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Государственное учреждение «Крымский государственный медицинский университет имени С.И. Георгиевского» (Симферополь)
95006, г.Симферополь, бульвар Ленина, 5/7
State Institution Crimea State Medical University named after S. I. Georgievsky
Ukraine, 95006, Simferopol, 5/7, Lenin Avenue
The treatment of wounds and skin trophic defects of different origin is a fundamental issue of contemporary purulent surgery that is today as well as at Hippocrate’s age very far from its final solution. Problem existence stimulates production of new multicomponent ointments but their price, necessity of changing drug and idiosyncrasy make them inaccessible for many patients. A variant of situation solution is using and production of preparations based on natural resources; e.g. Saki salty lake brines of different concentrations
We put the task to study impact of Saki salty lake brines of different concentrations on the course of wound process in patients with chronic skin defects as for their preparation for future surgery.
Materials and methods. 54 patients with bedsores of sacral-lumbar area. All of them were begun to be treated in the I phase of wound process. The groups were formed as follows: I (control) – antiseptic + dry aseptic bandage (11 patients), II (main) – antiseptic + brine bandage (31), III (comparative) – antiseptic + wet antiseptic bandage (12). After wound treatment with antiseptics we applied appropriate bandage for entire day. We studied concentrations 20, 40 and 60 g/l (groups IIа (11), IIb (10), IIc (10)) been obtained by solution of Saki salty lake brine with initial concentration 270 g/l with distilled water. Besides in the II group we used sinking patients into Saki brine tan (NaCl concentration 20 g/l) for 10-15 min in 37°С and cleansing enemas to eliminated endotoxins from the bowel. Within 45 days the control over wound process course was carried out. We assessed clinical signs, quality of discharge and condition of granulations, pace of epithelization by Popova and cytolological imprints been obtained by Pokrovsky-Makarova method. Results were processed by method of variation statistics.
Results and discussion. Comparative analysis of obtained results demonstrated that necrolysis in the group II began 1,7 times more rapidly, appearance of granulations and start of epithelization 1,4 times more rapidly than in the control group. In association of obtained results and wound process course it’s obvious that shortening terms of necrolysis, more early appearance of granulations and epithelization take place due to including balneological procedures in the complex of treatment.
In the I phase of wound process the brine of 60 g/l was the most efficient and demonstrated the maximal properties of physical antiseptics. Due to change of osmosis and diffusion from tissues to hypertonic solution we observed perfected exchange of tissue fluid. As the wound content is discharged it’s filled with tissue fluid containing nutritives, antibodies, enzymes and other BAS those are necessary for normalization of nutrition and intracellular metabolism; it’s accompanied with decrease of toxins and products of tissue breakdown products absorbtion. In hypertonic medium the microbes loss water, shrink, become inactive and undergone for impact of antibodies, enzymes, and phagocytosis. Cytological investigation on the wound surface reveal cells of vasogenic origin: neutrophills, eosinophills, monocytes, and lymphocytes; among them there was the majority of neutrophills on the different stage of phagocytosis and degeneration, a lot of microbes.
In the phase of proliferation the most efficient was the brine of 20 g/l. It being keeping the properties of hypertonic solution, significantly less inhibited growth of young connective tissue containing a lot of cells providing proliferation (fibroblasts). We observed improvement of tissue trophics, germination of new capillaries to new-formed tissues, perfection of microcirculation, reduced tissues swelling. After appearance of granulation tissue in the wound one discovers young oval-shaped polyblasts, shown phagocytosis and phagocytolysis, lesser degenerative neutrophils and microbial bodies. During rejection of dead tissues and occurrence of solid granulation barrier in cytological imprints one discover a lot of polyblasts been grouped for 10-15 cells, among which there are a lot of active phagocyting macrophages. The number of degenerative neutrophils and microbes is sharply reduced. As complete wound cleaning from dead substrate and occurrence of normal granulation polyblasts become oblong-shaped and are transformed to fibroblasts.
Thus, positive effect of Saki brine in intensification of wound process in bed-sore patents is obvious and confirmed by clinical and cytological investigation. It enables to stimulate wound healing and prepare the patients for soon surgery.
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