RU2559731C1 - Method of treating hand burns and preventing post-burn cicatrical deformities and syndactylies - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: hand burns are surgically treated and coated with gel urethane foam, LOCUS preparation. For coating, the hand is placed down without restrain on a surface covered with a sterile polyethylene film. The dorsal surface is first coated, and then the coating is applied into web spaces with fingers spread as much as possible along the full depth of the web spaces and along the finger length. The exposure is held until the coating is polymerised completely. The hand is turned up, and the palmar surface and fingers are coated with the gel urethane foam to simulate an urethane foam glove covering 2-3 cm of the intact skin and kept until the coating is polymerised completely. The hand covered with the urethane foam glove is placed into a closed container with an elastic cuff sealing the wrist; low pressure of 10-150 mm Hg is generated in the cuff within 12-48 hours. The urethane foam glove is removed as far as the wound fluid is collected with the above procedure repeated as may be required from time to time until the burn wound is epithelised, or dermoplasty appears to be indicated.

EFFECT: reducing the length of treatment by creating optimum conditions for wound healing, and by providing the comfortable use of the coating.

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Description

FIELD OF THE INVENTION

The invention relates to medicine, in particular to polymer-based dressings, and can find application in surgery for the treatment of burns of the hand and the prevention of post-burn Scar deformities and syndactyly.

State of the art

The prior art method of treating burns of the hand, in which a variety of painkillers, antiseptic, bacteriostatic and adsorbing agents are used: lotions, powders, ointments, antiseptic emulsions. The burn wound is protected with a dressing slightly soaked with sterile sea buckthorn, peach, petroleum jelly, sunflower oil or antiseptic emulsion. Dressings are rarely done, the burn itself is re-treated without removing the layer adjacent to the wound, and an ointment dressing is again applied. It is advisable to place the affected brush in a specially treated plastic bag or glove. This protects the burn wound of the hand from a secondary infection and allows early active finger movements (Reid, 1974).

The choice of method for treating burns of the hand depends on the length, depth of the burn, the general state of health of the victim and other conditions. The surgeon's task is to prevent the development of infection, constricting scars, contractures and ankyloses of fingers and hands. For this it is necessary, having processed the burn wound, not to allow bandaging of the fingers brought together, to splint the hand in a functionally advantageous position. (E.V.Usoltseva, K.I. Mashkara. Surgery of diseases and injuries of the hand https://bone-surgery.ru/view/ozhogi_kisti/).

However, it is not always possible to choose the optimal treatment method that provides healing of a burn wound without constricting scars and in a short time when it is necessary to start active movements of the hand and fingers in a timely manner. Dressings in most cases are traumatic and painful for the patient, time-consuming medical staff.

Closest to the claimed is a method for treating burn wounds (patent RU 2240763, A61F 13/00, A61F 13/10) using a device that maintains the pressure inside the wound closure structure below ambient pressure, which reduces the healing time of the wound. Moreover, the device for promoting wound healing contains a walling for receiving the affected part of the body and connecting means for attaching the internal cavity of the walling to a lower than atmospheric pressure source, wherein the walling includes an airtight protective shell and a porous gasket inside the protective shell, the porous gasket being adapted to contact with the surface of the wound. For the treatment of burn wounds of the hand, the enclosing structure is made in the form of a glove, the glove made of flexible flexible foam or foam rubber, and the outer protective shell made of sheet material not permeable to air. Typically, foamed flexible plastic is a polyurethane foam or foamed polyvinyl alcohol having communicating cells with each other, or a combination of such foamed materials, for example, in the form of a laminate. In such a laminate, a layer of polyvinyl alcohol can be located next to the wound. The connecting means contains a tube that communicates with the foam material inside the protective sheath. The protective shell has a hole that is resealed to ensure tightness, allowing you to examine the wound from time to time. The pressure source is a suction pump. The device may include a filter container for collecting wound exudate.

When using the invention according to the patent RU 2240763, the patient’s hand with a burn is introduced into the protective sheath. After that, the hand is inserted into a porous pad, which can be pre-assembled or assembled in place around the injured hand. When the foam material is placed in a predetermined position in which it covers (surrounds) the injured hand, the protective sheath is pulled back onto the porous pad. After that, the tubular element is connected to the suction pump. A pulsating, periodically applied, or continuously applied pressure below atmospheric pressure may be applied to the patient’s hand. It has been found that treatment by applying sub-atmospheric pressure using the device of the invention stimulates the healing of burns and reduces the development of cell necrosis under burn injury. In addition, by increasing blood flow to the wound area, infection is prevented and granulation of the wounds is stimulated. One additional positive effect of therapy using the device according to the invention is that during treatment, the hand is firmly held in a half-closed position, which is the optimal position to stimulate healing.

However, this method is quite complex and time-consuming for medical personnel and painful for the patient. In addition, a dense porous polyurethane foam pad cannot fully match the complex relief of the burn wound of the hand, interdigital spaces and fingers, creating smudges and pockets that contribute to the development of infectious complications and local melting of tissues.

Disclosure of invention

The objective of the present invention is to provide a more effective method of treating burn wounds of the hand with damage to the interdigital spaces and the prevention of cicatricial deformities and syndactyly.

The technical result, to which the claimed invention is directed, is to reduce the treatment time by creating optimal conditions for healing, the comfort of wearing a polyurethane foam coating for the patient, and painlessness during dressings.

The problem is solved in that after surgical treatment on the burn wounds of the hands of the hand, polyurethane foam of low-temperature polymerization in gel form is applied. Applying a coating in this state allows you to congruently fill the complex relief of the bottom of the burn wound and the wrist and fingers, as well as to achieve additional sterilization of the wound, since the polyurethane foam is bactericidal in the gel phase. The wrist is freely placed on the surface covered with a sterile plastic film, with the palm surface facing down, and the coating is applied sequentially to burn wounds of the back surface of the palm of the hand, then into the interdigital spaces with the fingers extended as far as possible across the entire depth of the interdigital spaces and along the length of the fingers withstand exposure to complete polymerization coverings. Applying the coating first on the back of the hand allows you to fix the fingers slightly bent, in a physiologically correct position, which is important to eliminate contractures and early activation of finger movements. Next, the hand is turned with the palm surface up and low-temperature polymerization polyurethane foam is applied in a gel state to the burn wound of the palm surface and fingers, forming a "polyurethane glove" with a grip of 2-3 cm of intact skin around the burn wound and subsequent soaking until the polymerization of the polyurethane foam. After that, the hand in the "polyurethane glove" is placed in a closed container with sealing elastic wrist cuff and made with the possibility of creating a reduced pressure of 10-150 mm RT. post for 12-48 hours through the tube. The “polyurethane foam glove” is removed as the wound is accumulated in it with the repetition of the procedure as necessary until the epithelization of burn wounds or referral for dermaplasty surgery.

As a gel-like polyurethane foam, the drug "LOCUS" is used, the composition of which contains nanocrystalline boehmite (see patent No. RU 2424825).

The application of a polyurethane foam coating in a gel state with the formation of a “polyurethane foam glove” ensures full correspondence of the bottom of the burn wound to the inner surface of the coating, and the absence of adhesion of the coating to the wet surface of the burn wound - its subsequent painless removal. The dressing procedure is simple and does not take much time from the medical staff.

Brief Description of the Drawings

The invention is illustrated by drawings, where Fig.1-4 presents a diagram of the application of polyurethane foam on the brush with subsequent suction drainage.

The implementation of the invention

After surgical treatment, low temperature polymerization foam in a gel state is applied to burn wounds of the hand, for which the components of the polyurethane coating (polyol and isocyanate) are thoroughly mixed. In this case, the hand is freely placed on the surface covered with a sterile plastic film, the palm surface down (Fig. 1), and the gel-like coating (1) is applied sequentially to burn wounds (4) of the back surface of the palm, then into the interdigital spaces with the fingers extended apart. along the entire depth of the interdigital spaces and along the length of the fingers (2). The exposure is maintained until the coating is fully polymerized (Fig. 2), after which the hand is turned with the palm surface up and low-temperature polymerization polyurethane foam is applied in the gel state (1) onto the burn wound (4) of the palm surface, the interdigital spaces and fingers (5), forming "Polyurethane foam glove" (3) with the capture of 2-3 cm of intact skin around the burn wound and subsequent exposure until the polymerization of the polyurethane foam (Fig.3). Then the wrist in a "polyurethane glove" (3) is placed (Fig. 4) in a closed elastic container (6), for example, made of polyethylene or polypropylene, with its sealing, for example, using an elastic cuff placed on the wrist (7) over capacity or capacity provided by the design to ensure reliable sealing and made with the possibility of creating in it a reduced pressure of 10-150 mm RT. a column in the range of 12-48 hours through a tube connected to the tank by means of an adapter (8) and a free end with a vacuum pump. Reduced pressure inside the container allows you to get rid of mediators of inflammation in the burn wound, reduces the risk of suppuration and accelerates healing. The “polyurethane foam glove” is removed as the wound is accumulated in it with the repetition of the procedure as necessary until the epithelization of burn wounds or referral for dermaplasty surgery.

The polyurethane foam coating in the present method can be formed by the drug "LOCUS", made, for example, according to patent RU 2424825, the composition of which contains nanocrystalline boehmite, characterized by improved sorbing properties. The coating consists of two liquid components (polyol and isocyanate), which are located in a specially designed container (patent RU 2457992), and are mixed immediately before application to the burn wound. The use of this drug in the claimed method - gel-like polyurethane foam, is explained by a number of its properties, which distinguish it from foam materials of a different nature. Firstly, a gel-like polyurethane foam coating is obtained immediately before application to the wound, which ensures sterile closure of wounds in both clinical and extreme field conditions. Secondly, the coating has an open porous structure, which provides excellent absorption properties of the dressing, which allows you to remove wound. Thirdly, such a coating is easy to apply on the entire surface of the wound. It is known that the physical and mechanical properties are responsible for the sorbing properties of polyurethane elastic foam. The capillary system is formed by open foam cells, interconnected by the so-called Plateau-Gibbs channels. In ordinary elastic polyurethane foam of open cells of the order of 60-70%, respectively, the same 60-70% of the foam volume is involved in the sorption process. It is known that the stability of polymer foam and the drainage properties are better, the higher the physical and mechanical properties of the coating material. In addition, it is known that the solid mechanical particles used as a reinforcing filler of polyurethane are centers of formation of gas bubbles, the so-called nucleosiates. The smaller the nucleucleates, the smaller the gas bubbles, the smaller the radius of the Plateau-Gibbs channels, the higher the drainage capacity of the capillary system of the foam coating. One of the well-known fillers that improves the mechanical properties of polyurethane foam is boehmite (see above, n. RF No. 2271929). However, the use of boehmite nanoparticles in the composition according to patent RU2424825 increases the sorbing properties of polyurethane foam. The use of boehmite, particles of which are from 10 to 50 nm, is due to the fact that they are uniformly dispersed throughout the mass of the polymer, which increases the number of open cells and Plateau-Gibbs channels, and, as a result, the drainage properties of the entire foam volume increase. With this amount of filler added and with this size, the maximum elasticity and strength of the capillary system is maintained.

The invention is illustrated by examples of practical use of the proposed method.

Example No. 1. B-naya P., 40 years old. Received with a circular burn of the right hand IIIA degree. After surgical treatment, the Locus polyurethane foam coating was applied first on the back surface of the hand, then on the palm surface with the formation of a “polyurethane foam glove”, the affected hand was immersed in a plastic bag, sealed with an elastic cuff on the wrist and a negative pressure of 25 mm RT was created. column for 24 hours according to the method described above. The procedure was repeated after the wound was completely saturated. After cleansing the burn surface from non-viable tissues and forming granulations, an autodermoplasty operation was performed with good graft engraftment. The healing period was 14 days, the patient noted the convenience of wearing dressings and painless dressings.

Example No. 2. Boy S., 52 years old. Entered with a circular burn of the right hand of the II degree. After the surgical treatment, the Locus polyurethane foam coating was applied first on the back surface of the hand, then on the palm of the hand with the formation of a "polyurethane glove", then immersed in a plastic bag, sealed with an elastic cuff on the wrist and created a negative pressure of 15 mm RT. post for 48 hours according to the method described above. The procedure was repeated three times until self-epithelialization. The healing period was 8 days, the patient noted the convenience of wearing dressings and painless dressings.

Claims (2)

1. A method for the treatment of burns of the hand and prevention of post-burn cicatricial deformities and syndactyly, including surgical treatment of burns of the hand with subsequent application of a gel-like polyurethane foam, while the hand is freely placed on the surface covered with a sterile plastic film, palm surface down, and the coating is applied sequentially first on the back surface of the palm, then into the interdigital spaces, with the fingers of the hand as far apart as possible across the entire depth of the interdigital spaces and along the length of the fingers, withstand exposure until the polymerization of the coating is complete, after which the hand is turned with the palm surface up and the gel polyurethane foam is applied onto the palm surface and fingers of the hand with the formation of a “polyurethane glove” with a grip of 2-3 cm of intact skin, followed by exposure until the polymerization of the polyurethane foam then the wrist in the “polyurethane foam glove” is placed in a closed container with a flexible cuff of the wrist and hermetic pressure is created in it 10-150 m Hg. column in the range of 12-48 hours, the "polyurethane glove" is removed as the wound is accumulated in it with the repetition of the above procedure as necessary until epithelialization of burn wounds or referral for dermoplasty surgery. 2. The method according to p. 1, characterized in that the polyurethane foam coating is formed with the drug "LOCUS", the composition of which contains nanocrystalline boehmite.

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