Method for preparing to fulfill limb's replanting

FIELD: medicine, traumatology, resuscitation, field surgery, medicine of catastrophes.

SUBSTANCE: the present innovation deals with helping patients at any variant of limb's detachment at its preparing to replantation. Into soft tissues of detached limb one should introduce oxygenated perfluorane at the dosage of 30 mg/kg of detached limb, and then it should be placed into replantation sac. The innovation enables to hold back the development of ischemic toxicosis due to creating the stock of oxygen carrier, temporarily, up to the moment of replanting, improve tissue structures, up to the moment of replantation, improve the safety of tissue structures and increase the quality of replant's functioning.

EFFECT: higher efficiency.

1 ex

 

The invention relates to medicine, namely to traumatology, resuscitation, military surgery, disaster medicine, and can be used to aid with any abjunction limbs. The invention can be used also in the pathophysiology.

The term "reconstructive" introduced in the literature .Hopfner (1903), and in our country Nasocort (1913), denotes the engraftment of a limb to the body.

Obstacle to the successful solution of the problems of limb replantation is acute anoxia bodies (Khovanov CENTURIES, 1979), which leads to disruption of the structural integrity of tissues, disruption of tissue and cell homeostasis, diffuse autolytic changes (Sarkisov D.S., 1976; Panchenko L. F. et al., 1976, 1978). These variations cause severe postischemic disorders in the limbs and in the body of the recipient after replantation (Radaev VI Preparation of a limb to replantation. Kemerovo, "folk medicine", 1993, C.11). Therefore, there must be events, warning of severe consequences of replantation.

The known method of regional intensive care otchlenennoy limb by perfusion otchlenennoy limbs before reconstructive, according to which produce mechanical leaching from otchlenennoy limbs of toxic products is aerobnogo metabolism, toxins, blood clots. As a perfusion solution use saline solution with heparin, protein-salt solutions, cryoprecipitate plasma, a solution of perfluorocarbons (Datiashvili P.O. the Reconstructive limb. - M.: Medicine. - 1991. S).

The disadvantages of this method: no cooling.

Perfusion leads to a marked swelling of the tissues, mechanical damage of the vascular walls, the microcirculation disorder and other

Perfusion as the procedure requires time and therefore delays the restoration of normal blood flow in repentance.

The techniques of perfusion prevents known method prehospital.

There is also known a method of regional intensive care otchlenennoy limbs before reconstructive, including isolated limb perfusion with artificial blood circulation oxygenated blood in "light mode", detoxification of ischemic tissues by hemadsorption, normalization of metabolic processes in ischemic limb tissues by including in the perfusion circuit canned in liquid nitrogen tissue donor liver (Radaev VI Preparation of a limb to the replantation / Veerudu, Alekseevskii, Liesthen - Kemerovo: folk medicine, 1993 S. 21, 100).

The disadvantages of this method: no cooling

Perfusion as the procedure requires time and therefore delays the restoration of normal blood flow in repentance.

The techniques of perfusion prevents known method prehospital.

Incomplete preventing ischemic toxicity.

Also known is a method of preparation of organs (heart, lung) transplantation by injection of perftoran to the donor at a dose of 10-15 ml/kg of body weight with the purpose of anti-ischemic protection of these organs (Shumakov V.I., Onishchenko N.A., Santharian RS, Tarabara N.V. the Use of perfluorocarbon emulsions in organ transplantation (results and prospects), Perfluorocarbon compounds in biology and medicine, busine, 1999, p.143-145).

The advantages of this method are: improving the security of tissue structures and the improvement of the quality of functioning transplant provided intravascular infusion of perftoran.

There are no data on the use of this method for the replantation of limbs.

There is also known a method of conservation of the limbs, according to which the limb is lined with snow or ice ("dry cooling") (Datiashvili P.O. the Reconstructive limb. - M.: Medicine.-1991. S. 24).

The temperature, according to the physical definition, the speed of movement of the molecules. The lower temperature means lower velocity and SL is therefore the decrease in the metabolic activity (RAPAPORT, F., Doss J. Transplantation of organs and tissues in humans, M, Medicine, 1973, S. 494-495). When the reduction of tissue temperature decreases not only the ability of tissues to oxygen uptake, but also the need tissues in it (Girgolu S., Ariev TA, Gamow B.C. the Experience of Soviet Medicine in the great Patriotic War of 1941-1945, M., Medgiz, 1951. S).

The disadvantage of this method is that direct contact of the legs with ice (snow) leads to hypothermia tissues, it is impossible to conduct a full and uniform cooling of tissues, especially of large segments of the limbs. Uneven cooling of the tissues leads to the fact that along with intact tissues are tissues with degenerative and necrotic changes (theory disseminated necrosis). Areas with a large number of foci of necrosis and degenerative changes characterized by reduced viability and reduced tissue resistance to infection (Girgolu S., Ariev TA, Gamow B.C. the Experience of Soviet Medicine in the great Patriotic War of 1941-1945, M., Medgiz, 1951. N.218-219). In addition, lowering the temperature of the water environment leads to structural change (crystallization), causing substantial damage to the preserved living systems (RAPAPORT, F., Doss J. Transplantation of organs and tissues in humans, M, M is decina, 1973. S).

There is also known a method of conservation of the limbs, in which otchlenennoy limb is placed in replantations bag, which is a double pack (two plastic bags, nested one in the other), in the inner section of which is placed amputirovannyy segment of the limb, and in the outer (around the inner package) - pieces of ice water, the capacity of the package seal plugs (Datiashvili P.O. the Reconstructive limb. - M.: Medicine. - 1991. S).

The advantage of this method is that it impedes the growth and reproduction of bacteria in the wound, which contributes to the prevention of postoperative infectious complications. The design of the package allows for uniform cooling otchlenennoy limbs.

The disadvantage of this method of preservation of limbs is that it is not possible to sufficiently restrain the development of ischemic toxicity.

The objective of the invention is to restrain the development of ischemic toxicity by creating stock vector oxygen, temporarily, until replantation, to improve the safety of tissue structures and to improve the quality of functioning of repentace.

This task is achieved in that in the method of preparing the limb for replantation in which otchlenennoy limb is placed in replantations bag before SIP is good otchlenennoy limb in replantations bag, in her major muscle groups injected oxygenated perftoran in a dose of 30 mg/kg of body weight.

The method is as follows. Soft tissue otchlenennoy limbs in the major muscle groups injected oxygenated perftoran in a dose of 30 mg/kg otchlenennoy limbs, and then it is placed in replantations bag. Thereupon deliver the victim and his limbs in the nearest branch where it can be performed reconstructive.

Introduction oxygendemanding of perftoran restrains the development of ischemic toxicity due to the optimization of the oxygen regime, to improve the safety of tissue structures and to improve the quality of functioning of repentace.

Muscle groups contain myoglobin, which carries oxygen. Myoglobin, like hemoglobin, performs respiratory function, contributing to the absorption of oxygen from oxygendemanding of perftoran and its use in the oxidation processes in muscle tissue (Kosmeticeskij, Kuna, Bunge). Myoglobin acts as a reserve of oxygen in the muscles, vector and intracellular catalyst. Myoglobin plays a role in muscle short-term reserve of oxygen and is part of the oxygen transport system inside the cells. Properties of myoglobin well adapted by nature for the implementation of this function is tion: he has a higher affinity for oxygen than hemoglobin, can recombine with oxygen to dissociate, releasing oxygen very quickly (Pairblack Myoglobin and its role in physiology and pathology of animals and humans, M., Medgiz, 1961, p.47-54).

An example of a specific application of the method.

Investigations were carried out on outbred laboratory rats weighing 250-350 g Experimental animal under anesthesia has odclenila both rear legs at the hip level. After 1 hour in the soft tissue of one limb introduced oxygenated perftoran (PO2=250 mm RT. tbsp. at a dose of 0.5 ml). The second limb perftoran was not introduced. After 6 hours of thermal anoxia explored the muscles of both limbs on the content of products of lipid peroxidation (LPO). Determined the number of active products thiobarbituric acid (TBA). In the homogenate of the muscles of the limb without perftoran concentration products TBQ was 35, and in the homogenate of the muscles of the extremities with perftoran - 28. This indicates a certain deterrent effect of perftoran on the FLOOR. Also conducted angiography 76% urografin - 7 ml. In both limbs was observed fine, rare, small extravasate. In addition, in the limb without perftoran was contrastives only the main artery. In the limb, which was introduced perftoran, clearly contractibility artery 3 and 4 of the order. This indicates more possible to pass the t of the vascular bed for contrast limbs, which was introduced perftoran. A similar result angiography indirectly indicates greater preservation of the vascular bed in the limb with perftoran.

The advantages of the proposed method

The method allows to constrain the development of ischemic toxicity, to improve the safety of tissue structures and to improve the quality of functioning of repentace.

The method is simple to use.

The method can be used at the prehospital stage.

The method of preparation of the limb to replantation, which otchlenennoy limb is placed in replantations bag, characterized in that before you put otchlenennoy limb in replantations bag, in her soft tissue introduce oxygenated perftoran in a dose of 30 mg/kg otchlenennoy limbs.



 

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