings, differing in chemical composition. However, so far there is no universal drug (Bairamov, Aoarashi, Weglarski "Burns" guide, St. Petersburg, spec lit, 2000).

One of the new drugs used in the burn center hospital №18 of Ufa, is a coating based on PVA and chitosan in combination with an antibacterial agent. One of the indications generated bipartite is to protect the donor site after autodermoplastiki.

Contraindications to the use of these biocrete not found.

Known coating for the treatment of wounds donor places with the use of a perforated film of polyvinyl alcohol. This film under the title "miniplan" produced Okhta scientific about svojstvennym Association Plasmapool" (Nizhny Novgorod research Institute of traumatology and orthopedics, Sepahaua Surgery of burns in children, 1997, P.118-121).

The method of treatment is simple. After cutting the skin graft donor wound impose a gauze pad, then it's removed, respectivey perforated foil, cover with 2-3 layers of gauze and secured with a bandage. The film leave until complete healing. After healing of the wound film is gradually falling behind and it is removed. The healing time of wounds from 6 to 12 days after the operation.

Unlike the proposed method:

Time epithelialization 6-12 days.

Film single pack consists of degradiruemosti PVA, after healing of the wound occurs the necessity of removing the film.

Not antibacterial, anesthetic properties.

Performs only the function of mechanical protection, protecting the wound from external mechanical influences.

Film bioinert, enzymatic not are degraded, decomposed due to the swelling and mechanical damage, which is a long process.

Not marked reuse epithelizing donor places as the donor site.

Closest to the claimed is a method of treatment of donor wounds, which use complex film coating, developed at the Department of conservation tissues NIETO, which is a membrane consisting of layers of polysaccharides and collagen, and pregnenolone fine DCM (demineralized bone matrix). The polysaccharide layer contains antibacterial (application No. 98102038 from 28.01.98).

The film is fixed on the wound without adhesive means and allows visual monitoring of the condition of the wound. Developed coating can reduce the healing time of donor wounds for 4-7 days.

In a functional purpose to the disadvantage of the coating is that the coating can remain on the wound surface only a few days. When single use CPR is not enough, it requires the use of two or more times, thus the necessary condition is the removal and replacement of the film coating.

Layer-by-layer (membrane) structure checkpoint, including collagen, prevents the full enzymatic biodegradation of the coating on the wound surface in a time comparable with the period of epithelialization, the consequence of which is the need to replace the transmission. The experience of the applicant shows that when using pure collagen even in the form of fibrous material not observed any significant birthrate material 1-2 weeks of being on the wound surface (proceedings of the 7th all - Russian scientific-practical conference on the problems of thermal lesions. Chelyabinsk, 1999).

The task of the claimed invention is an improvement of the method cured the I donor wounds after surgery loose skin autoplasty.

The technical result when using the reduction of treatment time, improve functional results.

The proposed method is implemented as follows.

After running autodermoplastiki on the surface of donor wounds once impose perforated 1:4 film containing chitosan, polyvinyl alcohol, antibiotic aminoglycoside number of gentamicin and anesthetic, with the following ratio of components, in mass proportions: chitosan 78,3-89,4; polyvinyl alcohol 9,8-19,8; antibiotic 0.5 to 2.0; anesthetic 0.1 to 0.2. The film is fixed with a bandage. The next day the gauze bandage is removed, the film leave until complete wound healing. Experimentally found the ratio of the polymer components to achieve the required level of strength and elasticity of the film, providing the possibility of mechanical punching, sufficient for practical use, using standard equipment and safety forms even perforated film on the surface of the wound in the early postoperative period.

This represents a major problem when using pure chitosan, quickly swelling to wet the surface and losing strength. The film does not prevent the desiccation of the wound surface that does not retain moisture, enough gaspron zaema to ensure flowing of reparative processes, requiring oxygen. The ratio of the components, in which the continuous phase is birthdaaay polyaminoacid, and perforated structure ensure the complete destruction of the coating to the end of the regeneration phase of the wound healing process, thereby reducing trauma to the wound, namely germ layer. Due to the rapid healing of the donor wounds reduced time to re-fence the skin.

The reduction in the content of PVA against the proposed leads to an undesirable reduction of the period of existence of the integral coating on the wound, and the increase of its content leads to the fact that after epithelialization of the wound surface are fragments of the coating that must be removed mechanically.

Being transparent and sufficiently elastic, it allows visual observation of the condition of the wound and well-modeled on the skin surface.

Marked good cosmetic effect.

The main tasks to be addressed the proposed method are:

- prevention of infection of the wounds, stimulation of reparative processes;

a good cosmetic effect;

- ability to improve the timeliness of donor sites for re-sampling of the skin.

The associated analysis of the prototype shows that the inventive method differs from the known fact that Les is possible donor RAS use single use perforated film based on a mixture of chitosan and synthetic polymer polyvinyl alcohol. This allows to make a conclusion on the conformity of the proposed solutions to the criterion "novelty". The film has biocidal properties, performs mechanical protection, stimulates reparative processes. The possibility of introducing anesthetic in the composition of the film provides a local anesthetic to numb the wound surface. Time epithelialization of donor wounds - from 4 to 7 days.

From the literature we have found the use of film to protect the donor wounds of this composition. Experimentally chosen percentage of components.

The proposed method for the treatment of donor wounds has features that distinguish it not only from the way the prototype, but also on other technical solutions. The authors experimentally demonstrated that a single application of films containing chitosan and polyvinyl alcohol, perforated 1:4, leads to a considerable reduction of terms of epithelialization of the wound and a good remote results, thus, the present invention meets the criterion of "inventive step".

The method was tested in the burn Department of the city clinical hospital №18 of Ufa, in the group of ten patients with extensive deep burns of different localization. The control process carried out on the basis of a number of clinical criteria: period of epithelialization, bacteriological research, these cytologica is to change the Russian Academy of Sciences, but also consider the long-term results.

Example No. 1. Case history No. 20.

Patient Yusupov was hospitalized in the burn unit with 08.01.04 on 09.02.04,

The final diagnosis clinical: Burn 3 - B Art. trunk, perineum, lower limb 12%. Burn recovery.

History: trauma 30.12.03. household hot water. Performed in the outpatient area of the dressing to the desired result has not led, transferred to the RTC. Treatment in the postoperative period by the proposed method. The results of the treatment was evaluated by clinical effectiveness - the case of epithelialization, cytological changes, RAS, bacteriological monitoring of the wound.

The purpose of comparative study of the method, the donor site of the right lower limb were deposited film, and the wounds on the left limb was carried out in the traditional way.

In the burn wound treated under the films, there is a change in the cellular composition of tissues compared with wounds treated with bandages. Cytological study of wound surface covered by a film, revealed a decrease in the number of neutrophils and higher, compared with the control plots, the number of Poliplast and macrophages, which indicates that during the process of regenerative type. Bacteriological monitoring of the wound is obnarujeno quantitative reduction of microflora compared to control plots. With a good performance of the cytograms, the microbial landscape of wounds received good results - complete epithelialization of donor wounds under film for 4-6 days, in the control case epithelialization 10 - day.

Data bacteriological tests:

21.01.04. smear with wounds after ADP-stroke with RAS under the film - St. epidemidis 1st degree control - St. Aureus 1st degree

23.01.04. smear with RAS under the film - Acineto lwoffii 1st degree control - St. Acineto lwoffii 1st degree, St. Aureus 1st degree

25.01.04. smear with RAS under the film - growth of bacteria not detected control - Acineto lwoffii 1st degree, St. Aureus 1st degree.

The results of the cytograms

3 - the day after the ADP-control: macrophages 1-0-1 in the field of view

experiment: tissue macrophages 3-4-3 in the field of view, vacuolization of the cytoplasm

5 - the day after the ADP-control: macrophages 2-1-2 in the field of view

fibroblasts 1-0-1

plasma cells 2-1-0

experiment: tissue macrophages 4-3-6

in the field of view fibroblasts 3-2-1

plasma cells 2-1-1

elastic fibers +

For dynamic monitoring stations maintained by the film, through the month stated a good cosmetic effect. Unchecked growth of scar tissue, unlike other areas maintained the traditional method.

In this case, there were signs of growth in young scar tissue, itching, discomfort.

Case history No. 47.

Bo is Inoi Erastov,, 49 L. were treated in the Department with 19.01.04.-16.12.04.

Diagnosis clinical: Granulating wound body 10%. Burn recovery.

Treatment on the selected scheme - after ADP single overlay plates on donor sites.

04.02.04. - ADP 250 cm2

In the postoperative period for cytological examination was taken brushstrokes - prints under the films and under the bandages. On the 4th day after surgery, after treatment under the plates microflora was no longer determined by comparison with the control.

Data bacteriological tests:

06.02.04. smear with RAS under the film - St. epidemidis 1st degree control - St. Aureus 1st degree, Pseudomonas aeruginosa 1st degree.

08.02.04. smear under the plate the growth of bacteria not detected, the control - St. saprophyticus 1st degree, St. Aureus 1st degree.

The results of the cytograms.

After autodermoplastiki over 3 days:

smear under the plate - tissue macrophages 3-4-3 in the field of view

plasmablast 1-1-2, sometimes up to 11 in the field of view

control macrophages 1-3-1 in the field of view

neutrophils in large quantities

fibroblasts 1-0-1 in the field of view

5 - day

smear under the plate - collagen fibers +

tissue macrophages with varying degrees of maturity cytoplasm

8-6-8 in the field of view

neutrophils isolated in a field of view

fibroblasts 2-1-1 in the field of view

collagen fibers +

PLA is automatic cell 2-1-1

control macrophages 3-4-2 in the field of view

neutrophils 20-23-21 in the field of view

fibroblasts 1-0-1 in the field of view.

Thus, given the above, there is reason to believe that the proposed treatment of the donor wound is more effective and preferable compared to the other for several reasons:

first, it reduces the number of dressings, trauma wounds, rapid epithelialization, prevention of suppuration, the ability to reuse epithelizing donor places as donor sites when you conduct autodermoplastiki, anesthetic effect, good cosmetic result;

secondly, the method is simple to use, economical, can be used in the outpatient network.

Thus, the present invention meets the criterion of "industrial application".

Treatment of donor wounds, including the application of precompositional film containing polysaccharide and an antimicrobial substance on donor wounds after autodermoplastiki, characterized in that once lay film, which further comprises polyvinyl alcohol and anesthetic, and as a polysaccharide and antibacterial substances it contains, respectively, the chitosan and the aminoglycoside antibiotic series, such as gentamicin, p is hairouna with coefficienta stretching 1:4, when the following ratio of components, parts by weight:

Chitosan78,3-89,4
Polyvinyl alcohol : 9,8-19,8
Antibiotic aminoglycoside number0,5-2,0
Anesthetic0,1-0,2



 

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22 cl, 4 tbl, 5 ex

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