Method for treating ulcerous defects at diabetic foot syndrome

FIELD: medicine, purulent surgery.

SUBSTANCE: it is necessary to apply dressings with suspension consisting of thrombocytes-rich plasma, 10%-CaCl2 solution at equal volume and antibacterial preparation to which ulcerous microflora is sensitive. The volume of dressing for 1 dressing should be determined by the following formula: V=S×h×C, where S - the area of ulcerous defect, h - its depth, C - the coefficient. At the rate of ulcerous surface epithelization being under 25% weekly C=1.25, and at the rate being above 25% weekly C=1.0. The innovation provides the chance for individual dosing autogenous tissue growth factors and matched efficient antibacterial preparations and, thus, accelerated phase II of wound process and shortened terms of epithelization of ulcerous defects in the present category of patients.

EFFECT: higher efficiency of therapy.

1 ex

 

The invention relates to medicine, namely to purulent surgery, and can be used for the treatment of nonhealing ulcers in the diabetic foot syndrome.

Diabetic foot syndrome is one of the serious complications of diabetes. From 40 to 70% of all nontraumatic amputations in the world is produced in patients with diabetes mellitus [1]. According to the center "Diabetic foot" International Program "Diabetes" in 19.4% of cases amputation is preceded by a nonhealing foot ulcer. The average duration of treatment in these patients is 4 months, and 10% of patients - more than a year [2]. This is due to the fact that the course of wound healing in patients with diabetes mellitus has its own characteristics, namely low rate of epithelialization of the ulcer surface, the tendency to generalization of infection, negative impact on the reparative processes of chronic renal failure. From literature data it is known the role of growth factors and cytokines in the treatment of chronic ulcers and nonhealing wounds, also points to the significant reduction in the level of growth factors in patients with diabetes [3].

A new trend in surgery is the use of platelet-rich plasma to accelerate the process of regeneration. Platelet-rich plasma is an autologous is i.i.d. source of growth factors, which is obtained by separation of whole blood by density gradient. Platelet-rich plasma contains high concentrations of platelet-derived growth factor and transferowy growth factor [4].

A study of patent and scientific and medical literature has identified the following methods that are used to treat ulcers in the diabetic foot syndrome.

There is a method of treatment of diabetic foot syndrome [5] by applying ozone. The method involves intraarterial introduction of antiseptic - ozonated saline solution in combination with the local effects of ozonized physiological solution in two stages. At the first stage removes necrotic tissue stream with the output pressure of 80 atmospheres. In the second stage infiltrate the fabric of the jet with the outlet pressure of 150 atmospheres. In the particular case intraarterially ozonated saline solution is administered in therapeutic dose up to 5 times per day course of treatment up to 15 days.

The disadvantages of the method are that it does not provide additional infusion of autologous factors that accelerate epithelialization of the ulcer. Intraarterial injection of ozonized physiological solution increases the number of medical invasions and increases the number of "entrance gate" infection in the blood system on f is not severe immunosuppression. Infiltration of the tissues of ozonized physiological solution under high pressure will cause mechanical damage to the latter, which will adversely affect the course of the wound process and can contribute to the generalization of inflammation.

There is a method of treatment of diabetic angiopathies of the lower extremities [6], which includes the improvement of microcirculation impact on patient centrifugal forces in the direction of the head of the lower limb. The speed of rotation of the centrifuge 36-42 rpm Mode of treatment is determined by the achievement and maintenance of gravitational hyperemia of the lower extremities, and increased regional blood flow, as evidenced by the increase factor photoplethysmogram feet, measured according to the formula.

Similar cannot be used to treat infections of the soft tissues of the foot. Similar is contraindicated for patients with diseases involving narusheniami cerebral and coronary blood flow, as well as conditions involving changes in the physical state of the blood and a tendency to thrombosis. For the application of the method requires special equipment, which greatly limits its clinical use.

There is a method of treatment of destructive forms of diabetic foot syndrome [7], used for the local treatment of patients who aharmim diabetes with purulent-necrotic complications of the foot and the high resistance of microorganisms to antibiotics. The method consists in the use of the drug, reducing the resistance of microbes to antibiotics, which is used as a 1% solution of hydrochloric acid, which impose in the form of a wet bandage on the wound surface pre-coated with an antibiotic. Ligation repeat daily until fresh granulation.

The disadvantages of the method are related to the fact that the application of 1% solution of hydrochloric acid on the purulent wound can only lengthen and strengthen" phase hydration of the wound healing process, not exerting a positive influence on the regeneration of tissues exposed to purulent inflammation, due to the effect of a 1% solution of hydrochloric acid, "reducing the resistance of microbes to antibiotics".

There is a method of treatment of trophic ulcers on the background of diabetic foot syndrome, in which the femoral artery of the affected limb injected autolymphocyte treated Glutoxim 20 mg for 45 min Autolymphocyte get on plasmasphere blood cells AS-TEC 204 firms "Fresenius". The procedure is performed twice with an interval of 48-72 h [8].

The disadvantages of the method are that it does not impact directly on the affected soft tissue, the method does not use individually, taking into account the sensitivity of selected antibacterial agents.

There is a method of surgical treatment of chronic is unspecified lower limb ischemia, as well as diabetic foot syndrome, in which one you have several different angles trepanation channels, blind with extra set of conductors used to carry out subsequent effects on the bone marrow of low-intensity laser radiation at the time of its aggregate impact on the bone marrow in a single session from 5.0 to 30 minutes and intraosseous administration of drugs, as the outer physical therapy effects using the effects of ultrasound with a frequency of 880 kHz intensity of 0.4 W/cm for 5-6 minutes per session, carried out in the projection zones are made canals and along the great vessels, and the number of sessions of exposure to ultrasound and low level laser radiation is at least five that provides the blood supply to the limb [9].

The disadvantages of the method due to the lack of techniques to accelerate epithelialization of the ulcer, to suppress infectious inflammation, in addition, the mechanical stresses on the bone of patients with diabetes, can lead to the development of complications such as deep intermuscular abscess and osteomyelitis.

It is known tool that improves peripheral circulation, which it is used for the treatment of diabetic foot syndrome. The invention lies in the fact that the suggested means to improve the peripheral blood circulation local action contains both nitroglycerin and aminophylline in again the type for local action. The tool may be made in the form of an emulsion, gel, ointment [10].

The method has the following disadvantages - it does not impact on the wound surface autogenous tissue growth factors and antibiotics.

There is a method of treatment of purulent wounds by exposure to jet antiseptic under pressure, characterized in that the wound affect stream antiseptic with an output pressure of 40-50 ATM from a distance of 8-10 cm from its surface, then fine stream of ozonized solution with an output pressure of 70-90 ATM from a distance of 2-3 cm from the surface of the wound with exposure 4-5/cm2the 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 wounds [11].

The disadvantages of the method are that it does not provide additional infusion of autologous factors that accelerate epithelialization of the ulcer. Irrigation of the tissues of ozonized physiological solution under high pressure can lead to mechanical damage that will adversely affect those who drop wound healing and may contribute to the generalization of inflammation.

The prototype of the present invention as the most similar set of features of the claimed method the chosen method of treating ulcers in the diabetic foot syndrome [12], including the use of the napkin "Al" with different active substances in a certain sequence.

The disadvantage of this method is the lack of napkins "Al" autogenous tissue growth factors that accelerate the II phase of wound healing and epithelization. In addition, when using wipes "Al" it is impossible to make an individual selection of antibacterial drugs.

The task of the invention is to accelerate the second phase of wound process, the holding of local antibiotic therapy in combination with the stimulation of epithelialization of the ulcer surface.

This object is achieved in that when the dressings used suspension consisting of platelet-rich autoplasma antibiotic to which sensitive microflora ulcers, and CaCl2, the volume of sediment is determined by a formula that takes into account the size of the ulcers and the rate of epithelialization.

The method is as follows. Collect 200-300 ml of autologous blood through a Central venous catheter with a speed of 50 ml/min in a centrifuge that rotates at a speed of 5600 rpm During blood sampling for PR is to prevent clotting automatically add preservative (nitroglycerin) in a ratio of 1 ml of preservative 5 ml of blood. In the centrifuge the blood is divided into three factions: the red blood cells, platelet-rich plasma and depleted platelet plasma. First separate depleted platelet plasma (about 150 ml). Once separated depleted platelet plasma, the rotation speed of the centrifuge is reduced to 2400 rpm for more accurate separation of platelet-rich plasma and erythrocytes. Then separate the platelet-rich plasma (about 70 ml), the latter is separated erythrocytes (about 180 ml). Plasma is straw-yellow in color and is placed in the package (container) for storing blood products. Stored in the refrigerator. Before applying 10 ml of platelet-rich plasma fill the syringe, then add 10 ml of 10% solution of calcium chloride (CaCl2). The syringe shake before coagulation, and then its contents are mixed with the antibiotic (which has a sensitivity of microorganisms).

The volume of sediment with biologically active substances necessary for one ligation, calculated by the formula: V=SxhxK, where S is the area of the ulcer, h is the depth of the ulcer, the K - factor.

When the rate of epithelialization of the ulcer surface less than 25% in week K=1,25, when the rate of epithelialization of the ulcer surface more than 25% per week To a=1.

Suspension is applied to the surface slowly granulating ulcers. Ligation is performed 2 times in the night. Spend antibacterial therapy taking into account the sensitivity of microflora, symptomatic therapy of diabetes mellitus.

The method was tested in 14 patients in the surgical Department MLPOS GB No. 7 of Rostov-on-don.

A specific example of the method.

Patient D., 64 years old, was admitted to the surgical Department 14.06.2005 year with complaints about the presence of extensive long-term unhealed ulcers on the plantar surface of the right foot. For 15 years has diabetes type 2, severe, 5 months. back on the plantar surface of the right foot was formed, the ulcer gradually increasing in size. Were outpatients with minor effect appeared sluggish granulations. Admission: General condition of the patient moderate. The pulse rate of 72 per minute. AD=130/75 mm Hg At examination revealed neuro-ischemic form of diabetic foot syndrome with a prevalence of neuropathy, 3 tbsp. At primary inspection: on the plantar surface of the right foot in the area of the 1st metatarsus-galanopoulou articulation has ulcer 3×4×1.2 cm, the bottom is made sluggish by granulation tissue with areas of overlap fibrin. The edges of the ulcer - "saped"presented by hyperkeratosis. Radiography: expressed phenomena of osteoporosis metatarsal head 1 and the main phalanx 1 finger. When taking a deep biopsy revealed Staphylococcus aureus, Chu is responsive to Ceftriaxone. Immunological studies of tissue ulcers installed a sharp decline in T-cell and epidermal growth factors.

Diagnosed with diabetes mellitus type 2, moderate, neuro-ischemic form (with the prevalence of neuropathy) of the diabetic foot, 2nd degree, trophic ulcer of the right foot. Assigned glucosaminidase and neurotropic therapy.

Preparation of suspension held in accordance with the developed method.

During the first ligation isikli ulcer edge, represented by hyperkeratosis. On the ulcer surface was covered 18 ml suspension of platelet-rich plasma and Ceftriaxone. Ligation was performed two times a day. By the 5th day appeared marginal epithelization. The amount of the mixture applied with dressings was calculated by the presented formula. 23 days of ulcers completely epithelials. In the same period revealed normalization of epidermal growth factor. At the control examination after 6 months. the plantar surface of the right foot with areas of hyperkeratosis, ulcer not.

Compared with the prototype of the proposed method for the treatment of ulcers in the diabetic foot syndrome shortens the period of epithelialization of the ulcer surface through the use of autogenous tissue growth factors that accelerate the II phase of wound healing and epithelization. When using botanova method is effective individual selection of antibacterial drugs.

References

1. Dedov I.I. coauthors. Diabetic foot, M. 2005

2. Guriev YA, with co-authors. Diabetic foot. Is it possible effective prevention?. Breast cancer, Volume 9, No. 24, 2001

3. Myskina N.A., Tokmakova, A., Antsiferov could BE the Process of reparation of venous ulcers in patients with diabetes mellitus" problems of endocrinology, 2004 t, No. 2, P.34-38.

4. Oral surg Oral med Oral pathol Radiol endod 1998, 85 P. 638-646.

5. RF patent 2154484 C2 from 2000.08.20.

6. RF patent 2227005 C2 from 2004.04.20.

7. RF patent 2184551 C2 from 2002.07.10.

8. RF patent 2228204 C2 from 2004.05.10.

9. RF patent 2228715 C1 from 2004.05.20.

10. RF patent 2246934 C2 from 2005.02.27.

11. RF patent 2068263 C1 from 1996.10.27.

12. RF patent 2178310 C1 from 2002.01.20.

A method of treating ulcers in the diabetic foot syndrome by dressings with active substances, characterized in that the active substances used suspension consisting of platelet-rich plasma, 10%-aqueous solution of CaCL2in equal volume and antibacterial drug to which sensitive microflora ulcers, the volume of sediment for one ligation calculated according to the formula V=SxhxK, where S is the area of the ulcer, h is its depth, K - factor, and at the rate of epithelialization of the ulcer surface less than 25% in week K=1,25, and at speeds of over 25% per week K=1,0.



 

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12 cl, 9 dwg, 15 ex

FIELD: medicine.

SUBSTANCE: method involves carrying out patient premedication with Phenozepam tablets at a dose of 0.0005-0.001 g, Sibazon intramuscularly introduced at a dose of 10 mg 30 min before operation on the eve and in the morning at operation day and Dimedrol at a dose of 10 mg. Then the patient is placed on operational table on mattress heated to temperature of 37-39°C and connected to monitor. The central vein is punctured and catheterized and preoperative patient infusion preparation is started by intravenously dropping 500 ml of crystalloid solutions heated to temperature of 37-42°C like Ringer solution or Acesol, or Trisol, or Lactasol, and the same quantity of colloid solutions HES 6% or HES 10%. Then epidural space is punctured at Th7-L1 level with subsequent catheterization following so that with catheter top being arranged at Th5-Th11 level. 4 ml of 0.5% Bupivacaine hydrochloride solution test-dose is epidurally introduced in bolus mode into the epidural space with its action being estimated. Then anesthetic is fractionally introduced in 4-5 ml large portions under arterial blood pressure and pulse control with the total amount reaching 15-20 ml with earlier entered test-dose quantity being taken in account. Oxygen inhalation is carried out through narcosis apparatus mask at a rate of 5-8 l/min on the background of independent patient breathing. Then intravenous bolus 0.1% atropine injection is introduced at a dose of 0.005 mg/kg. Anesthesia induction of 2% sodium thiopental solution is carried out at a dose of 4-5 mg/kg, and also 0.005% Phentanyl solution at a dose of 0.0025-0.0035 mg/kg as intravenous bolus injection into the central vein. Trachea intubation is carried out on the precurarization background by introducing Arduan at a dose of 1-2 mg or Esmeran at a dose of 10-20 mg. The patient is transferred to artificial lung ventilation on the background of a muscular relaxation by introducing 2% Ditiline solution at a dose of 1.5-2 mg/kg, and body temperature control gauge is arranged in the middle one-third of patient esophagus. Anesthesia is supported at all stages of operation under artificial lung ventilation conditions by carrying out inhalation with nitrous oxide and oxygen mixture with their proportion being from 2:1 up to 3:1 using flow-reversing respiratory contour having respiratory ventilation volume of 7-8 ml/kg and minute ventilation of 100-120 ml/kg. 0.5% Bupivacaine hydrochloride solution is also introduced into the epidural space every 120-150 min at a dose of 3-5 ml, Arduan is intravenously introduced every 40-60 min at a dose of 2-4 mg or Esmeron every 25-35 min at a dose of 10-20 mg. Intravenous dropping infusion of crystalloid solutions heated to temperature of 37-42°C is carried out at a rate of 10-20 ml/kg/h at neoplasm removal stage. 500 ml of colloid solutions heated to temperature of 37-42°C or 400 ml of 20% albumin solution heated to temperature of 36-37°C is intravenously introduced 25-35 min prior to the beginning of chemotherapy. Transfusion of 400-450 ml of fresh frozen blood heated to temperature of 36-37°C is carried out. The warming up mattress is switched off at chemotherapy preparation stage. Patient head occipital part and main cervical blood vessel passage area is compulsorily cooled with ice packages at the beginning of chemotherapy stage, with intravenous heated crystalloid and colloid solutions, albumin and blood plasma introduction being simultaneously terminated and crystalloid solutions introduction at room temperature being continued with patient body temperature controlled not to be above 38.5°C according to esophageal gauge indications. Sodium bicarbonate and electrolytes are intravenously introduced in planned amount after having finished the chemotherapy treatment. Anesthesia is stopped at operation finish stage by stopping introducing the preparations into the epidural space and intravenously introducing relaxants, continuing artificial lung ventilation using oxygen and air mixture with FiO2 equal 0.4-0.6.

EFFECT: maximum nociceptive pulsation blockade from surgical intervention zone; patient body temperature supported at the level of 36-37°C; prevented brain hyperthermia.

4 cl

FIELD: surgery, traumatology, orthopedics.

SUBSTANCE: method of preparing platelet-rich blood autoplasma for regeneration of cortical bone consists in adding it to autogenous stabilizer blood, centrifugation, adding pre-coagulant containing 10% CaCl2 solution, and a blood coagulation factor. Centrifugation is conducted at ambient temperature for 5-8 h at a rate of 1000-2300 rpm and than 5000 units of prothrombin (blood coagulation factor II) is added.

EFFECT: increased productivity of platelet-rich blood autoplasma preparation and reduced expenses owing to exclusion of expensive equipment.

FIELD: medicine, oncology.

SUBSTANCE: the present innovation deals with treating patients in case of skin melanoma stage III. For this purpose blood plasma should be incubated with the following chemopreparations: cisplatin 30 mg, metotrexate 5 mg, cyclophosphan 600 mg in a thermostat at 37°C for 30 min and in pre-surgical period it is necessary to inject it for a patient into subcutaneous fatty fiber due to paracenteses from 4 sides under the focus of malignant growth. During the same day it is important to star gamma-therapy at the dosage of 2.4 Gy daily for 5 d, then comes 1-d-long interval and the same order of procedures should be continued twice more. In 2 d one should carry out operation in the volume of wide dissecting the primary focus at regional lymphadenectomy. In 2 wk after operation - with the same preparations and at the same dosages 5 times every other week. During the next 2 yr it is necessary to carry out analogous adjuvant autohemochemotherapy once/3 mo. Application of the complex therapy suggested enables to achieve higher percentage of tumor regression, increase duration and improve quality of life.

EFFECT: higher efficiency of therapy.

1 ex

FIELD: medicine.

SUBSTANCE: invention relates to biomaterials and can be used in plastic surgery and stomatology in conservative treatment. Proposed material based on calcium inorganic phosphates comprises additionally calcium carbonate wherein it comprises chlorapatite, calcium and iron phosphate hydrate, calcium - iron phosphate and calcium hydrogen phosphate as calcium inorganic phosphates, and these components are taken in the definite ratio. The more ratio Fe/Ca is 0.02-0.06, and dispersed composition of the main fraction is in the range 5-40 mcm. Proposed material for medicinal using is biocompatible with living body tissues completely, it possesses transdermal activity, analgesic effect and ability for repairing and strengthening osseous tissues, and to relieve and strength dental enamel in stomatology.

EFFECT: valuable medicinal properties of material.

3 cl, 3 dwg

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