Purulent wound repair technique

FIELD: medicine.

SUBSTANCE: treatment of the patients with purulent wounds is ensured by bathing of a purulent wound that is being in alterative and exudative inflammation phase, with physiologic saline. It is followed with registering fluorescence of the purulent wound within its depth, centre and infiltrate. Thereafter a factor K1=Iav/If is calculated, where Iav is an average fluorescence index of the wound within depth, centre and infiltrate, If is a standard fluorescing reference of a comparison object which is the fluorescence of earlap. Then the wound is sponged with a probiotic in amount 5.0-50.0 ml and more considering the wound extent. It is drained and loosely filled with a probiotic-saturated tampon. Thereafter an aseptic dressing is applied, and conventional integrated therapy is administered. Probiotic re-management of the wound is carried out once a day and more often, with multiple bathing of the purulent wound and fluorescence registration. Provided K1>>K2, where K2 is the fluorescence measured again in combination with the integrated therapy, the same is continued. Otherwise, the integrated therapy is corrected by changing an antibacterial preparation and/or prescribing the other antibacterial preparations and/or additional oral introduction of probiotic Euflorin L and B dosed 1 tablespoon 1-3 times a day. The therapy is prolonged until granulations are observed in the wound, and until K1>>Kn is provided, where Kn is a value verging towards fluorescence powers specific for intact tissues or varies no more than by 5-20%.

EFFECT: higher effectiveness of purulent wounds repair combined with integrated therapy without local application of antibacterial preparations owing to local introduction of probiotics in this case acting as antagonists to pyogenous flora of the wound.

2 tbl


The invention relates to medicine, in particular to the treatment of diseases and microbial processes of nature with the study of probiotic preparations.

The spectrum of clinical syndromes and pathological conditions, the pathogenesis of which is believed to be associated with changes in the composition and functions of the microflora inhabiting the skin and mucous membranes, in the present wide and has a tendency to increase (abscesses, phlegmon, diarrhea, constipation, colitis, gastritis, duodenitis, peptic ulcer ischemia, Hypo - and hypercholesterolemia, rheumatoid arthritis, various lesions of the connective tissue, malignant neoplasm of colon and breast cancer, menstrual irregularities, tooth decay, kidney stones, dermatitis, various allergic reactions, various liver damage, endo - and superinfection different localization and others).

Bacterial infections are the most frequent diseases in humans and animals throughout their lives. In recent years, the possibility of treatment of purulent-inflammatory diseases have increased significantly due to the emergence of a large number of new effective antimicrobial agents. However, the results of treatment of these diseases often remain unsatisfactory - slow flow, relapse, superinfection and, sometimes, death. The latter is most often noted is carried out with the complications of purulent-inflammatory diseases, such as sepsis, meningitis, mediastinic etc. it is Considered that only the observance of the conditions for the selection of effective drugs and protocols for the rapid diagnosis of purulent surgical infection and its treatment on the basis of rational use of antimicrobial drugs will reduce the frequency of purulent-inflammatory diseases and, thus, will lead to the reduction of treatment time (the biggest item of expenditure on medical care), and will reduce morbidity and mortality (Guidance on infection control in the hospital. TRANS. from English. Ed. Roncella, Tbrewer, J.-Pbutler. - Smolensk: IACMAC, 2003).

The combination of these provisions is compounded by the complications associated with nosocomial infection and translocation of microbes of the gastrointestinal tract in the focus of inflammation, especially against the uncontrolled intake of broad-spectrum antibiotics, which even more complicates the diagnosis of etiologic organisms, an adequate choice of therapeutic drug and thereby exacerbates the disease, complicates its treatment, and increases recovery time.

It is known that in modern clinical practice for local treatment of patients with purulent-inflammatory diseases are mainly used antibiotics and the following Antisept the ical preparations: furatsilin, Miramistin, chlorhexidine, dioxidine, himopsina, each of which has an antibacterial effect. In the work of S. Titova. "Development of a rapid method of selecting effective antiseptics for treatment of purulent wounds of the maxillofacial region", M., 2003, a comparative evaluation of drugs and found that at present the most effective products are the Miramistin and dioxidine. However, the author indicates that the individual choice of antiseptic should be based on objective evaluation using laser fluorescent diagnostics, because with this method it was shown that certain patients were effective furatsilin and himopsina, and some are not effective chlorhexidine and dioxidine. All this suggests that without an adequate method of control at the point of care the selection of antimicrobials for treatment of purulent wounds treatment may not be effective. In addition, it is known that antibiotics and antiseptics contribute to the development of allergic reactions, inhibit local and General, specific and nonspecific immunity, which complicates the treatment and exacerbates the disease. These same factors contribute to the emergence of drug resistant forms of bacteria, which leads to the need to change drug treatment and lengthens the time is ecene patient. This problem is a significant lack of technology, which we took as a prototype.

This allows us to put forward a position on the necessity of finding more effective treatments that do not have these disadvantages. Some of these promising drugs are probiotics, representing a comprehensive bio of live bifidobacteria and lactobacilli (eubiotics) and products of their metabolism (postbioptic).

These products are amino acids (aspartic, glutamic, folic acid, glycine, serine, Proline, histidine, tyrosine, tryptophan, valine, phenylalanine, isoleucine, lysine, alanine); low molecular weight proteins (peptides); organic acids (lactic, formic, acetic, propionic, Polenova); antibiotics of natural origin, including thermostable (acidophilus, lactocidine, Lactalis); vitamins C, D, B; enzymes, in particular lysozyme.

The complex, consisting of two active principles, inhibits the growth of putrefactive and pathogenic organisms, addresses the lack of normal microflora contributes to the destruction of toxic products of metabolism that are carcinogenic action of nitrite, lowers cholesterol and oxalates, contributes to the breakdown of lactose.

Liquid eubiotics enhance local immunity Sanir the bathrooms of their mucous membranes by increasing their lysozyme activity and secretion of IgA, and this, in turn, leads to expulsion from the cells of the mucous membranes of intracellular parasites, such as Mycoplasma, chlamydia, Listeria, not to mention the positive effect of liquid eubiotics on banal flora festering wounds.

The task to be solved by the invention is the development of medical technologies for wide multi-purpose and integrated use of liquid eubiotics that can provide high efficiency of treatment of purulent wounds without antibiotics and noticeable improvement organismic environment in conditions of deep ecological crisis.

However, these applications of probiotics require appropriate quality control and the frequency of application and evaluation of clinical effect in General.

For these purposes, the problem is solved by the fact that for assessing the quality probiotic preparation before its clinical application and to assess the clinical effect of the use of probiotics for the treatment of purulent surgical infection suggested to use the method of rapid diagnosis at the point of care is a method of laser fluorescent diagnostics. Technically for the treatment of purulent surgical infection method, as the object of the invention is as follows.

1. Opening purulent with subsequent local and systemic cured the patient eat with a group delay of CLO.

2. Lavage purulent wounds with saline solution in the amount of not less than 5.0 to 50.0 ml with the purpose of removal of necrotic masses from the wound and create a better contact of the pathogen with subsequent introduction into the wound of the probiotic.

3. Registration fluorescence festering wounds in the field of depth (Iك), mid (IC) and infiltration (AI), thus registering a maximum average power of a fluorescence: SR=Iك+IC+AI/3, normalized with K1 on similar indicators standard fluorescing object comparison (F), where K1=SR/F. As a comparison object using the fluorescence of the ear lobe after wiping it with 70%alcohol and drying in the open air.

4. Measure the power of a fluorescence probiotic and if she is not less than 140-150 relative units and/or corresponds to the capacity of fluorescence standardized according to GOST sample, proceed to washing purulent wounds.

5. Then the wound is washed with a probiotic, such as eufloria L, in the amount of not less than 5.0-50.0 ml depending on the volume of the wound, drain it and loosely fill the ball with a probiotic with the subsequent imposition of aseptic dressings and spend the conventional complex therapy of the disease.

6. Re-treatment of the wound probiotic carried out in the same volume, 1-2 times a day (as needed 2 or more), while treatments 2 and 3 repeat and by the tea if K1 K2, where K2 is the normalized indicator after repeated measurements, on the background of a comprehensive treatment, indicates a positive treatment outcome, and Vice versa, while in the latter case, correction of the treatment by changing antibiotic and/or additions of antimicrobial treatment of other antimicrobials (1-3 preparation) are not antagonists broad-spectrum and/or appoint additional intake of probiotic, such as eufloria L and per os 1 tablespoons 1-3 times a day.

7. Treatment in alterative-exudative phase of inflammation to spend until the wound appears granulation, with K1 KP, where KP is the value To approaching the capacity values of the fluorescence of intact tissue (int), i.e. KP=hit or differs from it by no more than 5-20%.

Such methodological and methodical approach allows to reduce the duration of treatment for patients with different degrees of severity, for example, purulent-inflammatory diseases in 2-5 days depending on the severity and extent of the pathological process.

Thus, the proposed medical technology meets the requirements of modern medical Metrology, as increases the effectiveness of the treatment, such as purulent surgical infection, reduces the period of rehabilitation of patients and contributes to a more rapid organ-specifies the WMD regeneration of tissues.

Clinical testing applications eufloria for the treatment of patients with purulent-inflammatory diseases of maxillofacial area

30-35% of all surgical pathology associated with purulent infection, and up to 7% of them can be fatal. According to Professor V. Roginsky (1998), over the last 5 years in Moscow the number of children with inflammatory processes in tissues of the maxillofacial area, which required hospitalization, increased more than 10 times. In addition to significant changes in the qualitative structure of hospitalized patients in maxillofacial hospitals occurred in recent years a considerable qualitative changes in the clinical course of acute purulent odontogenic inflammatory diseases of maxillofacial area: and often begin very rapidly, aggressive, and then proceed with the dramatic worsening of the General condition of patients and the spread of inflammation from one anatomical region to another.

To date, the most effective way of treatment of patients with inflammatory diseases of CLO is complex, which combines both surgical and conservative treatment, surgical treatment method lies in the opening of inflammation and the provision of adequate drainage him, and conservative - in conducting R the national antibiotic therapy in combination with detoxification drugs. 65% of patients have to spend 2-3 or more operations to apply the powerful complex of therapeutic measures, often reanimation character. Based on the above data, the problem of treatment and prevention of complications of inflammatory diseases of maxillofacial area is urgent and requires special consideration.

Research work on the evaluation of the use of probiotic preparations for the treatment of patients with purulent surgical infection (cellulitis, abscesses, carbuncles, furuncles) is "Scientific-production center of medical and industrial biotechnology "Spectrolux" (SPC Spectrolux) at the surgical Department of hospital dentistry MMA. Sechenov.

At the moment cured 129 patients with inflammatory diseases of CLO, mainly with phlegmon, carbuncles and furuncles, main group is 61 persons, a comparison group of 68 people. The main group match patients in treatment who used the above probiotic preparations group of eufloria. In the comparison group patients were treated in accordance with the existing rules for the treatment of inflammatory diseases of CLO. All patients after opening the inflammation climbed the biomaterial (wound) and, for example, who was little more than bacteriological analysis. The results are presented in tables 1 and 2.

Table 1
The results of bacteriological studies of wound content of the patients before use of probiotic preparations
The selected microorganismsThe biomaterial
Wound, COE/ml before and after
Staphylococcus aureus101-108/growth no
Prevotella melaninogenica107/growth no
Peptostreptococcus saccharalyticus106/growth no
Streptococcus viridans group101-107/growth no
Streptococcus sp.105/growth no
Staphylococcus epidermidis101-103/101
Fusobactenum necriphorum106-103/growth no
Propionibacterium granulosum101-106/growth no
Actynomyces sp103/growth no
Corynebacterium sp103/growth no
Neisseria sp104/growth no

In some cases wound in the material growth of microorganisms was observed (52% of patients). On the first day after surgery, the wound surface was studied using the method LFD in the research process was measured symmetric intact region, the area of infiltration, the center of the wound periphery and the deepest part of the wound. This has resulted in the following pattern, indicating a decrease of fluorescence intensity of the pathological focus in the process of local treatment of purulent wounds with eufloria.

In addition to post-operative wound on the first day also investigated the substrate digestive tract using culture method and the method LTD. According to the results of bacteriological studies in patients with inflammatory diseases of CLO to ensure the state of the microflora of the gastrointestinal tract ranges from normalise to dysbiosis 2-3 degrees. According to the results obtained using LFD, indicators substrate gastrointestinal fluctuate at the beginning of treatment from 88.159 Ed. to 14.843 Ed. (Measures=60±3 Rel. units). After treatment, the maximum value corresponds Measures=83.49 Ed. (normal is 80-120 Rel. units), studies on personal leaves of patients occurred in the comparison group and the main group. The received data is redstavleny in the table below:

Table 2
Comparative characteristics of patients with inflammatory diseases of CLO in the two groups.
Bed-days in hospitalCellulitisBoils, carbuncles
MES (comparison group)1414
Clinical observation (main group)12.68.7
N1=41 (the number of observed boils, carbuncles),
N2=20 (the number of observed phlegmon),
N3=68 (comparison group: phlegmon 45, boils - 13).

The main group
The formation of granulationCellulitisBoils, carbuncles
The comparison group1111
The main group 8.34.2
N1=41, N2=20, N3=68.
Time sicknessCellulitisBoils, carbuncles
The comparison group88
The main group4.82.7
Efficiency3.25.3 1
N1=41, N2=20, N3=68.
Time epithelializationCellulitisBoils, carbuncles
The comparison group1313
N1=41, N2=20, N3=68.
Mild infiltration (day)CellulitisBoils, carbuncles
The comparison group1212
The main group9.84.4

Thus, clinically, bacteriologically and method LFD shown high efficacy of probiotics (Autorin L and C) in the complex treatment of patients with purulent-inflammatory diseases of maxillofacial area. This is determined by a decreasing term sickness 3.5-5.3 days, mild edema of the inflammatory infiltrate at 2.2-7.6 days more rapid formation of granulation 2.7-7.8 days that, in General, determined the reduction in bed-days by 1.4-5.3 days.

The method of treatment of purulent wounds, including comprehensive treatment through the introduction of antibacterial agents and washing of the wound cavity with subsequent monitoring observation of the wound, characterized in that alterative-exudative phase of inflammation spend washing purulent wounds with saline solution, then record the fluorescence of purulent wounds in depth, mid and infiltration and calculate the index K1=SR/F where SR - average fluorescence wounds in depth, mid and infiltration, F - indicator standard fluorescense of the comparison object, which is used as a measure of the fluorescence of the ear lobe; then the wound is washed probiotic in the amount of not less than 5,0-50,0 ml depending on the volume of the wound, drain it and loosely fill the ball with a probiotic with the subsequent imposition of aseptic dressings and conduct generally accepted comprehensive treatment, re-treatment of the wound probiotic spend 1 or more times per day, while washing purulent wounds and registration fluorescence repeat, and if K1>>K2, where K2 is the rate of fluorescence after repeated measurements on the background of complex treatment, then continue the same treatment in another Kucharova correction of complex treatment by changing antibiotic and/or additions other antibacterial drugs and/or appoint additional oral administration of the probiotic of eufloria L and In 1 tablespoon 1-3 times a day; treatment until the wound granulation, as well as to compliance with conditions, when K1>>Kn, where Kn is the value of approaching the capacity values of the fluorescence of intact tissue or differs from it by no more than 5-20%.


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