Local Wound Treatment Research Articles

Vivostat Platelet-Rich Fibrin® for Complicated or Chronic Wounds-A Pilot Study.

Vivostat Platelet-Rich Fibrin® (PRF) is an autologous platelet concentrate used for the local treatment of chronic or complicated wounds. Still, its application for this indication is not evidence-based. Therefore, we performed this monocentric retrospective pilot study investigating the clinical outcome of a local treatment of chronic or complicated wounds in 35 patients (23 male, 12 female, mean age 68.7 years) treated with Vivostat PRF®. This study population is the largest among published studies analyzing the clinical efficacy of Vivostat PRF® on chronic wounds so far. Using the perpendicular method we divided the wounds into three sizes (<10, 10–30, and >30 cm2). The clinical efficacy of the Vivostat PRF treatment was the primary endpoint and was divided into three groups of increasing degrees of wound improvement: (1) no improvement of the wound (wound area was not reduced > 10% under Vivostat PRF® treatment), (2) improvement of the wound (reduced area > 10% under Vivostat PRF® treatment) and (3) complete epithelialization (wounds that were completely re-epithelialized after Vivostat PRF® treatment). We included patients’ diagnosis and concomitant diseases (peripheral arterial occlusive disease (PAOD)), chronic venous insufficiency (CVI)), diabetic foot syndrome (DFS)) in our data analysis in order to investigate their potential impact on the wound healing capacity of Vivostat PRF®. Our results show that in the entire study population, 13 out of 35 (37.1%) patients experienced wound improvement and 14 out of 35 (40%) patients showed complete epithelialization of their wound under Vivostat PRF® treatment. In summary, 77.1% of the treated patients benefited from the Vivostat PRF® therapy. These positive wound healing effects were all observed within the first three to six Vivostat PRF® applications. Subgroup analyses showed that Vivostat PRF® appeared to be more efficient in patients without CVI in comparison to patients with CVI (p = 0.02). Moreover, Vivostat PRF® treatment seems to be particularly efficient in PAOD-related wounds with a reduced crural arterial blood supply (p = 0.01). Additionally, we performed an experimental human in vivo study on ten male students where we artificially generated bilateral gluteal wounds and analyzed the influence of the Vivostat PRF® treatment on the expression of two genes (human beta Defensin-2, ((hBD-2) and human beta-Defensin-3 (hBD-3)) in keratinocytes of resected wound specimens that are induced during wound healing. Interestingly, this analysis revealed that only seven of out ten individuals showed a relevant hBD-2 and hBD-3 gene induction after Vivostat PRF® treatment. This led to the novel “key-lock-hypothesis”. With the goal of an individualized precision medicine approach with optimized wound treatment strategies in the future, this is an important observation that demands further experimental and clinical studies.

Possibilities of using allogeneic mesenchymal stem cells and wound dressings based on aliphatic copolyamide in microautodermoplasty

Background. The treatment of victims with wound defects is an urgent problem of clinical medicine that doctors of various specialties, mainly surgeons and traumatologists, must face. Regardless of the etiology of the traumatic agent, the wound process is always subjected to fundamental pathophysiological processes. Despite the advances made by medical science in the local treatment of wounds (cell technology, modern wound coverings, and others), surgical procedures remain the main methods, and the search for new techniques to optimize reparative regeneration continues. This ongoing search indicates the absence of a universal algorithm for treating such defects. This lack of a universal treatment algorithm is of particular importance for assisting victims with extensive defects, which often leads to a shortage of donor resources.&#x0D; Aim. The aim of this study was to increase the efficiency of microautodermoplasty due to the use of allogeneic mesenchymal stem cells and wound dressings based on aliphatic copolyamide.&#x0D; Materials and methods. This paper presents the results of an experimental study involving 50 rats. All animals were divided into groups considering the choice of the method of the local treatment. The experimental wound was modeled according to its original technique. The evaluation of the effectiveness of the analyzed methods was performed using planimetric and histological research methods, and by calculating the healing index.&#x0D; Results. The most effective methods for treating experimental wounds using microautodermoplasty (MADP) are wound dressings based on aliphatic copolyamide (CoPA) and adipogenic mesenchymal stem cells (AMSC). By 28 days of treatment after performing MADP + CoPA wound dressings + AMSC, it was possible to reduce the defect area by 16 times compared with the control, and the healing index was the maximum value among all methods 12.5 units. The high regenerative potential was also confirmed by the results of the histological examination. The worst results were found in the MADP group with AMSK that did not cover the wounds with skin or wound dressing.&#x0D; Conclusion. The introduction of the analyzed methods into clinical practice will improve the results of treatment of patients with wound defects of various etiologies.

PRESCRIPTION PATTERN AND USAGE OF ANTIMICROBIAL AGENTS FOR TREATING DIABETIC FOOT INFECTIONS AT TERTIARY CARE CENTRE

Objective: Due to the uncertainty about optimal antibiotic treatment, and probably substantial variation in practice, the present study was carried out to determine the bacterial profiles of infected diabetic foot ulcers (DFUs) and also to analyze the prescribing pattern of antibiotics used.&#x0D; Methods: A prospective observational study was carried out in the department of General surgery at a tertiary care teaching hospital, Mangalore. Demographic details and treatment data of 78 patients were collected in a specially designed Proforma, and the data were analyzed using Microsoft Excel.&#x0D; Results: According to Meggit-Wagner's classification, patients admitted with DFUs predominantly belonged to WAGNER 1 category (36%), followed by WAGNER 4 (26%) and WAGNER 2 (22%) categories. Out of 66 culture-positive specimens, 21 (31.8%) had monomicrobial flora, and 45 (68.2%) had polymicrobial flora. A total of 148 organisms were obtained from the specimens. The most common isolates were Staphylococcus aureus (22.3%) and Pseudomonas aeruginosa (17.5%). Ceftriaxone was the most commonly prescribed empirical antibiotic (29%), followed by linezolid (20%), piperacillin-tazobactam (20%), amoxicillin-clavulanic acid (13%), cefoperazone-sulbactam (11%). After the culture and sensitivity (C/S) results, antimicrobials were changed in 74.61% of patients in the preference of Linezolid (51%), Amikacin (27%), Levofloxacin (19%), Ciprofloxacin (17%), Piperacillin-tazobactam (13%), Cefixime (15%), Ceftriaxone (11%) among others. Clindamycin and metronidazole were used to cover anaerobic microorganisms.&#x0D; Conclusion: Most of the microorganisms isolated from DFUs were resistant to many types of antibiotics. Gram-positive organisms were largely sensitive to linezolid and vancomycin, while Gram-negative organisms to amikacin and imipenem. Local treatment of wounds is essential.

New methods of local medical treatment of purulent wounds

Purpose of the study. To study experimental model of purulent wounds efficiency of the combined effects of benzalkonium chloride and metronidazole immobilized on various bases.Materials and methods. The material was in vitro studies and experimental animals (Wistar rats), which was modeled a purulent wound and then divided into 3 groups according to the treatment method with the three studied combinations, each of which contained benzalkonium chloride and metronidazole, the combinations differed in bases, which were polyethylene oxide or sodium salt of carboxymethylcellulose, or polymethylsiloxane polyhydrate. Research methods: in an in vitro experiment, growth retardation zones were determined for the most common pathogens of wound infection using the standard disc method. In an in vivo experiment the healing process was evaluated by Popov's planimetric method, the contamination of the wounds was studied by sowing the biopsy of wounds on nutrient media with subsequent counting of the grown up colonies. The data were processed statistically, the reliability of the differences was assessed by the Kruskal-Wallis test.Results. All test combinations showed high growth retardation areas for all test strains of microorganisms. Objectively, the highest results were observed with a combination of polyethylene oxide (Staphylococcus aureus 30 (29; 30), Bacillus cereus 27 (27; 28), Escherichia coli 20.5 (20; 21), Proteus vulgaris 21.5 (20; 22), Pseudomonas aeruginosa 17 (16; 17), Candida albicans 25.5 (25; 26)). In determining the healing rate, it was noted that the maximum values in the groups when using combinations based on the sodium salt of carboxymethylcellulose and polymethylsiloxane polyhydrate occurred on day 1–3 (29.6 (27.6; 31) and 20.2 (18.8; 24.2) mm2/day, respectively), and in the group using a combination on polyethylene oxide — for 3–5 days (20.6 (17.3; 22.8) mm2/day).Conclusion. Our studies have shown the high antimicrobial activity of all the developed combinations for all the strains of microorganisms studied. It is also possible to recommend combinations on polyethylene oxide and sodium salt of carboxymethylcellulose for further preclinical studies at all times of treatment, and a combination based on polymethylsiloxane polyhydrate only in the first phase of the wound process.

Electrospun Composite Nanofibrous Materials Based on (Poly)-Phenol-Polysaccharide Formulations for Potential Wound Treatment.

In this paper, we focus on the preparation of electrospun composite nanofibrous materials based on (poly)-phenol-polysaccharide formulation. The prepared composite nanofibres are ideally suited as a controlled drug delivery system, especially for local treatment of different wounds, owing to their high surface and volume porosity and small fibre diameter. To evaluate the formulations, catechin and resveratrol were used as antioxidants. Both substances were embedded into chitosan particles, and further subjected to electrospinning. Formulations were characterized by determination of the particle size, encapsulation efficiency, as well as antioxidant and antimicrobial properties. The electrospinning process was optimised through fine-tuning of the electrospinning solution and the electrospinning parameters. Scanning electron microscopy was used to evaluate the (nano)fibrous structure, while the successful incorporation of bio substances was assessed by X-ray Photoelectron Spectroscopy and Fourier transform infrared spectroscopy. The bioactive properties of the formed nanofibre -mats were evaluated by measuring the antioxidative efficiency and antimicrobial properties, followed by in vitro substance release tests. The prepared materials are bioactive, have antimicrobial and antioxidative properties and at the same time allow the release of the incorporated substances, which assures a promising use in medical applications, especially in wound care.

Clinical evaluation of polyabsorbent TLC-NOSF dressings on chronic wounds: a prospective, observational, multicentre study of 1140 patients.

The superior wound healing properties and cost-effectiveness of TLC-NOSF dressings in the local treatment of chronic wounds have already been demonstrated by several randomised controlled trials (RCTs) at a high quality level. Therefore, this study aimed to evaluate the efficacy and safety of new TLC-NOSF dressings with polyabsorbent fibres in an unselected population of patients under real-life conditions. A large, prospective, multicentre, observational study with two polyabsorbent TLC-NOSF dressings (UrgoStart Plus Pad and UrgoStart Plus Border, Laboratoires Urgo, France) was conducted in Germany between July 2017 and December 2018. Main outcomes included wound healing rate, clinical assessment of wound healing progression, local tolerability and acceptance of dressings. A total of 1140 patients with chronic wounds of various aetiologies (leg ulcers, diabetic foot ulcers, pressure ulcers, etc.) were treated with the investigated dressings in 130 centres, for a mean duration of 56±34 days. By the final visit, 48.5% of wounds had healed and 44.8% had improved. Similar results were reported regardless of wound aetiology or regardless of proportions of sloughy and granulation tissue at the start of treatment. According to the subgroup analysis by wound duration, the sooner the TLC-NOSF treatment was initiated, the better the clinical outcomes for all types of wounds. The dressings were very well tolerated and accepted by the patients. These results are consistent with those from RCTs conducted on TLC-NOSF dressings. They complete the evidence on the good healing properties and safety profile of these dressings, especially in non-selected patients treated in current practice, and regardless of the characteristics of wounds and patients. They support the use of the dressings as a first-line intervention and until wound healing in the management of chronic wounds, in association with appropriate standard of care.

Sociodemographic profile and treatment seeking behaviour of animal bite patients attending the anti-rabies clinic at Patiala, Punjab

Background: Rabies is an acute fatal viral disease. It can be prevented by eliminating exposures to rabid animals or by providing exposed persons prompt post exposure prophylaxis consist of local treatment of wounds in combination with appropriate administration of rabies immunoglobulin and vaccine. Aims and objectives were to study the sociodemographic profile of patients attending anti-rabies vaccination clinic and to study the treatment seeking behaviour and wound cleaning practices among them.Methods: This was a cross sectional study conducted among 150 randomly selected animal bite patients attended Anti Rabies Clinic, Department of Community Medicine G.M.C. Patiala from 1 November 2018 to 31 February 2019. Data collected and statistical analysis was done using epi info7.Results: Most of the patients were male 101 (67.34%). Out of 150 animal bite cases, majority of them were bitten by street dogs 135 (90%). It was found that 122 (81.34%) were category III bite, 26 (17.34 %) were category II bites and 2 (1.34%) were category I bite. Only 92 (61.34%) patients washed wound with water and soap. About 21 (14%) patients applied chilies or turmeric or oil on their wound.Conclusions: Majority of cases had bitten by dogs. Patients were less aware regarding proper wound care and seeking early treatment.

The experience of polyhexanide usage as a part of wet environment in the treatment of limited burns

INTRODUCTION. The results of the treatment of patients with restrictive burns I-II degrees are presented in the article. The OBJECTIVE of the research was to establish the efficiency of the usage of polyhexanide included in wet environment in the treatment of burns I-II degrees. METHODS AND MATERIALS. The research was conducted in 2 groups of patients. In the first group (N=33), local treatment of hand wounds was performed in condition of wet environment created by isotonic solution of sodium chloride, in the second group (N=18) - with usage of polyhexanide as antiseptic and isotonic chloride saline solution. For evaluation of efficiency of the treatment, we studied the terms of the beginning of epithelialization of the wound surface, pain syndrome severity, microcirculation and conducted microbiological research of wound exudate. RESULTS. The appearance of the first signs of wound epithelialization after the beginnings of treatment was observed in 1.5 times in average sooner in the second group than in the first group. Pain syndrome was jugulated by the 3rd day in the first (research) group in 19 % of cases, in the second (control) group - in 46 % (p&lt;0.05). In the second group, perfusion of tissues in the border area reduced, in the same time in the first group, it remained unchanged. The number of swabbing cases with Staphylococcus aureus, Staphylococcus epidermidis, Klebsiella pneumoniae and Enterococcus faecalis increased in the first group by the 3rd day in contrast with the second group, where such cases was not noted or occurred significantly less often. CONCLUSION. The usage of polyhexanide as a part of wet environment promotes the reduction of wound surface swabbing level that allows to speed up the appearance of the first signs of wound epithelialization, reduces the severity of pain syndrome, and modeling of tissue microcirculation in periwound area.

The effect of nanoscale biodegradable polymer film on the healing of cut wounds of the skin of complicated Psevdomonas auregenosa (Experimental research)

Introduction. Effect of the biodegradable polymer film saturated with zinc nanoxide and hydrated C60 fullerene on the healing of skin cut wounds complicated Pseudomonas aeruginosa are study.&#x0D; Materials and methods. The studies were performed on 35 Guinea pigs in vivarium of IvanoFrankivsk National Medical University.&#x0D; The animals were divided into three groups: group I (10 animals) the wounds were treated without the use of films; group II (10 animals) – the covering material for Curasorb Zn wounds was used; group III (10 animals) –the biodegradable polymer film with C60 fullerene and zinc nanoxide (nZnO – particle size of 30 nm) was used.&#x0D; The simulated skin cut wounds were infected with Pseudomonas aeruginosa and investigated wound healed at 3, 7, 14 and 21 days using a Curasorb Zn film and a biodegradable polymer film with C60 fullerene and zinc nanoxide. The area of the wounds was measured, the microbiological examination of the wound content and pathomorphological evaluation of the wound tissues.&#x0D; Results. Wounds area in animals of group II to the 3-rd day increased slightly by 8,9 mm2, and wounds area animals of group III decreased by 44,8 mm2, indicating the therapeutic effect and sorption capacity of the film from the first days of treatment.&#x0D; Curasorb Zn films reduced the bacterial pathogen by two orders and the nanooxide film reduced the bacterial level to non-pathogenic levels of magnitude by 3 orders of magnitude by day 3. The bacterial level remained high in the film-free group (group I).&#x0D; Conclusion. The polymer film saturated with zinc nanooxide and hydrated C60 fullerene has a high local wound healing effect, antimicrobial activity, which improves the effectiveness of local treatment of purulent wounds and reduce the healing time.

JUSTIFICATION OF THE EFFECTIVENESS OF THE USE OF DALMAXIN RECTAL SUPPOSITORIES (THIOTRIAZOLIN) IN THE COMPLEX TREATMENT OF ACUTE PARAPROCTITIS

Summary. The problem of treatment of acute purulent paraproctitis is one of the most urgent problems of modern coloproctology.&#x0D; Study objective. To evaluate the effectiveness of the use of Dalmaxin rectal suppositories in the complex treatment of acute paraproctitis.&#x0D; Materials and methods. The effectiveness of use of Dalmaxin rectal suppositories was conducted in 62 patients with acute subcutaneous paraproctitis, assigned to two groups, a main group of 30 patients and a comparison group of 32 patients. All patients underwent radical surgery. Antimicrobial, detoxification and symptomatic therapy was prescribed postoperatively. Local treatment of purulent wounds was carried out using hydrophilic ointments depending on the phase of the wound process; the patients of the main group were additionally administered Dalmaxin rectal suppositories twice a day. The effectiveness of the treatment was evaluated by the severity of the swelling, the nature of the discharge from the wound, the level of microbial contamination, the wound cleansing period, the appearance of granulation tissue and epithelialization, and by cytological examination. Furthermore, general laboratory and biochemical studies were performed. Endogenous intoxication (EI) and its changes in the course of treatment were evaluated by the level of average-mass molecules, leukocyte intoxication index and hematological intoxication index. Statistical processing and comparison of the obtained data was performed using the STATISTICA® 5.5 integrated system (STATSOFT® Inc., USA), license A XX 910A374605FA.&#x0D; Results. The study showed that in patients with acute paraproctitis, the severity of the postoperative period is due to the severe intoxication and the development of a systemic inflammatory response syndrome that were observed in patients at the time of hospitalization. After surgical intervention, clinical and laboratory parameters did not normalize in the first five days of the postoperative period, and only starting from the fifth day, there was a gradual decrease in the level of EI and laboratory indicators, reaching the normal ones only at the time of discharge from the hospital. EI complicates the course of the postoperative period, primarily by weakening the level of humoral immunity and inhibiting the processes of reparative regeneration. When comparing the results of treatment of acute paraproctitis in patients using Dalmaxin rectal suppositories with traditional methods. The hospitalization period of the patients of the main group was also shorter than in the comparison group, and was (9.2 ± 0.5) and (11.9 ± 0.9) bed days, respectively.&#x0D; Conclusions. A comparative evaluation of the use of Dalmaxin in the complex treatment of acute purulent paraproctitis showed that the drug, due to its properties, significantly improves the course of the postoperative period, as evidenced by faster reduction of endogenous intoxication, reduction of microbial contamination and wound cleansing from necrotic tissues, faster granulation and epithelialization, as well as wound healing, thus helping to reduce the time of hospitalization.

ТЕХНОЛОГИЧЕСКИЙ ТРАВМАТИЗМ В ПРОМЫШЛЕННОМ СВИНОВОДСТВЕ

Industrial injuries in pig farms of closed type are a very common pathology. Howev-er, nowadays, injury prevention and treat-ment of sick animals in the conditions of industrial pig breeding complex do not bring good results and require improvements. Ac-cording to the literature, there is no infor-mation about the results of the use of oint-ments and immuno- stimulators in the treat-ment of pigs with bitten wounds of the ears, tails and other parts of the body. In this re-gard, we have set a goal to develop therapeu-tic measures for injuries of piglets in a pig breeding complex of a closed type. We ana-lyzed the prevalence of industrial injuries in pigs. During the clinical examination, we studied the specific structures of injuries. The main cause of pigs injuries in industrial farming is cannibalism. In 28 days, 60% of pigs in the second experimental group, showed complete cicatrization of the wound, and 40% of animals showed this process regenerated on 85-95%, meanwhile 2 days they also had complete scarring of the wound. In 28 days, 50% of pigs of the third experimental group had a complete cicatriza-tion of the wound, and for 50% were ob-served scarring of the wound by 75-85%, and only after 4 days they demonstrated the complete scaring of the defect. For the treatment of bitten wounds as a result of developing cannibalism, it is recommended, to use local treatment of wounds with chlor-hexidine solution and argosulfan ointment daily 2 times a day and also to use the im-munostimulator “Ferrovir” in a dose of 1.0 ml/m2 per week. Such scheme of treatment of bitten wounds gives the best therapeutic effect.

Staged approach in the treatment of patients with enterocutaneous fistulae

To determine an optimal approach in the treatment of patients with intestinal fistulae. We have used the above-mentioned algorithm in the treatment of 46 patients. The majority of patients (n=44, 96%) were transferred under supervision of our multidisciplinary team with severe water-electrolyte disturbances and signs of secondary protein-energy malnutrition (PEM) that required complex combined nutritional support. A two-stage approach was applied in all cases. The first one was conservative and included correction and prevention of infectious complications, nutritional and metabolic therapy, local wound treatment, and anatomical assessment of the fistula. The second stage was reconstructive and implied various reconstructive interventions not earlier than 3 months after formation of the fistula. Conservative approach was followed by fistula healing in 6 patients, surgery was required in 25 patients. Complications with subsequent redo surgery occurred in 4 cases. In all cases, favorable outcome was noted. All 25 patients were discharged. Three patients refused reconstructive surgery after development of fistula, they were also discharged. Mortality rate was 26% (n=12). A multidisciplinary two-stage approach can significantly improve treatment outcomes in patients with intestinal fistulae.

Ways of limbs salvage in postoperative period of treatment of complications of diabetic foot syndrome

The article deals with the use of a genetically engineered drug for stimulation of angiogenesis as a component of combined treatment of complications of ischaemic form of diabetic foot syndrome, showing comparative results of using therapeutic angiogenesis in patients in whom it was impossible to perform operative revascularization of the affected extremity, also providing a detailed description of the methodology of combined treatment of pyonecrotic complications of diabetic foot syndrome. The study included a total of 62 patients with pyonecrotic complications of Wagner grade III-IV diabetic foot syndrome. The patients were divided into two groups. Group One patients after minor amputation on the foot were assigned to receive conventional basic therapy and topical treatment of the foot wound with antiseptics and modern dressings. Group Two patients, besides basic therapy, additionally received combined treatment which was carried out in two stages and included urokinase, sulodexide, and a venotonic agent. Local treatment of the foot wound was performed with the help of two-stage vacuum therapy. Both groups were further subdivided into subgroups A and B. The patients in subgroups B of both groups in order to prevent progression of limb ischaemia were additionally given Neovasculgen, a genetically engineered drug for stimulation of angiogenesis. The patients of subgroups A of both groups did not receive this drug. The immediate results were assessed on the 1st, 7th and 14th days of treatment by the dynamics of changes in subjective symptoms, cytograms of the wound surface, level of partial pressure of oxygen in capillary blood of foot tissues, and the necessity to perform repeated necrectomy. The remote results were evaluated by the dynamics of changes in the pain-free walking distance, maximum distance walked, ankle-brachial index, linear velocity of blood flow through tibial arteries and partial pressure of oxygen in capillary blood of the affected limb at the 6th, 12th and 36th months after the performed treatment, as well as by the limb salvage and patients' survival during 3 years.

Complex treatment of patients with pyo-necrotic complications of the neuropathic form of diabetic foot syndrome

Of study is improving the results of treatment of patients with pyo-necrotic complications of diabetic foot syndrome by including the method of negative pressure wound treatment in the complex treatment program in combination with using of the combined antibacterial drug Cifran ST and immunocorrective therapy. The results of examination and treatment of 184 patients with pyo-necrotic complications of the neuropathic form of diabetic foot syndrome were analyzed. According to choice of treatment methods in the postoperative period all patients were divided into two groups. In 95 patients (group I), iodine-containing ointments based on polyethylene glycol were used for local treatment of purulent foot wounds and standard systemic antibacterial therapy was performed. In 89 patients (group II), negative pressure wound treatment (NPWT) was used to treat wounds in the postoperative period. In addition to standard parenteral antimicrobial therapy, these patients also received an oral combined antibacterial drug Cifran ST and immunocorrective cytokine therapy (Leukinferon). The analysis of the dynamics of the wound process was carried out based on the clinical picture and the results of cytological, bacteriological and immunological studies of the wound exudate. The presented strategy of complex treatment of pyo-necrotic complications of the neuropathic form of diabetic foot syndrome allowed group II patients to significantly reduce the degree of microbial contamination of wounds, to achieve a faster regression of the content of proinflammatory and inflammatory cytokines in the wound exudate, as well as to reduce the time of wound cleansing and the transition of the pyo-necrotic process to the reparative stage in comparison with group I patients. This allowed group II patients to reduce the time of plastic closure of the wound from 24.3±0.5 to 15.6±1.7 days, to avoid generalization of infection, death and high level amputation of the limb. At the same time, 11.6% of patients in group I had high level limb amputation due to generalization of infection. The mortality rate in group I was 5.3%. Adding of vacuum therapy of wounds, systemic antimicrobial therapy using the combined antibacterial drug Cifran ST and immunocorrective cytokine therapy in the complex treatment program for patients with neuropathic form of diabetic foot syndrome after radical surgical treatment of the pyo-necrotic lesion allows reducing the time of wound cleansing and the transition of the pyo-necrotic process to the reparative stage. On the other hand, this makes it possible for this category of patients to perform plastic closure of the wound at an earlier date, avoid generalization of infection and high level amputation of the limb.

Experience in using povidone-iodine to treat superficial and full-thickness burns

Thermal injuries are now ranked number one among injuries, and incidence of injury-related complications, especially infectious and purulent, does not decrease in surgical practice, despite the modern methods for treatment and prevention. Purulent complications depress the speed and quality of wound healing and increase the number of bed-days and treatment costs. Moreover, infection spreading complicates treatment and increases mortality and disability of patients with burn injuries. Choosing the most effective antiseptic agent for burn injuries is crutial both from the perspective of effective local treatment of wounds and wound complications and from the perspective of pharmacoeconomic aspects. At the current time, povidone iodine solution and ointment are one of the leading antiseptics used at all stages of care for burn patients. Its efficacy has been proven by clinical trials and many years’ experience of use by specialists and patients. We have also gained extensive positive experience in using this drug to treat 269 patients with burns of 5 to 35% total body surface area (TBSA) and various thickness without development of resistance and pain in patients and with a pronounced antiseptic effect during its use on the basis of City Clinical Hospital No. 2 of Stavropol, which once again proved high efficacy and feasibility of the widespread use of povidone-iodine in practice due to antimicrobial activity, high bioavailability, ease of use and economic benefits.

Oxygen Sorption Treatment in the Treatment of Soft Tissue Wounds

Background. The number of patients with soft tissue wounds does not tend to decrease, which is largely due to the growth of patients with injuries, ulcerative defects, skin tumors, comorbid pathology, including diabetes mellitus, antibiotic-resistant strains and other causes. New methods of local treatment of wounds based on the application of the latest achievements of science are constantly being introduced into the work of surgical departments. High efficiency is demonstrated by the use of sorbents and oxygen, which enhance the reparative processes in wounds.The aim of the study was to study in experimental conditions the effectiveness of the method of surgical treatment of soft tissue wounds, based on the use of jet oxygen sorption treatment (SCS).Materials and methods. The study was performed on 150 white Wistar rats in 5 groups of animals. In the 1st control group treatment was not carried out. In the 2nd and 3rd control groups, the wound surface was treated with a jet of air and oxygen, respectively; in the 4th control group, sorbent was applied to the wound surface. In the 1st experimental group conducted scso wound surface. The study of the effectiveness of SCS was carried out using objective, planimetric, histological and histochemical research methods. Results. The use of sorbent (4th control group) and the method of jet oxygen sorption treatment (1st main group) led to the most pronounced positive changes-acceleration of relief of the studied symptoms by 1.1-1.3 times and 1.2 1.5 times, respectively, compared with the data obtained in the 1st control group. Treatment of wounds with oxygen jet (3rd control group) had practically no advantages in comparison with treatment with air jet (2nd control group).Conclusion. Indirectly, the highest activity of reparative processes during the observation period in the 4th control and 1st main groups was confirmed by the average optical density of RNA and SH-groups, and their desire to normalize to 10 days could indicate the completion of processes of stratification in the wound area. In total, the average area of wounds was minimal in the 1st experimental group, where this figure was by the 3rd and 10th days-74.0% and 99.5% compared to the baseline data.

Effect of a nanodispersion silica composite with polyhexamethylene guanidine hydrochloride on immunological indicators and indicators of oxidation and antioxidant homeostasis in rats with thermal burn

Worldwide, nearly 6 million people annually seek medical attention for burn wounds. Today, the main method of local treatment of wounds and burns, including infected ones, is the use of medicines containing antiseptics, antibiotics, sorbents, as well as their combinations.Purpose. To determine the effect of a nanosized silica composite with polyhexamethylene guanidine hydrochloride on the immunological parameters and oxidative-antioxidant homeostasis in the blood and in the lesion of rats with an uninfected thermal burn.Materials and methods. The study was conducted on 72 rats, which were modeled by a thermal burn of the II degree. The animals were divided into 4 groups: intact, control, treated with chlorhexidine, treated with a composite of nanosized silica with polyhexamethylene guanidine hydrochloride. On the 7th, 14th, 21st and 28th day, the animals were removed from the experiment and the immunological parameters and the parameters of oxidative-antioxidant homeostasis in the blood and skin in the lesion were determined.Results. Thermal injury is directly related to biochemical changes in the body. We compared the levels of anti- and pro-inflammatory cytokines, markers of free radical oxidation - diene conjugate (DC), the active products of thiobarbituric acid (TBA-AP), the activity of catalase (Cat) and superoxide dismutase (SOD). It was proved that the NDK + PHMG-GC composite showed significantly more pronounced compared with chlorhexidine, a pharmacological effect in reducing the level of pro-inflammatory cytokines IL-1β and TNF-α and an increase in the content of IL-10 in the blood and the focus of thermal burn during the entire observation period . Also, the composite effectively affects oxidation-antioxidant homeostasis, which is manifested in the normalization of the content of DC and TBA-AP on the 14th day, restoration of Cat activity on the 14th day, SOD - already on the 7th day compared with chlorhexidine.Conclusions. The study indicates that the NDS + PHMG composite has pronounced anti-inflammatory and wound healing properties, which allows it to be used as a combined preparation for the treatment of thermal burns

МЕСТНОЕ ЛЕЧЕНИЕ ГНОЙНЫХ РАН ПРИ ГНОЙНО-ВОСПАЛИТЕЛЬНЫХ ЗАБОЛЕВАНИЯХ ЧЕЛЮСТНО-ЛИЦЕВОЙ ОБЛАСТИ У ДЕТЕЙ

Importance ― optimization of local treatment of purulent wounds in inflammatory diseases of the maxillofacial area in children.&#x0D; Objectives ― improving the effectiveness of local treatment of children with purulent-inflammatory diseases of the maxillofacial area.&#x0D; Methods. The study included 74 children who were treated for abscesses and phlegmon of the maxillofacial area in the Republican Clinical Hospital of Ufa. The patients were divided into 2 groups. The main group included 34 children with abscesses and phlegmon of the maxillofacial area. For treatment they used ointment with Furacilin, Lidocaine and Dibunolum. The control group included 40 patients. For their treatment used ointment Levomecol.&#x0D; Results. The course of the wound process in patients of both groups was accompanied by edema in the postoperative wound area. Edema was stopped 1.2 times faster in the main group (p&lt;0,01). In the main group, hyperemia persisted for up to 3 days. In the control group, hyperemia persisted at 3.9 ± 0.2 days. Normalization of temperature after surgery in the main group occurred one day earlier (at 4,3±0,8 day). Reduced pain in children in the main group was observed after 3 days. Normalization of blood counts in the main group was faster. The healing of the postoperative wound in the main group occurred by 7.7 ± 0.2 days, in the control group – at 8.8 ± 0.2 days (p&lt;0,01). The dynamics of the wound process in the main group was faster.&#x0D; Conclusions. Thus, the ointment based on Furacilin, Lidocaine and Dibunolum provides a prolonged effect of drugs, prevents side effects, creates a high concentration of the drug in the short term, possesses osmotic activity, improves the drainage conditions of the wound, leads to anti-inflammatory, antimicrobial, anesthetic action. The ointment is convenient and hygienic to use.

Local treatment of burn wounds in animals using a new nanocomponent ointment

We have developed an ointment preparation consisting of silver and zinc oxide nanoparticles, which form the basis of the nanocomposition. This drug can reduce the healing time of the wound surface due to the inclusion of nanodispersed particles in the composition. Application of nanoparticles allows to reduce inflammatory process, to carry out disinfecting treatment of a wound surface from pathogenic microorganisms, and accordingly to create optimum conditions for reparative process. Nanocomposite preparation has many advantages over existing analogues without irritating and allergic effects. Due to the high adsorption capacity, it allows to accelerate the healing process of the damaged surface of the skin. Initial studies were conducted on laboratory rats at the age of 6 months with a close mass that was up to 250 g in accordance with international requirements for the use of laboratory animals. As a result of the experiment, a new ointment preparation based on silver and zinc oxide nanoparticles, which are active components of the nanocomposition, was obtained. The use of these components allowed to accelerate the process of reparative restoration of the skin with full recovery of the studied animals. As shown by the experience, the recovery rate on average accelerated by seven days, compared with similar drugs available on the pharmaceutical market.

Modified photodynamic therapy of purulent wounds (experimental study)

Introduction. The widespread use of antibiotics that have a mutagenic effect on the microflora causes a change in the etiological structure of purulent infection, as well as the biological properties of the microbial cell with the appearance of antibiotic-resistant strains of microorganisms. The consequence of this was a decrease in the effectiveness of antibiotic therapy, traditionally prescribed local treatment of wounds and amid growing allergization of the population. One of the promising methods of combating the antibiotic resistance of microorganisms is antimicrobial photodynamic therapy. Purpose. An experimental study is devoted to studying the results of the treatment of purulent wounds in the first phase of the wound process using modified photodynamic therapy depending on the species of the pathogen. Materials and methods. The study was conducted on 18 white Wistar male rats, divided into three groups depending on the type of sanation of purulent wounds (6 animals in each series). In the control group, wound treatment was performed by reorganization with chlorhexidine, in the second experimental group, photodynamic therapy sessions were performed, in the third experimental group, the photosensitizer was modified with chitosan. In dynamics, we studied the microbial contamination of wounds, the lethality of animals, and also performed histological and morphometric studies. Results. With regard to gram-negative rods, the use of «Photolon» as a photosensitizer led to a significant reduction in bacterial contamination: in the crops, the number of germinated colonies was less than 10 bacteria/ ml, which suggests the selectivity of this type of photochemical effect with respect to gram-negative flora. Conclusions. Modified PDT was effective against gram-negative bacilli (plating decreased from 3.70 ± 0.05 × 104 (log CFU/ml = 4.5682) to 2.90 ± 0.05 × 104 (log CFU/ml = 4.4623) and with respect to gram-positive pathogens: the number of CFU/ml after the second session was &lt; 1.0 ± 0.05 (log CFU/ml = 1). Histological and morphometric studies showed the advantages of modified PDT compared to traditional treatment of purulent wounds.