Method of treating trophic ulcers

FIELD: medicine.

SUBSTANCE: lipoaspiration cannula of the diameter of up to 1.2 mm is used to sample primary aspirate from subcutaneous fat of an anterior abdominal wall. The produced aspirate is washed with 5% glucose to prepare a lipid fraction to be diluted with 5% glucose in ratio 1:1 of glucose-fat, agitated to prepare a suspension. The skin is punctured to insert a blunt-ended injection cannula of the diameter of up to 1.2 mm into soft tissues surrounding an ulcer and immediately under an ulcerous defect. The cannula is delivered to an end of each marked beam, and the prepared suspension is administered at the output by removing the cannula gradually by simultaneous pressing on a syringe piston. Up to 5 insertions of the suspensions are fan-shaped from one puncture herewith creating a perifocal cushion of the thickness of up to 0.7 cm. A distance of passage beams shall not exceed 2-3 mm.

EFFECT: higher quality of treatment of this pathology by forming the normotrophic scar tissue by stimulating regional microcirculation.

3 tbl, 1 dwg, 1 ex

 

The invention relates to medicine and can be used in surgery, traumatology, dermatology.

Trophic ulcers is nonhealing epithelial defects tissue (skin or mucosa), arising mainly for disorders of blood circulation, and also by damage to the nerves or spinal cord. The majority of venous ulcers appear on the lower extremities. Trophic ulcer is characterized by the inability of tissues to self-healing.

In the treatment of venous ulcers is currently used in many different techniques and tools, including hyperbaric oxygen, ultraviolet irradiation, laser irradiation of blood, hirudotherapy, plasmapheresis, impossibly and other detoxification methods, the use of immunomodulators and other methods that have not undergone quality clinical research. From the perspective of evidence-based medicine they cannot be used as a standard treatment methods. While local therapy is one of the most important trends in the treatment of venous ulcers. (Clinical surgery. National leadership. TI./Ed. by V.S. Savelyeva, A.I. Kiriyenko. - M.: GEOTAR-Media, 2008.)

A well-known principle of complex therapy of trophic ulcers, combining conservative treatment (General and local) and different kind of surgical intervention. As a therapeutic means double the th therapy has been used in various antiseptics, native and immobilized enzymes proteolysis and their inhibitors, and others (Application of immobilized enzymes and their natural inhibitors in surgery / Thick P.I., Postyshev VK, Vasilkov SF etc. - Surgery. 1983. No. 6. S-96.)

However, despite the wide choice of therapeutic measures, it is not possible to shorten inpatient and outpatient treatment of patients with trophic ulcers. Also, when healing are formed hypertrophic or atrophic scars, which violates the trophism of the surrounding tissues, leading to frequent relapse and the development of functional and cosmetic defects.

It is safe to say that the treatment of trophic ulcers remains a major medical and social problem of the modern society. (The treatment of trophic ulcers of venous etiology: a Manual for physicians / edited by V.S. Savelyeva. - M.: Russian state medical University, 2000.)

There is a method of treatment of venous ulcers (RF Patent No. 2274479, A61N 5/067 AC 31/409, bull. No. 11, 20.04.2006, including the introduction to the plague of the photosensitizer and the subsequent irradiation of the laser. As photosensitizer use gel Photoditazine" based glutaminol salt of chlorin E6 "Photoditazine" with the concentration of the active substance is 0.5-1.5%, and the laser irradiation is carried out in a continuous mode at a wavelength of 660 nm, density applied to the wound energy 30-40 j/cm2, the practice of the particular power 0.8-0.1 W/cm 2. However, this method leads to a gross cicatricial changes of the skin around the ulcer.

Also known is a method of treatment of trophic ulcers in the diabetic foot (RF Patent No. 2357772, A61N 5/067, AK 31/409, AK 33/08, OR 17/02, bull. No. 16, 10.06.2009,), including the removal of necrotic tissue in the lesion area, issaka and the cortical layer of bone. Daily for 5-7 days wash out the surgery area with an antiseptic solution, impose gauze bandage, impregnated with 0.5% solution of itaperuna. Then on naked cancellous bone transplanted free flap. However, this method has a major drawback: long-term healing, the formation of coarse inverted scarring of the skin, inhibiting the function of muscles and tendons.

Closest to the supplied method is autologous transplantation of adipose tissue - lipofilling, not previously used in the treatment of trophic ulcers, and used for contouring (Scientific practical journal "Experimental and clinical dermatocosmetology No. 6", 2011). The method includes obtaining a viable pure fat, the laundering of aspirated fat with saline solution, and subsequent injection (using an injection syringe, the hall of which is attached a special lipofilling cannula for the introduction of the fat with internal diameter of 2 mm and a blunt tip) in roblimo zone in a 1:1 ratio of fat and saline solution.

The objective of the proposed method is to improve the quality of treatment due to the formation of normotrophic scar tissue and reduce the time of treatment of venous ulcers.

The task carried out due to the fact that using lipoaspiration cannula to 1.2 mm in diameter taking the primary aspiration of the subcutaneous fat of the anterior abdominal wall, which is subjected to washing with 5% glucose solution; the resulting fat fraction is diluted with 5% glucose solution in the ratio of 1:1 glucose-fat shake and get suspended; through punctures in the skin to 1.5 mm in soft tissue around the ulcer and directly beneath the ulcer defect injection cannula to 1.2 mm in diameter with blunt ends are at the end of each bulleted beam and introducing the obtained suspension at the outlet, gradually removing the cannula by simultaneous pressure on the plunger of the syringe; fan-shaped produce up to 5 injections suspension with one puncture, creating perifocal roller to 0.7 cm thick; the distance between the beams-channels should not exceed 2-3 mm

The method is as follows.

Before the operation the patient with the presence of venous ulcers, which are the second or third phase of wound healing, after the cleansing of necrotic tissues are marking the donor area. On the operating table in position PAC is enta lying after cleaning the skin with an antiseptic solution, mark the place of introduction of the needle in the donor and recipient areas, and rays-track excursions of the needle when the lipofilling in the recipient areas.

After processing the surgical field, under local infiltration anesthesia with 0.1% lidocaine solution with the addition of epinephrine (1:200000), conduct punctures on the skin up to 1.5 mm with an eye scalpel, and falling to 3-5 cm from the border of the donor area. Spend tumescence donor area, for example, when the fence 50 ml of fat infiltration volume of 200 ml Between infiltration and lipoaspiration should be a 15-minute exposure time for the implementation of the vasoconstrictor effect of epinephrine. Then using lipoaspiration cannula to 1.2 mm in diameter carry out careful tunnelization with minimum effort. Previous tumescence encourages the free and easy penetration lipoaspiration cannula in the tissue of the donor area.

Syringes for microlipoinjection should be no more than 20 ml, and a negative pressure is minimal. It is created by pulling the single piston of the syringe attached to the suction cannula. The resulting fat - initial aspirate. The primary fluid is further subjected to washing with 5% glucose solution. Received the fat fraction is diluted with 5% glucose solution in the ratio of 1:1 glucose-fat shake and get suspended.

Through punctures in the skin to 1.5 mm injection the Yu cannula to 1.2 mm in diameter with blunt ends are at the end of each bulleted beam and injected fat output, gradually removing the cannula by simultaneous pressure on the plunger of the syringe. Fan-shaped spend up to 5 injections suspended from a single puncture in the soft tissue around the ulcer, creating perifocal roller to 0.7 cm thick. The distance between the beams-channels should not exceed 2-3 mm also enter fan-shaped suspension and directly beneath the ulcer defect.

After removing the cannula beam-track channel gently massaged over the skin. Then impose aseptic wound dressing. With extensive ulcerative defects, the procedure was repeated after 14 days.

Healing takes place within 30 to 38 days with the formation of normotrophic scar.

Figure 1 indicates the direction of introduction of the suspension into the soft tissue around the ulcers, where:

1 - trophic ulcer;

2 - injection cannula to 1.2 mm in diameter with a blunt end;

3 - rays-track introductions suspension with a single puncture in the soft tissue around the sores.

Under our supervision there were 52 patients with trophic ulcers of the lower limbs receiving inpatient treatment in the surgical Department No. 2 in BUS "City clinical hospital №7" and the surgical Department No. 2 in Noosa heads "Road hospital secretness JSC "RZD"

The patients were divided into two groups (table 1).

Table 1
The distribution of patients by group
GroupThe number of patientsTreatmentThe duration of treatment (days)
1 group (the comparison group)25Traditional therapy63±12
2 group (main group)27Lipofilling34±4

The first group (25 patients) received conventional therapy, including surgical treatment of the wound and depending on the etiology of ulcers appropriate infusion, anticoagulant, desegregate therapy, prostaglandins E1, antispasmodics, analgesics, vitamins and analogues, antibiotics if necessary. Patients performed daily dressings and topical treatment. Also in the complex of therapeutic measures was included physiotherapy (UHF, magnetotherapy).

In the second group (27 patients) in the background similar to the traditional management of patients additionally conducted lipofilling trophic ulcers.

The study of the microcirculation of the nidus was performed using laser to ledovskoy flowmetry (LDF) in the red spectrum radiation using laser analyzer capillary blood flow BLF-21. Record LDF-grams were produced once in 3 days starting 9 days after lipofilling, directly at the edge of chronic ulcers in the symmetric points of a healthy limb (table 2).

Table 2
The change of tissue perfusion in the wound in patients of the 1st and 2nd group
Measuring pointPerfusion (perf. unit)
Groupto
treatment
9 day12 dayday 15
Edge-woundgroup 1 group 21,79±0,13 1,72±0,111,81±0,15 1,87±0,161,84±0,11 2,04±0,181,93±0,14 2,32±0,2
Healthy limbgroup 1 group 23,1±0,47 3,2±0,433,6±0,46 3,6±0,43,7±0,45 3,8±0,423,7±0,43 3,7±0,45

After 9 days after injection of the suspension into the soft tissue around the ulcer and under ulcerative defect in patients of the second group reported increased dormancy is the point of microcirculation by 8.7% compared with baseline values (table 2). During the 2-week monitoring of the microcirculation index patients of the first group was not significant increase in the perfusion territory of the pathological focus, while the patients of the second group to 15 days monitoring this indicator increased by 35% (1,72 perfed to 2,32 perfed) from the original values (table 2).

Thus, the use of autologous fat grafting using autogiro in complex treatment of chronic ulcers can increase the microcirculation of the nidus which, in turn, increases granulation, epithelialization and scarring.

Cytology imprint with trophic ulcers (color Romanovsky-Giemsa, magnification 400) revealed significant differences in the cellular composition before and after treatment in the first and second groups. After treatment in the second group with respect to the first detected a few neutrophils, a significant number of macrophages, endothelial cells, fibroblasts.

One measure of the effectiveness of local treatment of venous ulcers was careful planimetric study of wound defects. The dynamics of the square of trophic ulcers in patients first and second groups on treatment differed significantly and was associated with an acceleration of epithelialization and formation of a scar in patients W the Roy group (table 3)

Table 3
The relative reduction in the area of chronic wounds depending on the method of treatment
Before the treatment1-I ned2 weeks3 weeks4 weeks5th week
group 1100%92%79%67%60%52%
group 2100%78%53%38%26%13%

Based on planimetric indicators in patients of the second group by the end of the 5th week of treatment was noted reduction of the area of the wound defect is almost 7.7 times compared with baseline at the expense of epithelialization, whereas patients of the first group, the area of the wound decreased only 2 times. Final scarring and epithelization of chronic ulcers in patients of the first group about what mechali 65±16 days of outpatient treatment, and patients of the second group 34±4 days.

Clinical example: patient N., 53 years old, was admitted to the Department of surgery №2 in BUS "City clinical hospital №7" DS: Trophic ulcers of the lower third of the left tibia. The patient at admission was carried out treatment of purulent wounds of the lower third of the left tibia, size 3×4 cm, chlorhexidine imposed aseptic bandage. The patient is scheduled infusion, vascular, antibacterial, analgesic therapy.

The patient held daily bandaging and treatment of purulent wounds with chlorhexidine. On the 5th day, after cleansing of necrotic tissue (the second phase of wound healing), the patient was lipofilling.

Before surgery, the patient spent marking the donor area. On the operating table in position of the patient lying down after cleaning the skin with an antiseptic solution was to mark the place of introduction of the needle in the donor and recipient areas, as well as rays-track excursions needle for lipofilling in the recipient area.

After processing the surgical field, under local infiltration anesthesia with 0.1% lidocaine solution with the addition of epinephrine (1:200000) conducted a puncture in the skin up to 1.5 mm with an eye scalpel, and falling to 3-5 cm from the border of the donor area. Spent tumescence donor area. Between infiltration and lipoaspiration past the 15-minute exposure time for the implementation of the vasoconstrictor effect of epinephrine. Then using lipoaspiration cannula to 1.2 mm in diameter made cautious tunnelization with minimum effort. Previous tumescence contributed to the smooth and easy penetration lipoaspiration cannula in the tissue of the donor area.

Using a 20 ml disposable syringe attached to the suction cannula, due to the minimum negative pressure created by the moving piston, collected the fat - initial aspirate, which were further subjected to washing with 5% glucose solution. The obtained fat fraction was diluted with 5% glucose solution in the ratio of 1:1 glucose-fat, shook and got suspended.

Through punctures in the skin to 1.5 mm of the injection cannula to 1.2 mm in diameter with a blunt end held to the end of each bulleted beam and imposed a suspension on the output, gradually drew the cannula by simultaneous pressure on the plunger of the syringe. Fan made up to 5 injections suspended from a single puncture in the soft tissue around the ulcer, creating perifocal roller to 0.7 cm thick. The distance between the beams-channels does not exceed 2-3 mm also introduced fan-shaped suspension and directly beneath the ulcer defect.

After removing the cannula beam-the route of the canal was gently massaged over the skin. Then imposed aseptic wound dressing.

On the 10th day of pollypropylene: satisfactory condition; no complaints; the bottom trophic ulcers made bright granulation, redness, swelling around no, 32% epithelization of wounds; fibrin no.

On the 20th day after lipofilling: satisfactory condition; no complaints; the bottom trophic ulcers made bright granulation, redness, swelling around no, 62% epithelization of wounds and scarring.

After 1 month: 100% epithelialization of the wound, normotrophic scar.

The proposed method for the treatment of venous ulcers increases the effectiveness of treatment and shortens the period of epithelialization of ulcers, promotes the formation of normotrophic scar, improves the conditions of regional microcirculation. The method is simple, effective, affordable, performs the task, does not require expensive special equipment and can be widely applied not only in large medical institutions, but also in regional centres and clinics.

Treatment of trophic ulcers, including autologous transplantation of adipose tissue - lipofilling, characterized in that by means lipoaspiration cannula to 1.2 mm in diameter taking the primary aspiration of the subcutaneous fat of the anterior abdominal wall, which is subjected to washing with 5% glucose solution; the resulting fat fraction is diluted with 5% glucose solution in the ratio of 1:1 glucose-fat shake and get suspended; through punctures in the skin to 1.5 m is in the soft tissue around the ulcer and directly beneath the ulcer defect injection cannula to 1.2 mm in diameter with blunt ends are at the end of each bulleted beam and introducing the obtained suspension at the outlet, gradually removing the cannula by simultaneous pressure on the plunger of the syringe; fan-shaped produce up to 5 injections suspension with one puncture, creating perifocal roller to 0.7 cm thick; the distance between the beams-channels should not exceed 2-3 mm.



 

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FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely resuscitation and intensive care, and may be used in treating a craniocerebral injury. That is ensured by administering dexamethasone 0.3 ml and trental 0.4 ml into an inferior external orbital angle between an eyeball and a bone orbit, external and inferior rectus muscle of eye with underlying standard drug-induced therapy. The introduction is once a day daily for 5-7 days.

EFFECT: method provides the highest drug concentrations in the cerebral tissues once administered into the retrobulbar space over a shorter period of time than if administered otherwise that in turn leads to faster cerebral decongestion, peripapillar optic nerve decongestion, and as a consequence ensures faster coming out of coma of the patient with the craniocerebral injury.

3 ex

FIELD: medicine.

SUBSTANCE: invention refers to medical equipment and aims at the sterile storage and implantation of an implantable personal identification code. The container syringe: a device for the storage and implantation of the implantable personal identification code (chip) is made on the basis of a standard disposable injection syringe 2 ml. The syringe has a cut-off cylinder bottom with a needle seat bore, and the bottom is replaced by a removable closing plug which presses a catgut chip to a piston. The syringe piston has two symmetrical grooves on the piston edge (along the axis of motion) for catgut laying.

EFFECT: container syringe enables providing implantable chip sterility and safety of the use of the method for chip implantation.

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to ophthalmology, and can be used for treating luetic optic neuropathy. That is ensured by subconjunctival administration of Cefazolin 0.3-0.5 mg. That is combined with intramuscular injection of Gliatilin 2.0-4.9 ml, 1-3% Glutoxim 2.0 ml and Milgamma 1.0-2.0 ml. Dexazon 0.5 ml is introduced parabulbarly. The preparations are introduced once a day for 10 days. Additionally, starting with the first therapeutic day, 10 sessions of percutaneous transcranial magnetic stimulation of the optic nerves are conducted daily.

EFFECT: method provides improving the visual functions and eliminating the complications of the central nervous system due to the integrated treatment developed with the severity of the pathological process in these patients.

1 tbl, 2 ex

FIELD: medicine.

SUBSTANCE: invention relates to medical equipment, namely to aspirating catheters for aspiration of mucus and other flowing media and excretions at least from part of patient's respiratory ways, namely from tracheabronchial ways. Aspirating catheter contains case and multiple holes. Case is mainly tube-shaped with cavity formed inside it, and contains external surface, distal tip with hole, connected with cavity, proximal end with hole, connected with cavity and made with possibility of connection to source of underpressure. Multiple holes are located near distal end of said case. Holes have edges and area. Ratio of area of holes to area of external surface of catheter between edges of holes constitutes from 28 to 42 percent. Said holes are separated with transverse elements. Said transverse elements are bent outwards when brought in contact with object. In the second version of aspirating catheter implementation distal tip has multitude of located with equal spaces holes, positioned near distal tip and separated with transverse elements, bending outwards when catheter contacts with surface. Catheter possesses force of interaction which is at least 35 percent less than analogous catheter, made from the same material but without holes. In the third version of implementation aspirating catheter is made with strap, starting at the distance approximately from 1 mm to 3 mm from distal tip of catheter and continuing proximally for the distance approximately from 4 to 6 mm. Area of open holes constitutes approximately from 28 to 42 percent of said strap area.

EFFECT: technical result, achieved by claimed invention, consists in the following: holes become less susceptible to clogging, which makes it possible to achieve less traumatic force of aspiration in the course of procedure, and in addition, cause less traumas, when catheter encounters an obstacle such as sensitive tissue.

14 cl, 9 tbl, 13 dwg

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