THE TREATMENT OF THE I-II SТAGES PRESSURE ULCERS WITH MACERATION, LOCAL EXEMATISATION AND DESQUAMATION OF THE EPIDERMIS: SOME SPECIFICS OF MANUFACTURING AND USE, ANALYSIS OF CLINICAL CASES
Authors: A. R. Vergun, M. B. Kalytovska, A. V. Yutanova, V. V. Kulchytskyi, O. M. Vergun, M. R. Krasnyi, Z. M. Kit, Ja. B. Chulovskyi, O. M. Moshchynska, O. H. Marko
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It is known that the main causes of decubital ulcers (bedsores) are ischemia and neurotrophic soft tissue pathology caused by chronic local compression, nutritional disorders, urinary and fecal incontinence, metabolic disorders. Significant risk factors are the presence of diabetes mellitus, a condition after suffering a cerebral circulation disorder, and other neurological pathology, in patients with insufficient or inadequate care. In addition to decompression of problem areas, periodic changes in the spatial position of the body in combination with antiseptic treatment in complex therapy should take into account the nutritional state, circulation, microcirculation and oxygenation in tissues, skin moisture (excessive humidity increases the risk), neurodegeneration, the stage of process, local diaper rash and maceration. The aim of the work. To optimize and improve the results of treatment of stage I-II bedsores with diaper rash, maceration, exematisation and epidermis desquamation by local therapy using clinoptilolite-based powders and to substantiate the prospects of using this method in clinical practice. The main study group over 3-year period consisted of the results of complex treatment of 28 patients, age 72-87 years: 17 women and 11 men with I-II stages of bedsores with diaper rash, maceration, local exematisation and desquamation of the epidermis and formation of superficial ulcer. The control sample consisted of the results of the treatment of 32 patients with decubital ulcers I and II stages, who were treated inpatient in the palliative care departament of the municipal non-profit enterprise "4th City Clinical Hospital" in Lviv with the use of antiseptic remediation, use of streptocid and metronidazole containing powder according to generally accepted recommendations, clinical strategies, and local protocols.Patients in the main group performed sequential repair of the wound surface with a 3% solution of hydrogen peroxide, 20% chlorhexidine bigluconate solution and sprinkling extratemporally prepared powder containing fucorcin (17 patients) or brilliant green (11 other observations). Patients in the control group were sequentially sanitized with a 3% solution of hydrogen peroxide, 1% polyvidone iodine solution, and an extratemporally prepared powder, which, in addition to the adsorbent, contained powdered white streptocide and powdery metronidasole. During daily dressings repeated repairs were carried out – washing with antiseptics of maceration sites, drying with sterile gauze wipes and filling with powder. Patients with type II diabetes have insulin resistance and deviations from laboratory parameters. The criterion for the effectiveness of care and treatment was to reduce exudation with marginal epithelialization, and (or) crust formation. In the patients of the main group, the rate of healing of wounds and macerated areas was 4.8±0.12%, in the control group – 3.2±0.25% (χ2=28.62, p<0,01). In patients of the main group with cytological examination on 3, 5 and 12 days after the initial debridement in the smears of maceration areas consistently decreased the leukocytes, appeared macrophages and fibroblasts. In the control group at 5 days after primary debridement, segmental leukocytes were prevailed, cytological signs of regeneration were less pronounced (degree of exposure, χ2=31.12, significance level, p<0.01). On day 15, we observed the correction of sites of bedsores I and II stages with maceration and local epidermis desquamation in all patients of the main group and 60.71% of the of the control group. It is stated that clinoptilolite actively adsorbs of the wound secretions and bacterial toxins from the maceration surface and superficial I and II stages decubital ulcers, releases into the wound pre-adsorbed antiseptics, which are part of the proposed powders and have a pronounced antibacterial development, when is optimal for reparative processes and the healing environment that promotes healing of the superfitial pressure ulcers.