RU2438596C1 - Surgical technique for trophic wounds of various aetiologies - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: invention refers to medicine, namely surgery, and can be used for treating patients with trophic wounds of various aetiologies. The operation is single-step. Vertical sections are made on a surface of the trophic wound to blood-supplied subhacent tissue at a pitch of 0.5-1.0 cm. Then dermal lineages 2ù2 mm are implanted in the made sections. It is followed by autoplasty with a split-skin mesh graft. ^ EFFECT: use of the given invention allows reducing time and extent of the operation with maintained satisfactory functional surgical results, providing repair stimulation due to intensive epidermic tissue growth, preventing intra- and postoperative complications. ^ 1 ex

Description

The present invention relates to medicine, namely to surgery, and can be used to treat patients with trophic wounds.

The treatment of trophic wounds continues to be relevant at present. The main methods for treating ulcers are:

- operations aimed at eliminating or reducing chronic venous insufficiency;

- operations aimed at eliminating or reducing chronic arterial insufficiency;

- surgical interventions on the autonomic nervous system and peripheral nerve trunks;

- operations in the field of ulcers and surrounding tissues (Plastic surgery of chronic and neurotrophic ulcers / GD Nikitin [et al.] - St. Petersburg: SZHUZHT LLC, 2001. - 190 p.).

A known method for the surgical treatment of trophic ulcers of the leg caused by chronic venous insufficiency, including surgical correction of venous blood flow and excision of the trophic ulcer with fibrous-modified adipose tissue, and also to prevent the development of cicatricial deformity of the lower leg, immediately during the operation, the soft-tissue defect of the leg is eliminated by the introduction of a "hydrogel "(application RU 95118309, 1997).

A known method of treating trophic venous ulcers, including compression of the affected limb by applying a strip of tissue in which a hole is made at the location of the trophic ulcer, the ulcer periphery is closed with a foam rubber ring, during the treatment period, compressive force and positional drainage of the limb and ulcer are created, for which the limb is laid in an elevated position, tighten the laces, while the pressure on the limb can exceed by 10-15 mm the rate of venous pressure in the main veins (patent RU 2146510, 2000). The method speeds up the treatment time, reduces the number of relapses.

A known method for the treatment of burn wounds, which consists in the fact that they carry out "terminal necrectomy" with simultaneous skin grafting. The essence of the operation is that in the victim, in the early stages of the injury, peculiar windows are cut out in an array of dead tissue and split skin flaps are transplanted onto the wound surface. The grafts that have taken root grow to the sides. The process of scab rejection and epithelialization of wounds from transplants proceeds simultaneously.

The so-called "submersible" autodermoplasty is rarely used. As a rule, it is carried out in the treatment of wounds subjected to pressure in the absence of fluidizing beds. A small skin graft is inserted into the tissue with tweezers. After its engraftment, the epidermis grows, which “creeps out” onto the surface of the wounds (B.V. Paramonov, Y. O. Poremsky, V. G. Yablonsky. Burns: A Guide for Doctors. - St. Petersburg: SpetsLit, 2000. - 480 s .).

The disadvantages of this method are two-stage, the complexity of execution due to the performance of microsurgical anastomoses and the invasiveness of the operation.

The prototype of the invention is a method of surgical treatment of trophic and sluggish wounds, which consists in the fact that the operation is carried out simultaneously, while the wound surface is fenestrated to a healthy blood supply to the underlying tissue, the trophic wound is tangentially excised and autodermoplasty with a split mesh skin flap. The method allows to improve the functional results of treatment, to reduce the period of wound healing and reduce intra- and postoperative complications, which is achieved by stimulating the growth of granulation tissue (patent RU 2341208, 2008).

The objective of the invention is the development of an effective instantaneous treatment of trophic wounds of various etiologies.

The technical result is a reduction in the time and volume of the operation due to the elimination of the stages of fenestration and tangential excision while maintaining satisfactory functional results of treatment, stimulation of healing due to the intensive growth of the epidermis, prevention of intra- and postoperative complications.

The specified technical result is achieved by the fact that in the surgical method of treating trophic wounds of various etiologies by a simultaneous operation, including at the last stage autodermoplasty with a dissected mesh flap, according to the invention, vertical sections of the trophic wound are made up to the blood supply to the underlying tissue with an interval of 0.5-1.0 cm, after which the implantation of dermal germs with dimensions of 2 × 2 mm is carried out in the incisions of the trophic wound.

The proposed method is as follows. The operation on the surface of the trophic wound is carried out simultaneously. First, vertical sections of the trophic wound are made up to the blood supply to the underlying tissue with an interval of 0.5-1.0 cm, after which implantation of dermal germs with dimensions of 2 × 2 mm is carried out in the produced sections of the trophic wound. Subsequently, an intensive overgrowth of the epidermis occurs. To accelerate and stimulate epithelization of the entire surface of the wound, autodermoplasty is performed with a split mesh transplant. Dermal shoots are taken from the thigh, forearm, etc. Before and after the surgical period, infusion therapy is carried out aimed at improving the microcirculation and rheological properties of the blood. Antibiotic therapy, anticoagulant therapy, symptomatic treatment. Spend local treatment, which is aimed at stimulating epithelization, the prevention of suppuration.

The authors did not find an identical method of treating trophic wounds in accessible sources of scientific-medical and patent information, including vertical sections of the trophic wound to the blood supply to the underlying tissue with an interval of 0.5-1.0 cm, implantation of dermal germs 2 × 2 mm in size into the incisions trophic wounds. Thus, the claimed invention meets the criterion of "Novelty."

The studies of the authors proved that the proposed method for the treatment of trophic wounds, including vertical sections of the trophic wound to the blood supply to the underlying tissue with an interval of 0.5-1.0 cm, implantation of dermal sprouts with dimensions of 2 × 2 mm in the incisions made, reduces the time and volume of the operation while maintaining satisfactory functional results of treatment, provides stimulation of healing due to the intensive growth of the epidermis. Thus, the claimed invention meets the criterion of "Inventive step".

This method was used in 3 patients with trophic wounds in the Republican Burn Center, Municipal Clinical Hospital №18. In all cases, the specified technical result was achieved.

We give an example of clinical use of the proposed method.

Example. Patient 3. 47 years old, medical history No. 30686. He was treated at the Republican Burn Center of the Municipal Clinical Hospital No. 18 of Ufa in 2009 with a diagnosis of Trophic wound of the right lower leg. Type 1 diabetes mellitus, severe course. Micro - macroangiopathy. Hypertension of the II degree, I stage, risk 3. It is sick during the last 3 years. The wound area is 6 × 7 cm along the posterior surface of the lower third of the right lower leg. The department conducted vascular therapy. Operation: vertical sections of the trophic wound to the blood supply to the underlying tissue with an interval of 1.0 cm. Implantation of dermal germ size 2 × 2 mm into sections of the trophic wound, autodermoplasty with a split mesh flap 1: 2 60 cm ² . Complete engraftment, discharged in satisfactory condition.

The proposed method is easily reproducible in a hospital environment and when it is used, the indicated technical result is achieved. Thus, the claimed invention meets the criterion of "Industrial applicability".

Claims (1)

A surgical method for the treatment of trophic wounds of various etiologies by means of a simultaneous operation, which includes autodermoplasty with a dissected mesh flap at the last stage, characterized in that vertical sections of the trophic wound are made up to the blood supply to the underlying tissue with an interval of 0.5-1.0 cm, after which the dermal growths are implanted dimensions of 2 × 2 mm into produced sections of the trophic wound.