Authors
Fedzianin S.D.
EE «Vitebsk State Order of Peoples’ Friendship Medical University», Vitebsk, Republic of Belarus
Abstract
Backgraund: The problem of treating wound infections continues to be relevant at the present time. Particular difficulties arise in helping patients with extensive purulent wounds. It is necessary to develop new approaches to stimulate wound healing.
Aims: To develop a method for treating extensive purulent wounds, which is based on the use of autoaspirates of the red bone marrow.
Materials and methods: A method for the treatment of extensive purulent wounds has been developed and introduced, which is based on the use of autoaspirates of the red bone marrow.
Study Design: A prospective, simple, controlled, randomized clinical trial in two parallel groups of patients.
Under aseptic conditions under infiltration anesthesia with a needle for sternal puncture I.A. Kassirsky punctured the sternum and took out the red bone marrow. The wound surface was treated with a Volkman spoon. An automyeloaspirate was introduced into the edges of the wound and applied to the surface of the wound. Gauze napkins were placed on top. The technique was applied once in case of violation of regenerative processes in the phase of formation and maturation of granulation tissue.
A randomized study of the course of phase 2 of the wound healing process was performed in 57 patients with extensive purulent wounds of various origin and localization. The main group consisted of 27 patients. In the patients of this group, the developed method was used along with traditional complex treatment. The area of the wounds is 108,29±8,2 cm2.
The control group consisted of 30 patients. Patients in this group received traditional complex treatment. The area of the wounds is 103,93±11,05 cm2.
The determination of the area of the wounds was carried out according to the methods of L.N. Popova (1942) and A.N. Lyzikov et al. (2008). The wound healing rate was determined using the formula of L.N. Popova.
The cytological picture was studied by microscopy of smear smears from wounds according to M.P. Pokrovskaya and M.S. Makarov (1942).
Patients underwent surgical treatment of purulent wounds with necrectomy. Antibiotic therapy was carried out according to the empirical treatment regimens, developed for the department. After obtaining the results of microbiological research, if necessary, its correction was carried out. Drug therapy was aimed at improving blood rheology, microcirculatory processes.
Local treatment of wound defects was carried out using antiseptic agents (septomirin, mucosanin, dioxidine, iodine, 3% hydrogen peroxide solution), ointments («Mekol», «Povidone-iodine», «Reparef-2», «Methyluracil», «Gentamicin») ), gel «Septomirin gel», medical dressings «VAP gel», VAC-therapy.
Results: The wound healing rate in the main group was 6,33±0,15% per day, and in the control group — 3,37±0,08% per day and 1,88 times was significantly higher when using automyeloaspirate (p<0,05).
The duration of the phase of formation and maturation of granulation tissue in the main group was 5 (2; 8) days, and in the control group it was 13 (9; 15,75) (p <0,01).
Conclusions: The developed method for treating extensive purulent wounds is characterized by technical simplicity. Its use can significantly reduce the duration of the 2 phases of the wound process by 8 days.
Keywords: surgical infection, red bone marrow, purulent wound.
References
1. Sepsis: klassifikatsiya, kliniko-diagnosticheskaya kontseptsiya i lechenie. Ed by Gel'fand B.R. Moscow: MIA; 2017.
2. Khirurgicheskie infektsii kozhi i myagkikh tkanei: Rossiiskie natsional'nye rekomendatsii. Ed by Gel'fand B.R. Moscow: MAI; 2015.
3. Efimenko NА, Knorring GU, Novozhilov AА. Sistemnaya enzimoterapiya v gnoinoi khirurgii. Ambulatornaya khirurgiya. 2005;(3):51–55.
4. Strategiya i taktika ratsional'nogo primeneniya antimikrobnykh sredstv v ambulatornoi praktike: Evraziiskie klinicheskie rekomendatsii. Ed by Yakovlev S.V., Sidorenko S.V., Rafal'skii V.V., Spichak T.V. Moscow: Pre100 Print; 2016.
5. Dryuk NF, Kirimov VI. The revascularizing operations at an obliterating lesion of arteries of an anticnemion and foot at patients with a chronic critical ischemia of the lower extremities. Klіn Khіrurgіia. 2007;(5–6):48–49.
6. Fyodorov VD, Sarkisov DS, Tumanov VP, Glushchenko EV. Use of the cultivated fibroblasts at skin combustions. Vrach. 1993;(11):26–28.
7. Tret'yak SV, Baranov EV, Volotovskii ID, et al. Metod lecheniya s ispol'zovaniem autologichnykh mezenkhimal'nykh stvolovykh kletok iz zhirovoi tkani u patsientov s troficheskimi yazvami: instruktsiya po primeneniyu. Minsk; 2011.
8. Dryuk NF, Kirimov VI, Barna IE, et al. Application of autologous aspirates as well as multipotent stromal cells of the bone marrow and adipose tissue in vascular surgery. Klіn Khіrurgіia. 2012;(12):24–29.
9. Grin VK, Shtutin AA, Popandopulo AG, et al. Autotransplantatsiya stromal'nykh stvolovykh kletok v lechenii obliteriruyushchikh zabolevanii arterii nizhnikh konechnostei. Vestnik neotlozhnoi i vosstanovitel'noi meditsiny. 2010;4(11):512–513.
10. Badiavas EV, Falanga V. Treatment of chronic wounds with bone marrow-derived cells. Arch Dermatol. 2003;139(4):510–516. Doi: 10.1001/archderm.139.4.510.
11. Chittoria RK, Nandhagopal V, Mohapatra DP, et al. Autologous bone marrow aspirate therapy in wound healing. Adv Wound Care (New Rochelle). 2016;5(3):102–105. Doi: 10.1089/wound.2014.0612.
12. Gupta GJ, Karki K, Jain P, Saxena AK. Autologous bone marrow aspirate therapy for skin tissue engineering and tissue regeneration. Adv Wound Care (New Rochelle). 2017;6(4):135–142. Doi: 10.1089/wound.2016.0704.
