RU2546400C1 - Method for eliminating post-traumatic skin deformities by vacuum gradient distraction of perforated scars (versions) - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: there are presented two versions for eliminating post-traumatic skin deformities. According to one version, the first stage involves full-thickness tissue perforation and static vacuum gradient therapy of the perforated tissue. After 2-5 days following the first stage, the static vacuum gradient therapy of the same tissue is performed for the following 7-10-day second stage. According to the second presented version, eliminating the post-traumatic skin deformities involves the full-thickness tissue perforation. That is followed by implanting platelet-rich autoplasma containing at least 106 platelets in mm 3 into the perforations. The second stage follows 7-10 days later and involves the static vacuum gradient therapy of the same tissue for 7-10 days.

EFFECT: graftless elimination of the post-traumatic skin deformities of any origin by increasing a scar area.

14 cl, 4 ex

Description

The group of inventions relates to medicine, namely to cosmetology, plastic, reconstructive and reconstructive surgery, and can be used to correct cicatricial changes in the skin of various origins.

Treatment of pathological skin scars can be divided into surgical, conservative and various combinations thereof.

Local tissue repair (PMT) is the most common method for scar elimination (RU 2108064, 04/10/1998; RU 2195888, 01/10/2003).

However, due to the fact that in this case the defect is closed with mobilized local tissues, a necessary condition is the presence of a sufficient amount of intact skin in the immediate vicinity of the scar defect, which can be mobilized quite widely.

The implementation of free skin grafting (split or full-layer skin autograft) requires the presence of safe donor zones. Moreover, the use of split grafts in 30% leads to retraction of transplanted tissues, relapse of contractures, impaired pigmentation, lack of skin derivatives, scarring of donor zones. When using full-layer grafts, scarring of donor zones often develops.

Another surgical method is expander plastic surgery (RU 2271157, 03/10/2006) - a two-stage treatment method in which implants are used. However, the implementation of this method is possible only if there is intact tissue in the area of the defect. In addition, scarring of donor areas always occurs with plastic surgery by a stretched free skin graft.

Laser ablation (RU 2275881, 05/10/2006) is also actively used in the treatment of atrophic, normotrophic or hypertrophic scars that rise slightly above the skin. The method allows to achieve only a good aesthetic effect, but is ineffective when exposed to severe hypertrophic scars.

One of the currently popular methods is micronidling - scar perforation by dermorollers (Matthias C. Aust, MD Des Fernandes, MD, Perikles Kolokythas, MD MD Percutaneous Collagen Induction Therapy: An Alternative Treatment for Scars, Wrinkles, and Skin Laxity, 2008 http: //saveskin.ru/img/roller/11.pdf). The method is most effective for atrophic and normotrophic scars. Microperforation holes penetrating to a depth of 5 mm cannot affect the hypertrophic scar due to the considerable thickness of the latter, they are not able to solve the patient’s functional problems and “work” more in the cosmetic direction. Thus, with other types of scars, micronidling effectiveness is much less.

A combined method of scar treatment is also known, consisting in multiple perforations (macronidling) of scars that cause deformation of the skin or contracture, with simultaneous implantation into the formed wound channels of the patient's autogyro tissue (Khouri RK, Smit JM, Cardoso E, Pallua N, Lantieri L, Mathijssen IM, Khouri RK Jr, Rigotti G. Percutaneous aponeurotomy and lipofilling: a regenerative alternative to flap reconstruction? Plast. Reconstr. Surg. 2013 Nov; 132 (5): 1280-90 - prototype). Undoubtedly, this method has positive aspects. Macronidling makes the scar “porous” and more extensible. This provides tissue growth by an amount equal to the sum of the area of the perforations. Implantation of autogyros does not allow wound canals to contract rapidly after passing through fibrous inflammation, and the scar acquires a new morphological structure. However, this method is effective only in combination with physiotherapy and physiotherapy. Patients had to repeat the treatment several times to obtain lasting functional improvement.

The present invention was the development of a new method of surgical treatment of patients with deforming skin scars and contractures of any etiology.

Achievable technical result is the elimination of post-traumatic deformation of the skin of any etiology, without plastics, by increasing the area of the scar.

The result is due to the combined effect on the altered tissue:

- initially performing multiple through-hole perforation of the scar allows reducing “tissue tension” and contractility, and the subsequent vacuum-gradient effect on the perforated tissue causes metabolic “microexplosion” of tissue structures, provoking the release of biologically active substances (heparin, histamine, prostaglandins, cytokines, oxide nitrogen), contributing to a decrease in vascular tone, vasodilation. In addition, the vacuum-gradient effect on the perforated tissue allows to improve angiogenesis, which is due to a change in the liquid crystal structure of the cytosol of cells, activation of blood flow regulators, which increase the synthesis of arteriovenular anastomoses, and also increase the number of functionally active capillaries and blood flow velocity;

- a double, horizontal-vertical pressure gradient ensures the appearance of a difference in the gradients of hydrostatic and oncotic pressures in the surface and deeper microvessels, which in turn leads to an increase in the convection channel of liquids, proliferative and metabolic processes in tissues;

- the combined effect (through perforation, scar fragmentation and its subsequent vacuum disaggregation) promotes mechanical loosening of all tissue layers: collagen-elastic skeleton, myofibrils, thereby stimulating cell proliferation;

- through perforation, scar fragmentation, in fact, create the possibility of further migration of fragments during vacuum therapy.

In one embodiment of the method we developed, after perforation, autologous platelet-rich plasma (PRP-therapy, plasmolifting) is additionally introduced into the altered tissue. In this case, a plasma containing at least 10 ⁶ platelets in mm ³ (the so-called plasmolifting technique) is used.

Autologous platelet-rich plasma is enriched with cell growth factors. Sprout growth factors are actively secreted by platelets in order to begin wound healing and skin renewal. Such plasma includes blood proteins that act as cell adhesion molecules: fibrin, fibronectin and vitronectin. That is, the use of autoplasma has an additional stimulating effect on the synthesis of its own collagen, elastin, as well as hyaluronic acid, thereby increasing the elasticity of the altered tissue.

Thus, it is a combination of through perforation and subsequent vacuum disaggregation of the altered tissue that allows for optimal treatment of cicatricial changes of various nature.

The method is as follows.

Before the operation, an ultrasound of the scar is performed, determining its length, density, thickness, as well as the location of the blood vessels in the immediate vicinity of the scar.

The need to perform preoperative ultrasound examination is due, on the one hand, to control the angioarchitectonics of the operating area, which will exclude surgical damage to blood vessels, and, on the other hand, the importance of determining the depth of future penetration into the altered tissue with a perforating device.

Next, an operation is performed (the first stage), during which the scar is perforated right through with a special device. Various devices can be used as such a device, for example, an intravenous injection needle with a cut tip. Moreover, the end of the needle should have a limiter that does not allow to violate the limited depth of penetration.

In a "staggered" order, multiple through-hole perforations of scar tissue are made by the above or a similar device, making twisting movements. The most optimal is the distance between the holes is not more than 1-2 mm.

Then, a static vacuum-gradient therapy of a perforated scar is performed intraoperatively with a vacuum-gradient therapy by pressure, the effect is carried out until painful sensations appear.

In the postoperative period, from 2-5 days after the operation (second stage), static vacuum gradient therapy is performed on the zone of altered tissue. This therapy is carried out for 7-10 days. Moreover, the effect is carried out until the onset of pain.

One of the options of the developed method is the additional introduction into the altered scar tissue after its perforation of autoplasma enriched with platelets. For this, an autoplasma enriched in platelets containing at least 10 ⁶ platelets in mm ^{3 is} implanted into the perforation holes. In this case, the second stage is carried out 7-10 days after the first. During the second stage, static vacuum gradient therapy of the same tissue area is carried out for 7-10 days.

When both options are implemented, it is possible to apply, including corticosteroids or enzymes, to the area of the altered tissue before performing a vacuum gradient effect (once or before each).

When applications can be used, for example, the following drugs:

1. Collalysin - a proteolytic enzyme preparation Collalysin, D03BA03 Bromelain (ATX) / solution

2. Fermencol (enzyme composition of 9 collagenolytic proteases with a molecular weight of 20 to 100 kDa obtained from the digestive organs of marine invertebrates) group cosmetics / gel

3. Prednisolone (corticosteroids for systemic use) / solution

4. Kenologist 40 (Triamcinolone (Triamcinolone) glucocorticosteroid / solution

5. Hydrocortisone (Hydrocortisonum) Н02АВ09, glucocorticoid / ointment

The developed complex, to obtain the most optimal physiological result, can be repeated in courses, for example:

1. Conducting repeated courses of vacuum scar distraction (for example, 2 weeks, then a month break, then a repeat).

2. Conducting a second course of perforation-vacuum (3-4 months after the first).

Example 1:

Patient M., 15 years old. Diagnosis: post-burn scars of both upper limbs.

Complaints about the presence of a hypertrophic scar in the area of the right elbow joint, causing contraction, discomfort during movement. Surgical treatment with the developed method was performed. From the 4th day of the postoperative period, a vacuum gradient therapy of the scar area was performed for 8 days.

On the 7th day, visual flattening of the scar was noted, smoothing of its edges. When the control ultrasound on the 7th day was noted - fragmentation and heterogeneity of the scar, as well as an increase in its hydrophilicity and vascular pattern of the study area during Doppler mapping. The patient noted an increase in range of motion in the area of the right elbow joint.

After the course of treatment, a decrease in the height of the scar, an increase in its hydrophilicity with a simultaneous increase in the area of the latter by 12%, the deficit of the range of movements (due to contracture, contraction) decreased.

Example 2:

Patient I., 6 years old. Diagnosis: post-burn scars of the right upper limb, chest. Adjacent contracture of the right shoulder joint.

Complaints about the presence of scars that cause constriction of the chest area and resulting contracture of the right shoulder joint, causing a restriction of movement above 160 °.

Surgical treatment was performed using the developed method of scars of the anterior surface of the right upper limb, the region of the shoulder joint and chest. Vacuum gradient therapy of the scar area in the postoperative period was carried out for 7 days.

Results - visual flattening of the scar. A significant decrease in the severity of adductive contracture of the right shoulder. Increased range of motion up to 170 °. A slight decrease in the height of the scar and an increase in its hydrophilicity with a simultaneous increase in the area of the latter by 10%. Fragmentation of the scar was noted.

Example 3:

Patient K., 10 years old. The diagnosis of post-burn scars of the upper limb and chest.

Complaints about the presence of hypertrophic scar of the right forearm.

An operation was performed using the developed method on the front surface of the right upper limb. Then, vacuum gradient therapy was performed for 6 days.

Results - a decrease in the height of the scar, smoothing of its edges. On the 6th day, an ultrasound scan increased the blood supply to the tissues of the operative zone and fragmented the scar.

Example 4:

Patient S., 16 years old. Diagnosis: post-burn scars of both lower extremities.

Complaints about the presence of a hypertrophic scar in the area of the right thigh, causing contraction and discomfort when moving in the hip joint.

Surgical treatment by the developed method was performed. Moreover, an additional 1 mm ³ of platelet-enriched autoplasma was implanted into the perforation holes. From the 8th day of the postoperative period after epithelialization of the wound for 7 days, a vacuum gradient therapy of the perforated scar area was performed.

On the 15th day, visual flattening of the scar, smoothing of its edges was noted. When the control ultrasound on the 15th day was noted - fragmentation and heterogeneity of the scar, as well as an increase in its hydrophilicity and vascular pattern of the study area during Doppler mapping. The patient noted a decrease in contractions in the hip joint.

Claims (14)

1. A method of eliminating post-traumatic skin deformations, comprising performing multiple perforations of deformed tissue, characterized in that the perforations are performed over the entire thickness of the deformed tissue, and at the first stage, the tissue is perforated at the same time and static vacuum gradient therapy of the perforated tissue is performed, then after 2-5 days after the first stage, a second stage is carried out for 7-10 days, including static vacuum gradient therapy of the same tissue area. 2. The method according to p. 1, characterized in that the depth of the perforations is determined previously based on the data of ultrasound examination of deformed skin. 3. The method according to p. 1, characterized in that the perforation is performed in a checkerboard pattern. 4. The method according to p. 1, characterized in that the static vacuum gradient therapy is carried out until the pain. 5. The method according to p. 1, characterized in that in the second stage, before applying the static vacuum gradient therapy, an application including corticosteroids or proteolytic enzymes is applied to the affected area. 6. The method according to p. 1, characterized in that, if necessary, the first and second stages are repeated. 7. The method according to p. 1, characterized in that, if necessary, repeat the second stage. 8. A method for eliminating post-traumatic skin deformations, comprising performing multiple perforations of deformed tissue, characterized in that the perforations are performed over the entire thickness of the deformed tissue, and at the first stage, the tissue is perforated at the same time, then platelet-rich autoplasma containing at least 10 ⁶ platelets is implanted into the perforations in mm ³ , after 7-10 days, the second stage is carried out, during which static vacuum gradient therapy of the same tissue area is carried out for 7-10 days. 9. The method according to p. 8, characterized in that the depth of the perforations is determined previously based on the data of ultrasound examination of deformed skin. 10. The method according to p. 8, characterized in that the perforation is performed in a checkerboard pattern. 11. The method according to p. 8, characterized in that the static vacuum gradient therapy is carried out until the pain. 12. The method according to p. 8, characterized in that in the second stage, before applying the static vacuum gradient therapy, an application including corticosteroids or proteolytic enzymes is applied to the affected area. 13. The method according to p. 8, characterized in that, if necessary, the first and second steps are repeated. 14. The method according to p. 8, characterized in that, if necessary, repeat the second stage.