RU2164427C1 - Method for treating purulent soft tissues diseases - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves applying napkin produced from dialdehyde cellulose as base and containing photosensitizing agent. The napkin being kept on wound during 24 h, the wound is exposed to light of 670 nm wavelength. EFFECT: enhanced effectiveness of treatment; accelerated treatment course.

Description

 The invention relates to medicine, specifically to surgical methods for treating extensive suppurative soft tissue diseases.

 There is a surgical method for treating purulent diseases of soft tissues, which consists in opening the purulent foci and wound toilet, then applying a bandage with antiseptic solutions or ointments, followed by daily dressings. At the same time, wounds are carried out using antiseptic solutions (Big Medical Encyclopedia, M, Sovetskaya Encyclopedia Publishing House 1974, v. 1, p. 20-21). Treatment with traditional dressings is long, lingering, dressings are painful due to the drying of the dressing to the wound.

 Known closest to the claimed method for the treatment of purulent lesions of soft tissues, which consists in applying a napkin with an immobilized proteolytic enzyme, Dalcextripsin, through which a semiconductor low-energy laser is irradiated daily (ed. St. USSR N 1598269, MKI A 61 N 5 / 06, 1988).

 Epithelization during treatment in a known manner was observed on days 9-12.

 The invention solves the problem of accelerating and increasing the effectiveness of the treatment of extensive purulent diseases of the soft tissues.

 The problem is solved due to the fact that in the method of treatment of purulent diseases of soft tissues, consisting in the fact that a wipe is placed on the wound based on dialdehyde cellulose containing a biologically active drug, followed by irradiation, use a napkin containing a photosensitizer "Photosens ", and after keeping the wipes on the wound for 24 hours, the wound is irradiated with red light emitted from a solid state yttrium aluminate laser with a double frequency and wavelength 670 nm or non-laser light source of a wide emission band of 600-700 nm and a wavelength of 670 nm.

 "Photosens" is a sulfonated - aluminum phthalocyanine and is a domestic photosensitizer developed in the State Scientific Center "NIOPIK". Permission for clinical trials was given by the Pharmacological Committee of the Russian Federation in 1994.

 ("Photodynamic therapy of malignant neoplasms", Second All-Russian Symposium with international participation, M, 1997, p. 21).

 The method is as follows.

 After the patient arrives at the hospital, a purulent lesion is opened, pus is removed, necrotic tissues are excised, followed by treatment of the wound with a solution of hydrogen peroxide and chlorhexidine, then a napkin made of dialdehyde cellulose (DAC) impregnated with a Photosensitizer solution with a concentration of 125-500 μg / ml, incubated 24 h and irradiated with red light emitted by a solid-state laser on yttrium aluminate with a double frequency and a wavelength of 670 nm or a non-laser source of light of a wide band of radiation 600-700 nm and a wavelength of 670 nm.

 The number of radiation sessions is determined depending on the severity of the inflammatory process and wound exudation.

 When treating with the proposed method, the treatment time is reduced to 5-10 days instead of 7-14 by the known method.

 Example 1

 Patient M., 19 years old, was admitted to the surgical department of the hospital with a diagnosis of acute purulent intramammary lactation right-sided mastitis, extensive infiltration with moderate hyperemia and fluctuation is determined in the upper quadrants. The patient was operated on. Under anesthesia, a radial incision of up to 12 cm was made.

 An extensive purulent cavity was opened, occupying the upper quadrants of the mammary gland and containing up to 1 liter of liquid pus with sequestered tissues. Necrotic tissue removed. The wound was washed with a solution of hydrogen peroxide and chlorhexidine, a wipe made from dialdehyde cellulose impregnated with a solution of photosensitizer "Photosens" with a concentration of 250 μg / ml.

The napkin is kept on the wound for 24 hours and then the wound is irradiated with red light emitted from a yttrium aluminate solid-state laser with a doubled frequency of "Pole-2" and a wavelength of 670 nm. The exposure time of 20 minutes per 1 cm ² . The distance from the working end of the fiber to the wound surface is 3-5 mm. After irradiation, the wound is closed with a cloth moistened with a solution of "Photosense", as described above. After a day, irradiation with red light is again carried out and the procedure is repeated one more time. A total of 3 sessions of phototherapy. The wound was sutured on the 3rd day after the last session of photodynamic therapy with drainage. Sutures were removed on the 7th day. Primary wound healing, inflammatory phenomena stopped by the 3rd day. On the 5-6th day, there was a lack of discharge through the drains. Body temperature returned to normal on the 3rd day after surgery. The patient received gentamicin in a daily dosage. The wound closed on the 8th day. Discharged after 9 days.

 Example 2

 Patient T., aged 59 years old, was admitted to the surgical department of the hospital with a diagnosis of phlegmon of the anterior abdominal wall (postoperative scar).

 The primary surgical treatment of phlegmon was performed. Antibiotic therapy was carried out, local treatment was carried out by dressings with antiseptic solutions and water-soluble ointments. On the background of the treatment, sluggish wound cleansing, the appearance of sluggish granulation and purulent discharge from the wound of the anterior abdominal wall measuring 15 x 5 x 10 cm were noted.

 On the 7th day after the operation, an application was made on the wound of a napkin soaked in a solution of photosensitizer "Photosens" concentration of 125 μg / ml.

After 24 hours, a session of photodynamic therapy was conducted with red light emitted from a solid-state laser with yttrium aluminate with a double frequency of "Pole-2" and a wavelength of 670 nm. The exposure time of 20 minutes per 1 cm ² . The distance from the working end of the fiber to the wound surface is 3-5 mm. Dressed with chlorhexidine.

 The next day, when dressing, the wound is clean, the granulation is juicy, lively, bright red.

 The sutures were removed on the 9th day after the operation, there are no complications (such as suppuration, divergence of sutures, necrosis of the edges) from the side of the wound.

 The patient was discharged.

 Example 3

 Patient 3., age 52 years old, was admitted to the surgical department of the hospital with a purulent wound of the right lower leg, size up to 6 cm, skin necrosis in the wound area 6.0x4.0 cm, fiber fluctuation.

 A purulent focus was opened, the cavity was sanitized with a solution of hydrogen peroxide, necrosis was excised, a bandage with iodopyrone was applied. Localis status: wound 6.0x4.0 cm with purulent discharge, hyperemia, edema.

 A day later, a wipe from dialdehyde cellulose impregnated with a photosensitizer solution "Photosens" with a concentration of 500 μg / ml was applied to the wound after treatment with a hydrogen peroxide solution.

After 24 hours, the first session of photodynamic therapy with red light was performed using a non-laser source of irradiation of a wide emission band of 600-700 nm with a wavelength of 670 nm. The exposure time of 20 minutes per 1 cm ² . The distance from the working end of the fiber to the wound surface is 3-5 mm. An antiseptic dressing is applied. A day later, a pronounced dehydration effect is noted, a wound without purulent plaque, single granulation, relief of edema, and the absence of hyperemia.

 The procedure for applying a napkin impregnated with a photosensitizer was performed again for 24 hours and the 2nd session of photodynamic therapy with red light was performed as described above. After a day, the wound is clean, there is no discharge, the granulation is alive, marginal epithelization. Then carry out dressings with solutions of antiseptics.

 On the 10th day after the operation, the patient was discharged with complete epithelization of the wound defect.

Claims (1)

 A method of treating purulent diseases of soft tissues, which consists in applying a napkin based on dialdehyde cellulose containing a biologically active drug, followed by irradiation, characterized in that a napkin containing a photosensitizer “Photosens” is used as a biologically active drug, and after aging wipes on the wound for 24 hours conduct irradiation of the wound with light with a wavelength of 670 nm.