Method for surgical therapy of purulent-necrotic complications of diabetic foot syndrome

FIELD: medicine, endocrinology, surgery.

SUBSTANCE: it is necessary to perform intra-pelvic novocain-antibacterial blockade by a certain technique at keeping a catheter in pelvic fiber for further prolonged novocain-antibacterial blockade, then it is necessary to fulfill necrectomy and lance purulent congestions followed by treating with VIER in flow-aerosol mode and application of a sorbent OUT-M till the transition of early wound process into the stage of proliferation; in case of dressing procedure one should apply prolonged intra-pelvic novocain-antibacterial blockade; after transition of early wound process into the stage of proliferation one should treat the wound with VIER in aerosol mode till application of the secondary sutures. The present innovation enables to remove degenerated substances from wound surface very quickly, improve microhemodynamics and lymphodynamics that, in its turn, favors rapid transition of wound process into the stage of proliferation and, thus, the quickest wound healing.

EFFECT: higher efficiency of therapy.

2 cl, 1 ex

 

The invention relates to medicine and can be used in complex treatment of purulent complications of diabetic foot syndrome.

A method of processing high-voltage pulse electric discharge (Vier) wounds (Shalin S.A. electrohydraulic treatment in the treatment of purulent wounds. / Abstract. Diss.... Kida. the honey. Sciences. - 1990. - 15 C.), which is not sufficiently radical in the treatment of purulent-necrotic complications of diabetic foot syndrome due to violations of tissue blood flow and metabolism, leading to acidosis and tissue hypoxia (Shor NA // Surgery. - 2001. No. 6. - P.29-33), due to the complexity of the anatomy of the foot (lokhvitski SV, etc. // Surgery. - 2001. No. 3. - p.34-35).

The improvement of results of treatment of purulent-necrotic complications of diabetic foot syndrome is possible with the use of a woven fiber sorbent for removal denaturirovannykh tissues (Reznik LB New technologies in complex treatment of purulent wounds. / Abstract. Diss.... Kida. the honey. Sciences. - 1998. - 22 S.), prolonged use of intrapelvic procaine blockade to decimalization limb (Shor NA // Surgery - 2001 - No. 6 - P.29-33; Bregadze A.A. abstracts of the VII Congress of traumatologists and orthopedists Russia. - Novosibirsk - 2002. - P.35), the use of lymphotropic antibiotic therapy in the treatment and prevention of infectious OS is ogneni (Eruhin IA, A.S. Rozhkov and others // journal of surgery. - 1992. No. 9-10. - S-216).

Object of the invention is to improve results of treatment of purulent-necrotic processes in the diabetic foot syndrome.

The problem is solved in that in the method of surgical treatment of purulent-necrotic complications of diabetic foot syndrome by affecting the necrotic tissue of high-voltage pulsed electric discharge is conducted intrapelvic novocaine-antibacterial blockade, then do necrectomy and reveal purulent leakages, the wound treated wear and impose sorbent OUT)

Intrapelvic novocaine-antibacterial blockade is performed in 200 ml of 0.25% solution of novocaine + 64 UNITS lidz + 1.0 g of amikacin + 0.2 g of metronidazole, prolonged intrapelvic novocaine-antibacterial blockade is performed in 800 ml of 0.25% solution of novocaine + 64 UNITS lidz + 2.0 g of amikacin + 0.5 g of metronidazole in the day.

At the first stage perform intrapelvic blockade (Shkolnikov-Selivanova-Codecs) by introducing a 0.25% solution of novocaine (warmed to body temperature) in an amount of 200 ml using a standard catheter for percutaneous vascular ⊘ 1.4 mm, held in pelvic tissue using the Seldinger techniques to improve the flow in the affected area (in the tissues of the foot) at the expense of off what I'm sympathetic innervation. With the aim of improving lymphogenic and prevention of purulent intrapelvic complications, holding lymphotropic antibiotic therapy in the fiber space of the pelvis is introduced 64 UNITS lidz and combination of antibiotics (amikacin 1.0 g + metrogylum 0.2 g).

Produce surgical treatment of purulent-necrotic lesion with subsequent impacts wear in jet spray mode by moving the nozzle electro-site at a distance of 40-50 mm from the surface of the wound with exposure 3-4 sec/cm2and the flow rate of the working solution (0.9% NaCl) 0,3-0,35 ml/sec, and then on the wound stack of woven carbon sorbent OUT) On the background of prolonged intrapelvic novocaine-antibacterial blockade (800 ml of 0.25% solution of novocaine + 64 UNITS lidz + 2.0 g of amikacin + 0.5 g metronidazole per day) during bandaging reuse wear in jet spray mode in combination with sorbent OUT-M to cleanse wounds. After the transition of the wound process in the stage of proliferation perform wound debridement wear in aerosol mode by moving the nozzle electro-site exposure 3-4 sec/cm2at a distance of 40-50 mm from the surface of the wound and the flow rate of the working solution (0.9% NaCl solution) 0.1 to 0.15 ml/sec.

For electro-processing using the device Electrocon-1". This device is creation, using the energy Wier, creates a high hydrodynamic pressure in the discharge channel, while providing a source of pulsed electromagnetic fields, ultrasound, ultraviolet radiation and pulsating stream of solution. The device consists of a generator connected through flexible conductors with electrohydraulic probe (node), and a power supply. AG node is a core opposing electrode system with a bit period of the rod-cone. One of the electrodes is made in the form of a rod, the other in the form of a hollow truncated cone with a removable nozzle in the form of a nozzle for remote jet aerosol processing torch drug solution. The device is powered by AC electrical current with frequency of 50 Hz and voltage of 220 C. the Parameters Vier: maximum current bit electric pulse of at least 500 And, the potential difference on the bit electrodes 3÷6 kV, pulse duration ≈ 0,2 μs, the duration of the pulse packet ≈ of 1.25 μs, the minimum pulse frequency of 70 Hz.

Woven carbon sorbent OUT-M is a glossy black fabric comprising carbon fibers and having a high elastic properties. Due to the woven structure of the sorbent has developed active sorbing surface is rnostly, specific absorption surface of the sorbent OUT-M is 6 m2/1 g of tissue.

Prolonged novocaine-antibacterial intrapelvic blockade is performed through a standard catheter for percutaneous vascular ⊘ 1.4 mm, held in pelvic tissue (Shkolnikov-Selivanova-Codecs) using the seldinger technique of 0.25% solution of novocaine 800 ml + 64 UNITS lidz + 2.0 g of amikacin + 0.5 g of metronidazole in the day.

The proposed method of treatment of purulent-necrotic processes in the foot in diabetes mellitus promotes rapid removal of degenerated substances from the wound surface, improves microgame and lymphogenic facilitates the rapid transition of the wound process in the stage of proliferation and eventually to rapid wound healing, provides for prevention of local and systemic infectious complications.

Example.

Patient P., 56 years old, was admitted to the Department of purulent surgery OGKB No. 1 on the 15th day from the onset of the disease with a diagnosis of Purulent wounds, osteomyelitis of the first toe of the foot in diabetes mellitus". On the second day of transaction - intrapelvic novocaine-antibacterial blockade on Shkolnikova-Selivanova-Codecs 200 ml of 0.25% solution of novocaine + 64 UNITS lidz + 1.0 g of amikacin + 0.2 g of metronidazole, catheterization pelvic tissue standard catheter for percutaneous vascular ⊘ 1.4 mm the BL is using the seldinger technique of, exarticulation I toe with subsequent treatment of the wound wear in jet spray mode, after which the wound surface was laid woven carbon sorbent OUT) In the future against the background of prolonged intrapelvic novocaine-antibacterial blockade (800 ml of 0.25% solution of novocaine + 64 UNITS lidz + 2.0 g of amikacin + 0.5 g metronidazole per day) during bandaging reused wear in jet spray mode in combination with sorbent OUT-M to cleanse the wound for four days. After the transition of the wound process in the stage of proliferation of processed RAS wear in aerosol mode. On day 7, superimposed secondary seams. On the 9th day removed the catheter from the pelvic tissue. The patient was discharged on the 22nd day of recovery.

1. The method of surgical treatment of purulent-necrotic wounds in the diabetic foot syndrome, including the impact on the necrotic tissue of high-voltage pulsed electric discharge (Vier), characterized in that perform intrapelvic novocaine-antibacterial blockade Shkolnikova-Selivanova-Tsodyks, leaving the catheter in the pelvic tissue to conduct further prolonged novocaine-antibacterial blockade, then perform necrectomy and reveal purulent leakages with subsequent processing Vier in jet aerosol regime the imposition of sorbent OUT-m to the transition of the wound process in the stage of proliferation; when the dressings prolonged use intrapelvic novocaine-antibacterial blockade; after the transition of the wound process in the stage of proliferation perform wound debridement wear in aerosol mode to overlay the secondary seams.

2. The method according to claim 1, characterized in that intrapelvic novocaine-antibacterial blockade is performed in 200 ml of 0.25%solution of novocaine, 64 UNITS lidz, 1.0 g of amikacin, 0.2 g of metronidazole in the day.

3. The method according to claim 1, characterized in. that prolonged novocaine-antibacterial blockade is performed in 800 ml of 0.25%solution of novocaine, 64 UNITS lidz, 2.0 amikacin, 0.5 g of metronidazole in the day.



 

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