Application of additional methods

Standard method of surgical treatment of purulent wound, local pathogenetic grounded treatment with the use of the modern combined preparations on occasion it is expedient to complement physical therapy methods. In the first phase of wound process apply ultrasonic cavitation of purulent cavities, different types of irrigation, hyperbaric oxygenation, treatment of wounds a high-power laser.

Together with physical methods, biological facilities of local treatment have the defined value (in particular, application of bacteriophage at antibiotic-resistant microflora of wounds). Important is also application of enzymic preparations – trypsin, chemotrypsin. These preparations cause the lysis of necrotic tissues, accelerate clearing of wound, and also influence on shells of microbial cages, increasing their sensitiveness to the utillized antibacterial facilities.

V. Reference basis of actions

Control of wound process flow

CLINICAL CRITERIA OF ESTIMATION OF WOUND PROCESS. Fix the terms of liquidation of perifocal edema, hyperemia and infiltration of wound edges and completion of necrolysis. Control the terms of appearance of granulations, their macrostructure, regional epithelization began.

LABORATORY METHODS OF CONTROL OF WOUND PROCESS FLOW.

The most widespread methods which are used in a practical health protection for objective control of wound process flow is a cytological study of strokes-imprints of wound surface, its bacteriological control and histological research of bioptat bottom (edges) of wound.

Method of cytological research. To the wounds surface touch preliminary fat free microscope slide which imprints of cages are on. Preparations dry a little on air during 10 minutes and fix in an ethyl alcohol (5 min.). After fixing preparation is painted on Romanovsky-Gimza during 10-15 minutes, then wash water and dry out outdoors. In the got preparation count up the amount of neutrophilic granulocytes, their degenerative forms, macrophages and fibroblasts.

Depending on cellular correlations in preparation-imprint determine one of six types of cytograms: necrotic, degenerative-inflammatory, inflammatory, inflammatory-regeneratory, regeneratory-inflammatory and regeneratory.

Bacteriological research of purulent wound. Bacteriological research is included by the high-quality and quantitative study of wound microflora in a dynamics. Research allows also to judge about efficiency of antibacterial treatment of wounds: the results of the repeated bacteriological control of wounds (each 2-3 days) are compared to the initial indexes and information of subsequent researches.

Bacteriological research includes authentication of exciter (high-quality composition of microflora), his sensitiveness to antibacterial preparations, and also quantitative descriptions (an amount of microbial bodies is in tissues or wound content).

Method of fence of material for determination of quantitative composition of microflora and histological study of wounds bioptates. For anaesthetizing use 2 % solution of Lidocaine, which on 1-2 minutes is inflicted as an applique on the wound surface. The area of tissue is excised on all of depth of wound by a sterile blade. Bioptat is placed in a sterile small bottle which contains 1 ml of physiological solution and in the special thermostat (t – 37 °С) sent in a bacteriological laboratory.

Treatment of purulent wound. Length of a skin cut, if localization of abscess allows, must correspond his extent.

Determination of scopes of delete of nonviable tissues (reliable signs of viability of tissues): it is necessary to consider appearance the reliable enough signs of viability of tissues in the process of delete of the abundant capillary bleeding, good reduction of muscles, and also rich colour of remaining tissues.

Method of draining of purulent wound

For providing of sufficient outflow a drainpipe must be located on the bottom of it, but not to «stick» out apeak. It is necessary to set drainage so that his outward end was disposed on possibility below than wound taking into account position which occupies sick abed. Quite often drainage hatches through contraperture, providing him position, maximally advantageous for realization of outflow. Considerably rarer inflammatory changes round drainage develop in those cases, when a tube hatches from a wound through healthy tissues. With the purpose of vacuum draining it is possible to use an ordinary rubber pear which is tacked to drainage in the compressed state; as far as its straightening in the system a «wound-pear» is provided rarefaction (vacuum).

Method of application of preparations for local treatment of purulent wound

Local treatment of wounds is conducted after their adequate surgical treatment or (during the subsequent bandaging) standard processing by modern antiseptic solutions. The combined preparations on modern synthetic bases enter in a wound with a tampon, impregnated with proper medication, then lay on a thin layer on a wound surface. Over serviettes lay on a sterile bandage which is fixed a bandage or court plaster.

Bandaging execute 1 time per days. Amount of preparation on one bandaging is determined the character and sizes of wound.

Testimonies to abolition of preparations is:

• in the first phase is the complete purging of wound from a purulent-necrotic sequestrum and its bacteriological sanitation;

• in the second and third phases is a positive dynamics of formation of granulations and epithelization of wound defect.