Novosti
Khirurgii

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Year 2017 Vol. 25 No 3

GENERAL & SPECIAL SURGERY

A.A. GLUHOV1, M.V. ARALOVA2

CLINICAL EFFICIENCY OF VARIOUS METHODS OF DEBRIDEMENT OF VENOUS ETIOLOGY TROPHIC ULCERS

FSBEE HE "Voronezh State Medical University named after N.N.Burdenko" 1,
BME VR "Voronezh Regional Clinical Hospital N 1" 2,
Voronezh
The Russian Federation

Objectives. To study the efficiency of various debridement methods of the surface of trophic ulcers in the 1st phase of wound healing process.
Methods. The regional treatment results of patients (n=53) with trophic ulcers (medium size) of the lower limbs against of varicose disease were analyzed. For excavation of the wound from necrotic masses, fibrin plaque, biofilm, pathological tissue and for stimulating the regeneration the surgical, autolytic, chemical and physical (cryodestruction) methods of treatments were used; the patients were divided into 4 groups according to those methods. The effectiveness of regional treatment was evaluated in 7th, 14th and 30th days taking into account the speed of wound cleaning, clinical manifestations of the ulcer regeneration process, subjective feelings of patients, the results of laboratory research methods (bacteriological, cytological analyses). For dynamic registration of the planimetric parameters of the wound defect, the mobile app+WoundDesk based on the usage of the smartphone camera (Android) were used.
Results. Within surgical treatment and cryodestruction in 75% of patients already after 7 days the wounds were completely cleansed from necrotic tissues, bacterial elimination was achieved 2 fold faster in comparison with hydrogels and 1,5 fold faster – enzymes. According to clinical data the stimulation of regeneration processes and the reduction of the wound surface area most effectively took place after cryosurgery and surgical treatment. The data of cytological studies confirm a more rapid transition to the regenerative cytograms during surgical treatment, the use of hydrogels and cryotherapy. Evaluating the wound healing after 30 days the greatest reduction of the defect wound area has been achieved during surgical treatment and after cryotherapy, 19 and 21%, respectively.
Conclusion. Debridement the wound from necrotic tissue, bacterial elimination, relief of local inflammatory reaction and the transition of the wound into the 2nd phase of wound process maximally quickly and effectively have occured during surgical treatment and cryodestruction.

Keywords: venous trophic ulcers, necrotic tissue, local treatment, methods of wound cleaning, cryodestruction, surgical treatment, inflammatory reaction
p. 257-266 of the original issue
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Address for correspondence:
394036, Russian Federation,
Voronezh, Moscow Ave, 151,
Voronezh Regional Clinical Hospital N 1,
Department of Outpatient Polyclinic Surgery,
Tel.: 8 803 854-05-43,
E-mail: Mashaaralova@mail.ru,
Mariya V. Aralova
Information about the authors:
Gluhov A.A. Professor, Head of department of the general surgery, FSBEE HE "Voronezh State Medical University named after N. N. Burdenko" .
Aralova M.V. PhD, Head of department of the out-patient policlinic, BME VR "Voronezh Regional Clinical Hospital N 1".
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