RU2775369C1 - Method for preventing the formation of cicatricial deformity of the wound edges during surgical interventions in patients with connective tissue dysplasia - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to surgery, and can be used to prevent the formation of cicatricial deformity of the wound edges during surgical interventions in patients with connective tissue dysplasia. At the time of suturing the wound, powder from the dried human dura mater is poured into it along the entire length of the incision at the rate of 1 gram of dry matter per 1 cm of the length of the sutured incision. On the 5th day after the operation, electrophoresis is prescribed with a 2.5% aqueous solution of potassium iodide and with a 2.5% aqueous solution of sodium bromide at the cathode and with 40 mg of an aqueous solution of chloropyramine at the anode. In this case, the cathode is made of two equal plates with an area of ​​at least 50 cm2, which are placed on both sides of the skin suture, and the anode, equal in area to the cathode, is placed on the surface opposite to the surface on which the suture is located. The current strength is 5 mA, the duration of treatment is 10 minutes daily for 12 days.

EFFECT: method provides prevention of formation of cicatricial deformity of the wound edges during surgical interventions in patients with connective tissue dysplasia due to a combination of physiotherapeutic and drug effects on the operation area.

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Description

The technical field to which the invention belongs

The invention relates to medicine, namely to surgery.

State of the art

Connective tissue dysplasia is a group of systemic connective tissue diseases caused by a violation of the development of connective tissue in the embryonic and postnatal periods and manifested by various pathological signs in one way or another associated with defects in fibrous structures and / or the basic substance of connective tissue. There are differentiated forms of connective tissue dysplasia (Ehlers-Danlos, Marfan, Stickler syndromes, osteogenesis imperfecta, etc.) - they are characterized by vivid clinical manifestations of hereditary syndromes; the schemes for managing these patients are well described, and undifferentiated forms of connective tissue dysplasia - their diagnosis requires additional methods studies due to the polymorphism of symptoms, there are no unified approaches to the management of these patients. The relevance of the problem of managing patients with signs of connective tissue dysplasia to date is due to the high frequency of visits to the doctor by children with disorders of various organs and systems against the background of external and internal (visceral) phenotypic signs of connective tissue dysplasia. The presence of connective tissue dysplasia in a child significantly worsens the prognosis of the course of concomitant chronic diseases (N.P. Shabalov, V.G. Arsentiev 2015). In connection with the foregoing, we have developed a method for preventing the formation of cicatricial deformity of the wound edges during surgical interventions in patients with connective tissue dysplasia.

Currently, there are several approaches to the management of patients with signs of connective tissue dysplasia:

- Known "Method of therapy of mitochondrial insufficiency in undifferentiated forms of connective tissue dysplasia in children" (RF patent for the invention No. 2379038 dated 27.11.2007). The authors propose to treat mitochondrial insufficiency with energotropic drugs, namely, phased treatment with a complex of drugs Riboxin, Limontar, Kudesan - for 1.5 months with Oligovit, Elkar, Magnerot - for 1.5 months and Preductal - MB - for 3 months , once a year.

- Known "Method of treating pregnant women with undifferentiated connective tissue dysplasia" (RF patent for the invention No. 2333018 of 04/06/2007). The authors propose to carry out physiotherapeutic treatment with a low-frequency running pulsed magnetic field with a magnetic induction power of 1.5 mT, a pulse repetition rate of 100 Hz, paravertebral at the level of C VII-ThV with paired solenoids of N-S polarity, the duration of the procedure is 15 minutes for 7-10 days against the background of intravenous drip injection of riboxin 1 time per day and infusion of hawthorn fruit 3 times a day for 10 days.

- Known "Method of correcting undifferentiated connective tissue dysplasia" (RF patent for invention No. 2290175 of 03.03.2005). The authors suggest that the patient take vitamin B6 and magnesium, while the patient daily takes additional vitamins A, E, C, D, B1, B2, B12, pantothenic acid, folic acid in combination with calcium, all vitamins and microelements are taken in doses not exceeding the daily needs of the body, for two to four weeks, the course of treatment is repeated at least 2 times a year.

All three methods of managing patients with various pathologies, combined with signs of connective tissue dysplasia, reflect modern views on the pathogenesis of undifferentiated connective tissue dysplasia.

As a prototype, we took the description of the method of wound treatment set forth in the RF patent for invention No. 2020898 dated 06/30/1992. The authors propose to use the replacement of wound defects with an implant, and as an implant, a preparation made from segments of filaments of the dura mater 1-10 mm long and 0.7-0.8 mm thick for 7-14 days is used (the "Biotex" preparation).

However, when using this method, the following disadvantages may arise:

1) the drug "Biotex" is not currently produced and obtaining segments of filaments of the dura mater 1-10 mm long and 0.7-0.8 mm thick is currently possible only by a handicraft method;

2) the authors do not indicate from which animals or humans the dura mater is taken;

3) it is possible to develop an allergic reaction to the introduction of a foreign protein.

Thus, it is necessary to develop a new method for preventing the formation of cicatricial deformity of the wound edges during surgical interventions in patients with connective tissue dysplasia. In the claimed method, the listed disadvantages are eliminated.

Disclosure of invention

The objective of the invention is to prevent the formation of cicatricial deformity of the wound edges during surgical interventions in patients with connective tissue dysplasia.

The technical result of the method is to reduce the risk of formation of cicatricial deformity of the wound edges during surgical interventions in patients with connective tissue dysplasia, due to the combined physiotherapeutic and drug effects on the surgical area.

Implementation of the invention. The claimed technical result can be achieved as follows:

1. Before the operation, a powder is prepared from the dried human dura mater - for example, the drug "Strip dura mater 1 × 1 cm LIO-92" by LyoPlast (https://lyoplast.com/catalog/product/poloska_tverdaya_mozgovaya_obolochka_1_kh_1_sm_lio_92/) or any another similar drug.

2. At the end of the operation, at the moment of suturing the wound, powder from the dried human dura mater is poured into it along the entire length of the incision at the rate of 1 gram of dry matter per 1 cm of the length of the incision to be sutured.

3. On the 5th day after the operation, electrophoresis is prescribed with a 2.5% aqueous solution of potassium iodide and with a 2.5% aqueous solution of sodium bromide on the cathode and with 40 mg of an aqueous solution of chloropyramine on the anode, while the cathode must be made of two equal plates with an area of at least 50 cm2, which are placed on both sides of the skin suture, and the anode is equal in area to the cathode on the surface opposite the surface on which the suture is located, and the current strength is 5 mA, the duration of treatment is 10 minutes daily for 12 days .

The novelty of the proposed method lies in the fact that:

- for the first time it is proposed to introduce into the postoperative wound allograft material containing collagen and microelements maximally tropic to the human connective tissue,

- during electrophoresis, iodine and bromine ions soften the emerging scar and reduce the risk of developing keloid deformation of the wound edges,

- the introduction of chloropyramine reduces the risk of an allergic reaction and suppresses the inflammatory process in the area of the postoperative wound, reduces itching.

Distinctive features of the method:

- at the time of suturing the wound, powder from the dried human dura mater is poured into it along the entire length of the incision at the rate of 1 gram of dry matter per 1 cm of the length of the sutured incision,

- on the 5th day after the operation, electrophoresis is prescribed with a 2.5% aqueous solution of potassium iodide and with a 2.5% aqueous solution of sodium bromide on the cathode and with 40 mg of an aqueous solution of chloropyramine on the anode

- the cathode is made of two equal plates with an area of at least 50 cm2, which are placed on both sides of the skin suture, and the anode, equal in area to the cathode, is placed on the surface opposite to the surface on which the suture is located,

- the current strength is 5 mA, the duration of treatment is 10 minutes daily for 12 days.

The proposed method is illustrated by the following examples.

Clinical example No. 1.

Patient A., aged 29, was admitted to the emergency department with a stab wound to the left shoulder. Upon admission, external stigmas of dysembryogenesis, characteristic of connective tissue dysplasia, were detected; an ultrasound examination of the heart revealed a chorda of the left atrium. The presence of undifferentiated connective tissue dysplasia is suspected. The operation was performed on the day of admission. During the operation, powder from the dried human dura mater, obtained by grinding 25 cm2 of the LIO preparation, was introduced into the wound. On the 5th day after the operation, electrophoresis was prescribed according to the proposed scheme for 12 days. When re-examined 6 months after discharge from the hospital, the condition of the postoperative scar is good, there are no signs of the development of a keloid scar, there is no compaction of soft tissues in the surgical area. The prognosis is favorable.

Clinical example No. 2.

Patient B, 31 years old, was admitted to the emergency department with signs of a stab wound to the soft tissues of the left thigh. Upon admission, phenotypic stigmas of dysembryogenesis and the presence of flat feet were revealed; ultrasound examination revealed a functional inflection of the gallbladder neck. The presence of undifferentiated connective tissue dysplasia is suspected. The operation was performed on the day of admission. Protocol treatment. When re-examined 6 months after discharge from the hospital, the condition of the postoperative scar is unsatisfactory, there are areas of divergence of the skin suture with the replacement of the defect with scar tissue, there are signs of the development of a keloid scar, there is compaction of soft tissues in the surgical area. The prognosis is unfavorable. Anti-scar therapy was prescribed. With further development of a cosmetic defect, surgical excision of the scar is recommended.

Claims (1)

A method for preventing the formation of cicatricial deformity of the edges of the wound during surgical interventions in patients with connective tissue dysplasia, which consists in the combined physiotherapeutic and drug effects on the area of operation, characterized in that at the time of suturing the wound, powder from the dried dura mater is poured into it along the entire length of the incision a person at the rate of 1 gram of dry matter per 1 cm of the length of the sutured incision, then on the 5th day after the operation, electrophoresis is prescribed with a 2.5% aqueous solution of potassium iodide and with a 2.5% aqueous solution of sodium bromide on the cathode and with 40 mg of an aqueous solution chloropyramine on the anode, while the cathode is made of two equal plates with an area of at least 50 cm ² , which are placed on both sides of the skin suture, and the anode, equal to the cathode in area, is placed on the surface opposite to the surface on which the suture is located, the force current is 5 mA, the duration of treatment is 10 minutes daily for 12 days.