RU2236856C1 - Method for stimulating wound reparation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: the present innovation deals with stimulating reparation of wounds healing due to primary tension. Wound should be sutured in. One should perform layer-by-layer drainage of subcutaneous, intermuscular and subaponeurotic layers of wound along carrying out constant aspiration of wound secreta and its cytological investigation. In the course of reparation phase characterized by prevailed population of fibroblasts one should introduce cryoprecipitate solution into the wound along the drainage at simultaneous removal of drainage tube.

EFFECT: higher efficiency of wound reparation stimulation.

1 ex

Description

The invention relates to medicine, namely to surgery, and can be used in plastic, abdominal surgery, herniology, where it is necessary to create a durable connective tissue scar.

Known methods of indirect stimulating effects on the phase of repair of the wound process, which include the use of metabolites, immunocorrections, biogenic stimulants, vitamin preparations and direct (direct) stimulating effects: defocused laser irradiation, ozone therapy, electrical stimulation, possible in an open wound healing by secondary intention [1-7]. The direct stimulating effect on the repair of a wound healing by primary intention, taking into account its morphological substrate, is a gap in surgery.

It is known to use a method for stopping bleeding from parenchymal organs and sealing surgical sutures, including the application of a drug, which includes cryoprecipitate, gentamicin sulfate, verografin, glutaraldehyde and gelatin [9].

However, this method cannot be used to stimulate repair in a postoperative wound.

The objective of the invention: the creation of a durable, uniform, complete and adapted to the specific wound conditions of the connective tissue scar.

The problem is solved by layered drainage of the wound; morphological substrate research; correction of the phase of inflammation (stimulation or inhibition); implantation into the wound through the drainage of a solution of cryoprecipitate in the repair phase.

The features of the proposed method are not identified in any of the sources of scientific, technical and patent literature, i.e. the invention meets the criterion of “novelty”.

The inventive step is confirmed by the fact that cryoprecipitate is used, as a rule, to stop bleeding, because an important role in the wound process is played by coagulation factors. Fibrinogen is a universal inflammation protein that does not have antigenic specificity. Possessing a high sorption ability ensuring its antitoxic properties, the latter, on the one hand, creates a matrix basis for the activity of fibroblasts, on the other hand, stimulates their activity [8]. Healing slows significantly with a deficiency of factor VIII, which is associated with impaired formation of fibrinogen and fibrin. With factor XIII deficiency, weak proliferation of fibroblasts is observed. It was established that the activity of the latter in wound tissues to a certain extent reflects the nature of the reparative process [7]. These components of the blood coagulation system are part of the preparation “Cryoprecipitate”. Based on the ideas about the staged nature of the wound process, a specific cellular substrate is inherent in each phase. The transition of the proliferative stage of inflammation to the repair phase, observed on days 5-7, for wounds healing by primary intention, is characterized by a predominance of a population of fibroblasts that perform a scar-forming function. The influence of certain factors of blood coagulation on the proliferation and collagen-forming function of fibroblasts has been established, which allows us to conclude that the use of cryptrecipitate has a positive effect on the formation of a strong connective tissue scar.

The method is as follows. Carry out layer-by-layer drainage of the wound (subcutaneous, intramuscular, subaponeurotic layers) with tubular drains removed through contrapertures with constant aspiration of the wound discharge and its cytological examination on days 3, 5, 7. When prolonging the phase of inflammation, attaching an infection, flow-aspiration drainage with antiseptic solutions is carried out, direct or indirect electrochemical stimulation. In the repair phase (6-7 days), under sterile conditions, a cryoprecipitate solution is introduced into the wound to drain the deep (subaponeurotic, intramuscular) layers while the drainage tube is removed. In this case, the administered drug is distributed evenly until the wound volume is completely filled. The result of using this method is an earlier onset of the phases of organization and remodeling of connective tissue.

Example.

Twenty-three chinchilla rabbits under sterile conditions underwent transrectal laparotomy in the mesogastric region with removal of a 1 cm ² section of the rectus abdominis muscle, suturing of the peritoneum and anterior wall of the rectus sheath. The deep layers of the wound (between the leaves of the opened sheaths of the rectus muscles) were drained with a thin (up to 1 mm in diameter) tubular polyvinylchloride drainage, brought out through the counter-hole. On the 7th day of the postoperative period, in the repair phase, 16 rabbits were implanted with 1 ml of cryoprecipitate solution, which was prepared from the blood of three rabbits of the same breed. The animals were withdrawn from the experiment in 4 groups: 6 individuals on the 7th day (4 - in the experimental group, 2 - in the control group); 6 - on the 14th day (4 - experimental, 2 - control); 5 - on 21 days (4 - experimental, 1 - control); 6 - on the 31st day (4 - experimental, 2 - control).

The material was taken by excision of the intervention zone together with the surrounding tissues after a macroscopic assessment of its density and uniformity. A histological examination of serial and step sections was performed. Sections were stained with hematoxylin and eosin, picrofuxin according to Van Gieson. To assess the histochemical composition of the intercellular matrix, a SIC reaction was performed; impregnation with silver nitrate according to Danilin was used to identify argyrophilic fibers.

Histological studies of the area of the emerging scar revealed a number of significant features of reparative processes when using cryoprecipitate in comparison with the control group. The main and fundamental difference was the earlier (by 10-15 days) onset of the phases of organization and remodeling of connective tissue, the creation of the anatomical integrity of the aponeurotic regenerate. After one month, the scar had the structure of a dense fibrous connective tissue, slightly different from its own fascia and aponeurosis. In the control series, morphological changes indicated a different nature of the reparative processes, resulting in the formation of a coarser, structurally less ordered scar, which combined areas of a dense and unformed, loose fibrous structure, and the inclusion of adipose tissue. This leads to the conclusion about the optimal nature of the repair of fascial and aponeurotic structures with the establishment of their anatomical integrity and continuity under the conditions of cryoprecipitate administration.

Thus, the task can be achieved due to the fact that it is performed: multilayer wound drainage with regular cytological monitoring of the aspirate, with prolonged inflammation - flow-aspiration drainage, direct or indirect electrochemical stimulation; in the repair phase, implantation of a solution of cryoprecipitate in the deep layers of the wound.

Sources of information

1. Adamyan A.A., Gogia B.Sh., Muradyan R.G. Electrostimulation in the treatment of wounds // Surgery. - 1998. - No. 1. - S. 57-59.

2. Galimov O. V., Muslimov S. A., Khanov V. O., Shumkin A. M. Method of use ″ Regeneration stimulator ″ in the surgical treatment of postoperative ventral hernias // Annals of surgery. - 2000. - No. 4. - S. 61-63.

3. Gostishchev V.K. Purulent operative surgery. - M.: Medicine, 1996 .-- 416 p.

4. Davydov Yu.A., Malafeeva E.V., Mikhailov V.P., Kostyuchenko K.V. Postoperative purulent complications and the immune status of the body during surgical treatment of colon cancer // Surgery. - 1994. - No. 11. - S. 35-37.

5. Devyatov V.A., Petrov S.V. Microbial contamination of wounds and prevention of purulent complications // Surgery. - 1992. - No. 7-8. - S. 70-74.

6. Zhebrovsky V.V. Early and late postoperative complications in surgery of abdominal organs // Publishing Center of KSMU, 2000. - 688 p.

7. Kuzin M.I., Kostyuchonok B.M. Wounds and wound infection (second edition). - M .: Medicine, 1990 .-- 591 p.

8. Myasnikov A.D., Kolesnikov S.A. The concept of autogernioplasty in the treatment of external abdominal hernias // Annals of surgery. - 2000. - No. 4. - S. 46-52.

9. RF patent No. 2026671, A 61 K 31/00, 1995

Claims (1)

A method of stimulating the repair of wounds healing by first intention, including suturing the wound, characterized in that they carry out layer-by-layer drainage of the subcutaneous, intramuscular and subaponeurotic layers of the wound, with constant aspiration of the wound discharge, its cytological examination, and in the repair phase, characterized by a predominance of fibroblast population a solution of cryoprecipitate is introduced into the wound drainage, while the drainage tube is removed.