Novosti
Khirurgii
This journal is
indexed in Scopus









Year 2012 Vol. 20 No 2

GENERAL AND SPECIAL SURGERY

V.V. BESCHASTNOV, N.YU. ORLINSKAYA, M.N. KUDYKIN

EXPERIMENTAL-CLINICAL JUSTIFICATION OF DOSED DERMOTENSION APPLICATION IN THE FIRST PHASE OF WOUND PROCESS

SBEE HPE Nizhny Novgorod State Medical Academy,
The Russian Federation

Objectives. To shorten the treatment terms of patients with extensive purulent wounds of soft tissues by expanding indications for the dosed hardware apparatus dermotension.
Methods. Influence of the dosed dermotension on the morphological characteristics of the structural wound components was studied in experiment on the model of the infected wound in rats. Changes occurring distantly from the area of tension were studied, directly in the area of the primary wound defect. Hypothesis was that tension of the paravulvar area tissues resulted in the production of inflammation mediators, cytokines and this in its turn led to the reparative process stimulation in the wound area. Criterion letting estimate the correctness of the hypothesis was the speed of wound healing and terms of epithelialization. Dosed hardware apparatus dermotension was applied in the clinic in 12 patients at the first stage of wound process; in 18 patients a traditional method of purulent wounds treatment under dressing was applied. Objective control of soft tissues state while applying hardware apparatus dermotension was carried out using the laser Doppler flowmetry method.
Results. Investigations which were done on the model of the infected wound in rats show that dosed dermotension of the paravulvar tissue influences positively the tissue qualitative composition which is formed at infected wound healing; it is proved by the ratio of granulated tissue and fibroblasts, acceleration of the wound cleaning processes and scar forming. In the clinic, using the dosed hardware apparatus dermotension, purulent wounds from 7 up to 16 cm in width were closed and after suturing wound healing according to the type of primary tension was achieved in 11 out of 12 patients.
Conclusions. Use of the dosed hardware apparatus dermotension to close extensive purulent wounds at the first stage of the wound process expands indications for application of active surgical tactics and it reduces terms of treatment of this category of patients.

Keywords: wound, wound process, primary tension, dermotension
p. 55 - 59 of the original issue
References

1. Hirshowitz B, Lindenbaum E, Har-shai Y. A skin-stretching device for the harnessing of viscoelastic properties of skin. Plast Reconstr Surg. 1993 Aug;92(2):26070.
2. Bogos'ian RA. Ekspandernaia dermotenziia novyi metod khirurgicheskogo zameshcheniia defektov kozhnykh pokrovov [Expander dermotension a new method of surgical replacement of skin defects]. Sovrem Tekhnologii v Meditsine. 2011;(2):3134.
3. Pasichnyi DA. Dermotenziia v lechenii povrezhdenii pokrovnykh tkanei stopy i goleni [Dermotension in treatment of integument lesions of the foot and leg]. Mezhdunar Med Zhurn. 2009;(3):8590.
4. McHugh SM, Hill AD, Humphreys H. Intraoperative technique as a factor in the prevention of surgical site infection. J Hosp Infect. 2011;78(1):14.
5. Melis P, Noorlander ML, van der Kleij AJ, van Noorden CJ, van der Horst CM. Oxygenation and microcirculation during skin stretching in undermined and nonundermined skin. Plast Reconstr Surg. 2003 Oct;112(5):1295301.
6. Huang X, Qu X, Li Q. Risk factors for complications of tissue expansion: a 20-year systematic review and meta-analysis. Plast Reconstr Surg. 2011 Sep;128(3):78797.
7. Nerobeev AI, Agadzhanian NA, Elfimov AI, Shekhter AB, Volozhin AI, Kibisheva AA. Gipoksicheskaia trenirovka effektivnyi metod povysheniia zhiznesposobnosti kozhi pri mestno-plasticheskikh operatsiiakh [Hypoxic preconditioning is the effective method of skin viability icreasing in local plastic surgery]. Stomatologiia. 2006;(2):4044.
8. Austad ED, Pasyk KA, McClatchey KD, Cherry GW. Histomorphologic evaluation of guinea pig skin and soft tissue after controlled tissue expansion. Plast Reconstr Surg. 1982 Dec;70(6):70410.
9. Brunius U. Wound healing impairtment from sutures. tensiometrie and histology study in the rat. Acta hir Scand.. 1968;395(21):2426.
10. Krupatkin AI, Sidorova VV, red. Lazernaia dopplerovskaia floumetriia mikrotsirkuliatsii krovi: ruk dlia vrachei [Laser Doppler flowmetry of blood microcirculation: a guide for physicians]. Moscow: Meditsina; 2005. 256 p.
11. Kanshin NN. Printsipy zakrytogo aspiratsionno-promyvnogo lecheniia zagriaznennykh i nagnoivshikhsia ran [Principles of closed aspiration/washing treatment of contaminated and festering wounds]. Khirurgiia. 1989;(6):11215.

Address for correspondence:
603001, Rossiiskaia Federatsiia, g. Nizhnii Novgorod, ul. Nizhne-Volzhskaia nab. 1/1, GBOU VPO Nizhegorodskaia gosudarstvennaia meditsinskaia akademiia, kafedra khirurgicheskikh boleznei,
e-mail: lancet2003@list.ru,
Beschastnov Vladimir Viktorovich
Information about the authors:
Beschastnov V.V., candidate of medical sciences, associate professor of the chair of surgical diseases of SBEE HPE Nizhny Novgorod State
Medical Academy.
Kudykin M.N., doctor of medical sciences, professor of the chair of the innovative surgery of SBEE HPE Nizhny Novgorod State
Medical Academy.
Orlinskaya N.Yu., doctor of medical sciences, associate professor of the pathologic anatomy chair of SBEE HPE Nizhny Novgorod State
Medical Academy.
Contacts | ©Vitebsk State Medical University, 2007