RU2260461C1 - Method for carrying out primary surgical treatment of bacterially contaminated wounds in orbital and paraorbital region using photodynamic therapy techniques - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves treating wound surface with 0.1-2% aqueous solution of photosensitizing agent or photosensitizing gel based on hyaluronic acid viscoelastic selected from a group of chealon, viscoate or hyatulon containing photosensitizing agent in the amount of 0.1-2% by mass. A photosensitizing agent of chlorine row like one taken from a group composed of photolon, radachlorine or photoditazine, is selected as photosensitizer solution or gel. Scanning laser radiation is applied to wound surface after 30-90 min long exposure without access of light. Wavelength is equal to 661-666 nm during 2-5 min with total radiation dose equal to 30-100 j/cm². Then, wound mouth is sutured.

EFFECT: stable cosmetic and functional results.

Description

The invention relates to medicine, namely to ophthalmology, to methods of primary surgical treatment of bacterially contaminated wounds of the face in the orbital and paraorbital areas, as well as in other areas of the skin using photodynamic therapy.

There is a method of primary surgical treatment of bacterially contaminated wounds of the face, including in the orbital region, including necrectomy, surface treatment of the wound with an antiseptic substance, suturing with drainage of the postoperative space (see \ Manual on eye surgery \ under the editorship of M.L. Krasnov and V.S. Belyaev, Moscow, Mir, p. 594-595).

However, the known method in its use has the following disadvantages:

- low efficiency of elimination of bacterial contamination of wounds in the period of more than 6-12 hours after injury.

- a high risk of suppurative complications and, as a consequence, severe deforming scarring and unsatisfactory functional-cosmetic result after the initial surgical treatment.

The objective of the invention is to provide a method for the primary surgical treatment of bacterially contaminated wounds in the orbital and paraorbital regions using photodynamic therapy.

The technical result is the possibility of obtaining stable functional and cosmetic results when treating a wound at any time after an injury and at any degree of bacterial contamination, including wounds with signs of an inflammatory process.

The technical result is achieved by treating bacterially contaminated wounds of the face, including in the orbital and paraorbital areas using photodynamic therapy. The used method of photodynamic therapy allows you to directly target a bacterially contaminated wound, the basis of this effect is light-induced chemotherapy. Photodynamic therapy using chlorine-type photosensitizers allows earlier relief of perifocal inflammation and stimulation of proliferation and epithelialization of wounds. The antimicrobial effect of photodynamic therapy is associated with active selective accumulation of the photosensitizer and its potential for exposure to microorganisms. During laser irradiation of the photosensitizer, singlet oxygen is formed, which has a high oxidizing ability, as a result of which a destructive effect on the shell of the microorganism is realized. Chlorine-type photosensitizers generate singlet oxygen well, are relatively quickly excreted from the body (elimination half-life up to 3 hours) and have low phototoxicity (they react poorly with healthy tissue cells under the influence of radiation, which virtually eliminates the risk of photodermitis, PS-induced nephritis, hepatitis and t .d.).

The method is as follows. After necrectomy and treatment of the wound surface with an antiseptic substance and before suturing, the surface of the bacterially contaminated wound is treated with a 0.1-2% aqueous solution of a photosensitizer or a photosensitizing gel based on viscoelastic hyaluronic acid selected from the group of chealon, viscoate or hyatulone containing 0.1-2 % wt.% photosensitizer. As a photosensitizer of a solution or gel, a chlorine-type photosensitizer selected from the group of photolon, radachlorin or photoditazine is used. Then, after a 30-90-minute exposure and without light access, scanning laser irradiation of the wound surface with a wavelength of 661-666 nm is carried out for 2-5 minutes with a total radiation dose of 30-100 J / cm ² , after which the wound edges are sutured and drain the postoperative space.

Among the essential features characterizing the method of primary surgical treatment of bacterially contaminated wounds in the orbital and paraorbital areas using photodynamic therapy, the following are distinguishing:

- treatment before suturing the surface of a bacterially contaminated wound with a 0.1-2% aqueous solution of a photosensitizer or a photosensitizing gel based on viscoelastic hyaluronic acid selected from the group of chealon, viscoate or giatulon containing 0.1-2% wt. photosensitizer,

- the use as a photosensitizer of a solution or gel of a chlorine-type photosensitizer selected from the group of photolon, radachlorin or photoditazine,

- the implementation after a 30-90-minute exposure in conditions without access of light, scanning laser irradiation of the wound surface with a wavelength of 661-666 nm for 2-5 minutes with a total radiation dose of 30-100 J / cm ² .

Experimental studies of the proposed method for the primary surgical treatment of bacterially contaminated wounds in the orbital and paraorbital areas using photodynamic therapy in clinical conditions have shown the high efficiency of the proposed method. Moreover, a smooth uncomplicated course of the postoperative period and stable functional and cosmetic results were obtained in the treatment of various wounds in the orbital and paraorbital areas.

The implementation of the proposed method for the primary surgical treatment of bacterially contaminated wounds in the orbital and paraorbital regions is illustrated by the following clinical examples.

Example 1. Patient B., 48 years old, was admitted to the Kaluga branch of GU MNTK \ Eye Microsurgery \ with a diagnosis of: \ A softened wound of the right eyelid and temporal region with the presence of foreign bodies and purulent discharge \. Condition after agricultural injury 18 hours ago.

Conducted standard processing of the surgical field, local anesthesia, necrectomy and removal of foreign bodies. The wound surface was treated with a 0.1% aqueous solution of a photosensitizer - radachlorin. Then, after a 90-minute exposure under conditions without light access, scanning laser irradiation of the wound surface with a wavelength of 661 nm was performed for 2 minutes with a total radiation dose of 30 J / cm ² , after which the wound edges were sutured and the postoperative space was drained.

A smooth flow was obtained in the early postoperative period without inflammatory complications, the sutures were removed on the 7th day. In the distant postoperative period, a gentle normotrophic scar was formed. There is no deformation of the eyelid and palpebral fissure. The closure of the eyelids is complete. The observation period is 14 months.

Example 2. Patient M., 16 years old, was admitted to the Kaluga branch of GU MNTK \ Eye Microsurgery \ with a diagnosis of \ Chopped-bruised wound of the left superciliary region and upper eyelid with purulent discharge, extensive hematoma in the left orbit \. Condition after falling from the attic and hitting a corner of a metal object 32 hours ago.

Conducted standard treatment of the surgical field, local anesthesia and necrectomy. The wound surface was treated with a 2% aqueous solution of a photosensitizer - photoditazine. Then, after exposure for 30 minutes without access to light, scanning laser irradiation of the wound surface with a wavelength of 666 nm was carried out for 5 minutes with a total radiation dose of 100 J / cm ² , after which the wound edges were sutured and the postoperative space was drained.

A smooth flow was obtained in the early postoperative period without inflammatory complications, the sutures were removed on the 7th day. In the distant postoperative period, a gentle normotrophic scar was formed. There are no deformities of the eyelid, eyebrow and palpebral fissure. The closure of the eyelids is complete. The observation period is 12 months.

Example 3. Patient D., 28 years old, was admitted to the Kaluga branch of GU MNTK \ Eye Microsurgery \ with a diagnosis of: \ Multiple puncture wounds of the right brow, nose bridge, upper and lower eyelids OD with the presence of glass foreign bodies \. Condition after a car accident 38 hours ago.

Conducted standard treatment of the surgical field local anesthesia, necrectomy and removal of foreign bodies. The surface of the bacterially contaminated wound was treated with a photosensitizing gel based on viscoelastic hyaluronic acid — a chealon containing 0.1% wt.% Photosensitizer — photolon. Then, after a 30-minute exposure under conditions without light access, a transcutaneous scanning laser irradiation of the wound surface with a wavelength of 666 nm was performed for 2 minutes at a total radiation dose of 30 J / cm ² , after which the wound edges were sutured and the postoperative spaces were drained.

An uncomplicated course of the early postoperative period without inflammatory complications was obtained, the sutures were removed on the 7th day. In the distant postoperative period, tender normotrophic scars formed. There are no deformations of the inner corner of the eye, eyelids and eyebrows. The closure of the palpebral fissure is complete. The observation period is 12 months.

Example 4. Patient F., 26 years old, was admitted to the Kaluga branch of GU MNTK \ Eye Microsurgery \ with a diagnosis of: \ Torn wound of the lower angle of the lower eyelid with the presence of a wooden foreign body. Condition after household injury 28 hours ago.

Conducted standard processing of the surgical field, local anesthesia, necrectomy and removal of a foreign body. The surface of the bacterially contaminated wound was treated with a photosensitizing gel based on viscoelastic hyaluronic acid — a viscoatom containing 2% wt. Photosensitizer — radachlorin. Then, after a 90-minute exposure under conditions without light access, a transcutaneous scanning laser irradiation of the wound surface with a wavelength of 661 nm was performed for 5 minutes at a total radiation dose of 100 J / cm ² , after which the wound edges were sutured and the postoperative space was drained.

A smooth flow was obtained in the early postoperative period without inflammatory complications, the sutures were removed on the 7th day. In the distant postoperative period, a gentle normotrophic scar was formed. There is no deformation of the inner corner of the eye, the closure of the eyelids is complete. The observation period is 12 months.

Claims (1)

The method of primary surgical treatment of bacterial contaminated wounds in the orbital and paraorbital areas using photodynamic therapy, including necrectomy, treatment of the wound surface with an antiseptic substance, suturing with drainage of the postoperative space, characterized in that before the suturing, the surface of the bacterial contaminated wound is treated with 0.1-2 % aqueous solution of a photosensitizer or photosensitizing gel based on viscoelastic hyaluronic acid selected from a chealon, viscoate or giatulon group containing 0.1-2 wt.% photosensitizer, moreover, a chlorine-type photosensitizer selected from the group: photolon, radachlorin or photoditazine is used as a photosensitizer of a solution or gel, then after a 30-90 minute exposure Under conditions without light access, they perform scanning laser irradiation of the wound surface with a wavelength of 661-666 nm for 2-5 minutes with a total radiation dose of 30-100 J / cm ² , after which the wound edges are sutured.