RU2847933C1 - Method for treating purulent-inflammatory diseases of the soft tissues of the maxillofacial region and neck - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, specifically to surgery, and can be used to treat purulent-inflammatory diseases of the soft tissues of the maxillofacial region and neck. The surgical field is treated twice with betadine and 70% alcohol. Then, the purulent focus is opened, the purulent-serous contents and detritus are evacuated, and the wounds are washed with a 3% hydrogen peroxide solution. At the same time, a mixture containing 3% lactic acid powder and ascorbic acid powder in a 1:1 ratio is applied to the wound, then gauze bandages impregnated with the water-soluble ointment "Oflomelid" are applied, which are changed once every two days.

EFFECT: to reduce treatment time and medication load by improving tissue trophic function and stimulating antioxidant activity in the wound.

1 cl, 10 dwg, 2 ex

Description

The invention relates to the field of medicine, namely to surgery, and is intended for the treatment of purulent-inflammatory diseases of the soft tissues of the face and neck (phlegmon and abscesses).

The treatment of purulent-inflammatory diseases of the maxillofacial region and neck, including abscesses and phlegmons, is one of the most pressing medical challenges and a key area of modern purulent surgery. Currently, conservative and surgical treatment methods are used to treat purulent-inflammatory diseases of the soft tissues of the maxillofacial region and neck.

A method for treating purulent-inflammatory diseases of the soft tissues of the head and neck area is known, which consists of using a biodegradable wound dressing Suprathel, an acid-containing dressing containing a polymer of lactic acid mixtures (Poly-lactic Acid (PLA) [Recent Advances in Biodegradable and Biocompatible Synthetic Polymers Used in Skin Wound Healing]. (see https://www.lotusmdc.com/katalog/UVCY/Eng-12-Suprathelin-cocuklarda-Gorulen-Derin-Dermal-Yaniklarda-Kullanimi.pdf).

This wound dressing is primarily used in the conservative treatment of epidermal, superficial dermal, and small-area wounds where spontaneous epithelialization is possible. The dressing is applied to non-suppurative and burn wounds and is not removed until signs of spontaneous epithelialization are observed. This dressing has found its primary use in the treatment of superficial burn wounds in children caused by hot liquids, when applied early after the burn injury and in the absence of signs of purulent perifocal inflammation.

The reasons that prevent the achievement of the technical result specified below when using the known method include the fact that it is used only for superficial burn wounds with no signs of purulent inflammation.

The objective of the invention is to create a method for treating purulent-inflammatory diseases of the soft tissues of the maxillofacial region and neck, ensuring the achievement of a technical result consisting in a reduction in the duration of the disease, accordingly reducing the duration of antibacterial therapy of a general and local nature.

The technical result is achieved by the fact that after treating the surgical field with betadine and 70% alcohol twice, the purulent focus is opened, the purulent-serous contents and detritus are evacuated, the wound is washed with 3% hydrogen peroxide, then dried, drainage is carried out, a mixture of powders consisting of lactic acid powder and ascorbic acid powder in a 1:1 ratio is applied to the wound, and then gauze bandages impregnated with the water-soluble ointment "Oflomelid" are applied, which are changed once every two days.

The combined use of two acid-containing powders—lactic and ascorbic acid—mixed in a 1:1 ratio improves wound nutrition and antioxidant protection. Lactic acid contains cellular metabolites, while ascorbic acid has an antioxidant effect, providing antioxidant protection. The water-soluble ointment "Oflomelid" ensures good water and gas exchange in the wound, painless dressing changes, and provides a good cosmetic effect without leaving scars.

Cotton gauze, which has sufficient adhesive capacity to mechanically remove remaining necrotic tissue elements, cellular detritus, and inflammatory products from the wound, serves as a dressing material that fixes the powder on the wound.

The invention is characterized by the following images:

Fig. 1 - view of the wound according to example 1 upon admission of the patient to the department after surgical treatment,

Fig. 2 - view of the wound according to example 1 on the third day after surgical treatment,

Fig. 3 - toilet of the wound surface according to example 1 before applying the powder mixture to the wound,

Fig. 4 - view of the wound according to example 2 upon admission after autopsy,

Fig. 5 - view of the wound according to example 2 on the 6th day before dressing,

Fig. 6 - view of the wound according to example 2 on the 10th day,

Fig. 7 - view of the wound according to example 2 after treatment with a mixture of powders, the wound on the 12th day,

Fig. 8 - view of the wound according to example 2, on the 14th day,

Fig. 9 - view of the wound according to example 2 on the 16th day,

Fig. 10 - view of the wound according to example 2 on the 17th day.

The method is carried out as follows.

Treatment of purulent-inflammatory diseases of the soft tissues of the maxillofacial region and neck is used in patients with purulent wounds of the face and neck with various sources of infection and different localizations.

After treating the surgical site twice with betadine and 70% alcohol, the purulent lesion is incised, and the purulent-serous contents and debris are removed. The resulting purulent-serous discharge is sampled for secondary microflora. The wound is flushed with 3% hydrogen peroxide. The wound is then thoroughly dried with gauze pads, and a drain or rubber drain is installed. A powder mixture is prepared consisting of 3% lactic acid powder and ascorbic acid powder. The preparations are mixed 1:1. The powder mixture from the container is applied to the wound in an even 0.2 mm layer, and the wound is covered with sterile gauze pads soaked in water-soluble "Oflomelid" ointment and secured with a gauze bandage. The pads are changed every two days.

The proposed method has a number of advantages: simplification and reduction of treatment duration, good patient tolerance, and can be widely used in practice.

Example 1.

Patient A. was admitted to the department on January 8, 2024. Diagnosis: Odontogenic phlegmon of the floor of the mouth.

Complaints upon admission to the department: pain, swelling of the floor of the mouth, tongue, pain when swallowing, trismus, chills.

Anamnesmorbi: 01/05/24, tooth 37 was removed due to exacerbation of chronic periodontitis, swelling appeared in the floor of the mouth, referred to maxillofacial surgery and hospitalized on an emergency basis.

Surgical treatment performed. On January 8, 2024, the purulent focus was incised and drained, after which patient A. was treated according to the stated method.

The surgical field was treated with betadine and 70% alcohol twice. A typical skin incision was made in the submental area, while a sharp incision was made through the subcutaneous fat, platysma muscle, and fascia. A blunt exploration of the submental and submandibular spaces and the root of the tongue was performed, with removal of purulent-serous contents and debris.

The wound surface was rinsed with 3% hydrogen peroxide, then thoroughly dried with gauze pads and a rubber drain was installed. A powder mixture consisting of 3% lactic acid powder and boric acid powder in a 1:1 ratio was applied to the wound in a thin, even layer (0.2 mm). The wound was covered with gauze dressings soaked in Oflomelid water-soluble ointment and secured with a gauze bandage. Dressings were changed every other day.

The treatment course lasted 8 days: complete wound healing occurred and signs of inflammation disappeared. She was discharged on the 8th day. Further follow-up with a surgeon at Patient A.'s local hospital revealed no complications.

Example 2.

Patient B. was admitted to the department on November 2, 2023. Diagnosis: Cellulitis of the neck. Concomitant diseases: Hypertension.

Anamnesmorbi: Considers herself ill since 10/30/23, when the dystopic 48th tooth was removed. After the extraction, pain appeared in the area of the extracted tooth. The next day, swelling appeared in the area of the extracted tooth. On 11/02/23, the swelling spread to the lower part of the buccal and parotid-chewing region on the right, then to the right submandibular region. There was a swallowing disorder, painful chewing, limited opening of the mouth, general weakness, decreased performance, insomnia, loss of appetite, a feeling of chills, t 38.9 ° C. Examined by a dentist and referred to the State Healthcare Institution Regional Clinical Hospital in maxillofacial surgery. Surgical treatment:

November 2, 2023. Opening and drainage of the abscess.

The wound on admission after autopsy (Fig. 4)

Postoperative wound: in the wound there is abundant serous exudation, “lymphatic drainage effect”, abundant purulent discharge, and the appearance of granulation tissue (Fig. 5, Fig. 6).

The treatment was carried out according to the stated method.

The wound after treatment with powder see Fig. 7, Fig. 8, the wound Fig. 9.

The following clinical features of the postoperative period were identified. The purulent wound progressed without symptoms of purulent intoxication or local purulent-necrotic inflammation.

During the initial stages of inflammation, if significant exudative phenomena were present, dressings were changed once daily. Once exudative phenomena subsided, dressings were changed once every two days.

The treatment course lasted 16 days: complete wound healing occurred and signs of inflammation disappeared. She was discharged on the 17th day. Further follow-up with a surgeon revealed no complications.

The proposed method reduces treatment time by 1.5 times, reduces the patient's medication burden, and potentially reduces the need for pain medication and antibacterial therapy. Wound treatment using the proposed method is compatible with any physical therapy or medication.

Another positive result of the invention is that its components are widely available in pharmacies and are affordable, which is very important in the treatment of extensive purulent lesions when calculating the material costs of treatment for patients in the budget category, which is important in terms of obtaining economic benefits for treatment in hospitals with budgetary financing.

Claims (1)

A method for treating purulent-inflammatory diseases of the soft tissues of the maxillofacial region and neck, including treating the surgical field with betadine and 70% alcohol twice, opening the purulent focus, evacuating the purulent-serous contents and detritus, washing the wound with a 3% hydrogen peroxide solution, drying and draining the wound, characterized in that a mixture containing 3% lactic acid powder and ascorbic acid powder in a 1:1 ratio is applied to the wound, followed by the application of gauze dressings impregnated with the water-soluble ointment "Oflomelid", which are changed once every two days.