Local use of sorbent-antibiotic composition reduce the duration of exudation phase and actively reduce wound surface and formation of new granulation tissue, destruction and lysis of newly formed epithelium is absent

Khomko, Bogdan Olehovich

Khomko, Oleg Yosupovuch

Knut, Ruslan Petrovuch

Randiuk, Roman Yuriyovuch

Sydorchuk, Ruslan Ihorovuch

Цифровий Репозиторій - Інтелектуальні Фонди Буковинського державного медичного університету

Powered by TCPDF (www.tcpdf.org)Powered by TCPDF (www.tcpdf.org)7  Кордунян А.Э.  АНГИОТЕНЗИОРЕОПЛЕТИЗМОГРАФИЯ – СОВРЕМЕННЫЙ          МЕТОД ДИАГНОСТИКИ И КОНТРОЛЯ ЛЕЧЕНИЯ БОЛЬНЫХ С АРТЕРИАЛЬНЫМИ ГИПЕРТЕНЗИЯМИ ....................................................... 147  Костенко М. К., Дороженкова Т.Е.  ЭПИДЕМИЧЕСКИЙ ПРОЦЕСС ПЕДИКУЛЕЗА В ГОРОДЕ МИНСКЕ        ЗА 2005-2016 ГОДА ............................................................................................ 152  Krechun1 Anastasiya, Mykchailenko2 Olga, Kovalev1 Vladimir  PRIMARY SCREENING OF COMPOSITION OF IRIS HUNGARICA (WALDST ET KIT.) THE BIOLOGICAL ACTIVE SUBSTANCES ................ 158  Курганская Ю.И., Гайдук А.Р., Саросек В.Г.  ИСПОЛЬЗОВАНИЕ СОВРЕМЕННЫХ ТЕХНОЛОГИЙ ЛУЧЕВОЙ ДИАГНОСТИКИ В ОНКОЛОГИЧЕСКОЙ ПРАКТИКЕ ............................... 161  Khomko B.O.*, Randiuk R.Y., Khomko O.Y., Sydorchuk R.I., Knut R.P.  MORPHOLOGICAL CHANGES IN PURULENT-NECROTIC PROCESSES     OF SOFT TISSUES IN PATIENTS IN LOCAL APPLICATION OF           SORBENT-ANTIBIOTIC COMPOSITION ........................................................ 166  Khomko B.O.*, Randiuk R.Y., Sydorchuk R.I., Kyfiak P.V., Khomko O.Y.  AN EXPERIMENTAL STUDY FOR CALCULATING PATIENTS          SEVERITY STATUS IN EMERGENCY SURGERY ........................................ 170  Khomko B.O.*, Randiuk R.Y., Sydorchuk R.I., Kyfiak P.V., Khomko O.Y.  ABDOMINAL SEPSIS AND ACUTE RESPIRATORY DYSFUNCTION ....... 173  Лабузько А.В., Гомзякова М.А.*  ПРИЧИНЫ РАЗВИТИЯ ГИДРОЦЕФАЛИИ У ДЕТЕЙ ................................. 176  Лойко В.С., Ланкевич Т.С., Дронина А.М., Бандацкая М.И.,                    Рашкевич* И.И., Крамник** Т.И.  ДИНАМИКА ЭПИДЕМИЧЕСКОГО ПРОЦЕССА СКАРЛАТИНЫВ ПЕРВОМАЙСКОМ И ПАРТИЗАНСКОМ РАЙОНАХ Г. МИНСКА ........... 182  Мазуркевич Д.А., Неверов П.С.  ЭКСТРЕННАЯ МЕДИЦИНСКАЯ ПОМОЩЬ И ВОЗМОЖНОСТИ ОТСРОЧЕННЫХ ВМЕШАТЕЛЬСТВ ПРИ КРОВОТЕЧЕНИЯХ ИЗ ВАРИКОЗНО РАСШИРЕННЫХ ВЕН ПИЩЕВОДА ..................................... 188    166  Khomko B.O.*, Randiuk R.Y., Khomko O.Y., Sydorchuk R.I., Knut R.P.  MORPHOLOGICAL CHANGES IN PURULENT-NECROTIC PROCESSES OF SOFT TISSUES IN PATIENTS IN LOCAL APPLICATION OF SORBENT-ANTIBIOTIC COMPOSITION Higher education institution in Ukraine "Bukovinian State Medical University"  Department of General Surgery  *RMI “Emergency Hospital” Chernivtsi, Ukraine Ключевые слова: гнойно-некротические процессы, морфологические изменения, местный сорбент. Аннотация. Местное применение композиции сорбент-антибиотик, приводит к сокращению продолжительности фазы экссудации и активно снижает размер раневой поверхности и улучшает формирование новых грануляционных тканей, при этом деструкция и лизис вновь образованного эпителия отсутствуют.  Keywords: purulent-necrotic process, morphological changes, local sorbent. Abstract. Local use of sorbent-antibiotic composition reduce the duration of exudation phase and actively reduce wound surface and formation of new granulation tissue, destruction and lysis of newly formed epithelium is absent. Introduction. Treatment and prevention of inflammatory diseases of the soft tis-sue and postoperative inflammatory complications of inflammatory origin remains one of the most important tasks in modern surgery [1, 2]. Local treatment of purulent necrotic processes (PNP) of soft tissues remains extremely difficult, especially under the burdened status of patients with dysmetabolic disorders, such as diabetes mellitus, disorders of blood circulation and influence of other factors inhibiting regenerative and reparative processes and contributing to the development of infection [3,4]. It is known that the most powerful local treatment of patients with PNP loses its effectiveness if it is not combined with technologies that help clean purulent wound and create favorable conditions for regenerative processes [5]. Thereby there should be found local treatments that would have absorptive and antibacterial properties. The aim of this study is to determine local morphological changes of purulent necrotic processes of soft tissue in patients under local use of sorbent-antibiotic com-position.  Tasks: 1. Determine local morphological changes of purulent necrotic processes of soft tissue in patients under local use of sorbent-antibiotic composition. Material and methods. The object of study is the marginal zone biopsies of skin wounds of purulent necrotic processes of soft tissue in target patients. A compre-hensive pathologic study includes biopsy material of 215 cases of surgical treatment of PNP. The main group consisted of 120 (55.8%) patients, who along with common treatment locally received applications of sorbent-antibiotic composition in exudation phase. The control group consisted of 95 (44.2%) patients with common treatment ac-cording to existing protocols. Both groups did not differ significantly by age and sex composition. General treatment in both groups was similar. Complied with the re-167  quirements of bioethics, all patients signed informed consent application forms to par-ticipate in the study. To assess the evolution of wound healing in all patients, dynamics of reduction of wound surface and formation of new granulation tissue was studied, and morpho-pathologic monitoring of the wound healing was carried out. Histological sections were studied, analyzed and photographed by means of image analysis-based computer system consisting of a light microscope Olympus CX-21 and digital camera Olympus C 450. Complex of histometric research was applied. Volumetric density of irreversibly damaged tissue, edematous fluid, vascular capillary bed, leukocyte infiltration of fi-brous, epithelial, muscle and adipose tissues indices were calculated. Measurements were carried out using a computer image analysis system (Image Tools 2.1.2 soft-ware). Statistical processing of the results was carried out by methods of variation sta-tistics using the Statistica 7.0 software package. Results and discussion. Tissue samples (bioptates) of the wound edges at the time of administration of the patients to the hospital, and primary surgery, and at 3rd, 6th, 9th and 15th day after initiation of treatment were examined. On the background of necrotic changes, elements of granulation tissue in the form of short thin strands of proliferating fusiform fibroblasts, accompanied by capillaries were observed, while in 61 (28.4%) patients no such phenomena were present. At a distance of 0.1-0.3 mm from the edges of the wound the phenomenon of regeneration of the epidermis in small thin layers of newly formed keratinocytes was observed. In both investigated groups there was histologically determined reduction of edema, cellular infiltration, microcirculatory disorders in the marginal zone in the dynamics of wound treatment. At 6th day after starting treatment, mature granular tissue in biopsies was found. It consisted of a large number of vascular loops, oriented perpendicular to the wound surface, and numerous strands of fibroblasts (Fig. 1).    Fig. 1 Boundary wounds' zone. 3d day of treatment. Neoangiogenesis. 3rd day of treatment. Formation of granulous tissue. Coloration: hematoxylin and eosin, × 400.  168  Thin-walled vessels were located evenly throughout the granular tissue, almost of the same diameter. Vascular network occupies 16,6±1,5% of regenerate. Among fibroblasts, mitotic cells were discovered. Swelling significantly decreased, although we have not seen abundant leukocyte infiltration in regenerate. A characteristic fea-ture was the discovery of large number of mast cells in granular tissue and in the der-mis of adjacent intact skin unlike in the control group, where they were more evident. Meanwhile, in the control group by 6th-9th day the affected area remained with swelling and neutrophilic infiltration of tissues, with the spread of necrotic changes of hypodermis and adjacent skeletal muscle in some cases, which can be interpreted as a sign of prolonged exudative phase of inflammation (Fig. 2).    Fig. 2 Boundary wounds' zone. 6th day of treatment. Neoangiogenesis. For-mation of delicate fibrous stroma. Coloration: hematoxylin and eosin, × 400.  Microcirculatory disorders were expressed in the form of venules plethora, phe-nomena of capillarostasis, erythrocytes hemolysis and regional clotting elements formed in venules and capillaries. Vascular network occupies 11,7±1,0%, but vascular loops were irregularly arranged and in different in size. At 15th day there was active epithelialization of the wound defect, and if at the edge of the deffect in control group there was not more than two layers of cells, in the main group up to 4 layers were found. A newly formed layer covered the wound sur-face from the preserved skin. Epithelium formed characteristic light layers of cells with broad cytoplasm. Fibroblasts with mitosis (Fig. 3) can be seen in the dermis.  169   Fig. 3 Boundary wounds' zone. 15th day of treatment. The initial (boundary) epi-thelization. Mature granulation with the presence of collagen fibers. Color: trichrome by G. Gömöri, × 400  The appearance of destruction and lysis of newly formed epithelium was ob-served in the comparison group, which we have not seen in the main group. The for-mation of granulation tissue in the control group in comparison is slow, in the form of amorphous formation of connective tissue, whereas in the main group, this process occurs uniformly throughout the lesion with the formation of classic granulation. Conclusions. 1. Under the local treatment of purulent necrotic processes of soft tissue in patients with complicated general condition in both groups we histologically determined reduction of edema, cellular infiltration, microcirculatory disorders in the marginal area of the wound in the dynamics of treatment. 2. Use of local sorbent-antibiotic composition reduced duration of exudation phase, actively reduced the wound surface and caused formation of new granulation tissue (p<0.05), no destruc-tion and lysis of newly formed epithelium was observed  Literature 1. Fonder M.A. Treating the chronic wound: A practical approach to the care of nonhealing wounds and wound care dressings / M.A. Fonder, G.S. Lazarus, A.J. Mamelak [et al.] // J. Am. Acad. Dermatol. – 2008. – Vol. 58, № 2. – P. 185-206.  2. Mekkes J.R. Causes, investigation and treatment of leg ulceration / J.R. Mekkes, M.A.M. Loots, A.C. van der Wal, J.D. Bos // British Journal of Dermatology. – 2003. – Vol.148. – Р. 388-401. 3. Morinо R.J. Interactive Dressings and Topical Agents / R.J. Morinо, N.L. Tomaselli // Clinics in Plastic Surgery. − 2007. − Vol. 34. − P. 643-658. 4. Puri V. Trophic ulcers – Practical management guidelines / Vinita Puri, N Venkateshwaran, Nishant Khare // British Journal of Dermatology. – 2012. – Vol.45. – Р. 340-351.  5. Skorkowska-Telichowska K. The local treatment and available dressings designed for chronic wounds / K. Skorkowska-Telichowska, M. Czemplik, A. Kulma, J. Szopa // J. Am. Acad. Dermatol. – 2011. – Vol. 6. – Р. е1-е10.    

MORPHOLOGICAL CHANGES IN PURULENT-NECROTIC PROCESSES OF SOFT TISSUES IN PATIENTS IN LOCAL APPLICATION OF SORBENT-ANTIBIOTIC COMPOSITION

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Цифровий Репозиторій - Інтелектуальні Фонди Буковинського державного медичного університету