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DOI: http://dx.doi.org/10.20534/ESR-16-9.10-112-114
Murodov Alijon Salimovich, Teshaev Oktyabr Ruhullaevich, Tashkent Medical Academy, Tashkent. Uzbekistan E-mail: saodat.us@mail.ru
Impact of photodynamic therapy and laser treatment on the planimetric figures of festering wounds in the experiment
Abstract:
Objective: assess the complex action of photodynamic therapy and C02 laser on planimetric figures purulent wounds in the experiment.
Materials and methods. purulent wound model reproduced in 80 male rats by MP Thick (2002) with some modification. Animals from the third day were divided into 4 groups: 1) 20 rats with physiological regeneration, 2) 20 rats with standard therapy, and 3) 20 rats PDT 4) rats 20 inclusion complex treatment with conventional methods, the C02 laser 3-4 times daily until the wound cleansing from necrotic raids and PDT. Studied plane geometry, healing time, peripheral blood counts and morphology of biopsies from the wound bed and the wall on the 1st, 3rd, 7th and 10th day of the experiment.
Results. Photodynamic therapy in a C02 laser complex was not sufficiently effective invasive treatment of purulent wounds and allows to recommend its use in clinical practice for the treatment of local purulent-destructive diseases of soft tissues. Complex application of PDT and C02 laser leads to an earlier cleansing from the pus, the active formation of granulation tissue and shortening deadlines complete epithelialization of the wound surface.
Conclusions: Complex treatment with C02 laser and photodynamic therapy is the most effective, as compared to other methods studied separately.
Keywords: purulent wounds, planimetry, laser, photodynamic therapy.
Despite the fact that the history of the issue of treatment of these pathologies has more than one decade, and to date has offered a large number of different methods, the problem of the effectiveness and speed of the results is still not resolved until the end. Bacterial contamination of the wound supports inflammation and slows down the course ofreparative processes [1,4]. An unsolved problem is the resistance of pathogens to antimicrobial therapy and the problem of hospital infections. In this regard, continued development of alternative technologies and practices in the local treatment of infectious diseases of the skin and soft tissues of different etiology [3; 5].
To resolve this problem in recent years successfully used laser photodynamic therapy [5; 6; 9; 12]. Photodynamic therapy is a relatively new method of treatment of purulent diseases, and is currently PDT has a high potential for its application in many clinical areas. In sensitized cells and tissues its develops a photochemical reaction with the release of singlet oxygen free radicals and highly active biological objects existing detrimental, in particular on tumor cells, microorganisms, and etc. [2; 3; 8; 10; 11].
Objective: To evaluate the effect of a complex of photodynamic therapy and C02 laser on the dynamics of planimetric figures festering wounds in the experiment.
Materials and methods. For experimental researches were used 80 white mongrel male rats. Purulent wound model reproduces all rats as recommended by M. P. Tolstyh (2002), with the introduction of some modifications. In pre-depilated and twice treated with antiseptics skin site of femoralgluteal region with a diameter of 2.5 cm, was excised skin and subcutaneous tissue to the superficial fascia, crush injuries and underlying muscles region, injected the 24-hour suspension of the mixture of microbes (museum strains of Staphylococcus aureus and Escherichia coli), containing in 1 ml 10 9 microbial cells in a volume of 2 ml. In order to create an impermeability, to prevent injury and contamination of the surrounding organisms to the edges of the wound stitched plastic ring with a side height of 1.2 cm and 2.5 cm in diameter, fixed ring with two sides, inserted into a dry sterile gauze ball and imposed suggestive nodal joints. Wherewith 2 rats died of generalized infection.
Impact of photodynamic therapy and C02 laser treatment on the planimetric figures of festering wounds in the experiment
Festering wounds in rats were formed after 48 hours and had all the classic signs of inflammation. Animals from the third day were divided into 4 groups depending on the treatment (Table 1). Photodynamic therapy (3rd group) were carried out after removal of the gauze ball and processing solution of hydrogen peroxide with the application of sterile gauze ball soaked 0.005% aqueous solution of methylene blue (MB) to the wound surface layer of 1-2 mm, with full closure of the wound surface. Then superimposed opaque bandage, after 30 minutes application irradiated
with installation FDI-1 with a power density of 200 mW/cm 2, with a duration of10 minutes on the field every day, a total of 6 sessions [10]. The animals of group 4 underwent complex treatment including conventional methods of C02 laser (JZ-3A) 3 times daily until the wound cleansing from necrotic raids, and photodynamic therapy in the same conditions. For morphological evaluation process of wound tissue samples taken, obtained from the bottom of the wound and the wall on the 1st, 3rd, 7th and 10th days after its application.
Table 1. - Groupings of animal
№ Monitoring groups Number of rats
1 Observing the natural course of wound healing 18
2 The traditional method of treatment (debridement, ceftriaxone, levomekol) 20
3 Study of the effect of photodynamic influence on the course ofwound healing 20
4 The influence of the traditional method of treatment in combination with C02 laser and photodynamic therapy on the course of wound healing 20
To assess the effectiveness of the treatment was carried out a thorough dynamic monitoring of the general state of the animals, the local course of the wound process, the progress ofwound healing. It has been observed and assessed the rate of contraction of the skin, the presence and disappearance of redness around the wound, the rate of primary and secondary scab, the nature of discharge from the wound — its color, smell, and amount. Watch for changes in the peripheral blood, a qualitative and quantitative change in the dynamics of microbial inoculation of the wound. The complex evaluation of the effectiveness of the treatment the following parameters were included: laboratory, thermometry, the nature and amount ofwound, planimetric (change in wound area), the timing ofwound cleansing, the time of appearance of granulation, as well as morphological and bacteriological parameters.
Digital material is treated by variational statistics.
Results and its discussion
Planimetry of lesions in experimental animals of all groups on the first day before the start of the treatment points to the expansion
of the focus of infection, accounting for 745±23.2 mm (Table 2). On examination, there was a moderate redness and swelling of the wound edges, the bottom was covered with a dirty grayish bloom. The surrounding tissues were lots diapedetic hemorrhage. In the dynamics of physiological regeneration we observed a gradual decrease in the size of the purulent center, while during the standard therapy showed a significant decrease in their in 1.17; 1.27 and 1.45 times the value of the 1st group of animals, respectively maturity at 3, 7 and 10 days of starting treatment. Carrying only photodynamic therapy (group 3) also noted a decrease in wound area of 1.24; 1.33 and 1.52 times, respectively, with respect to the parameters of group 1, and was not significantly different from that of the group of rats treated with conventional treatment. Earlier healing purulent focus observed in the 4th group with a combination of C02 laser and photodynamic therapy: focus area decreased to 1.9; 2.41 and 4.78 times the performance of group 1; 1.62; 2.41 and 3.3 times as compared with the 2nd group; 1.52; 1.81 and 3.14 times — compared with the values of the third group of rats, respectively terms.
Table 2. - Indicators planimetry (mm2) of purulent lesions in the dynamics of treatment, M±m
Groups Dates of researches
Until treatment On the 3rf day On the 7th day On the 10th day
1 745±23.2 723.0±19.0 661.5±15.9 a 581.4±11.3 a
2 745±23.2 619.0±16.1 a- b 518.8±17.1 a, b 401.3±10.3 a, b
3 745±23.2 581.6 ±10.2 a' b 495.8±6.8 a, b 381.8±8.3 a, b
4 745±23.2 381.6±8,3 a' b' c' d' 274.6±9.1 a, b, c d 121.6±3.6 a, b, c, d
In the animals of the 1st group who did not receive treatment, cleansing the wound surface from necrotic masses observed for 17 days (16,5 ± 0.7 days) in group 2 — to 10-th day (9.4 ± 0.8 days), group 3 — to day 7 (6.3 ± 0.8 days), whereas animals of group 4 — to 6th day from the start of treatment (5.2 ± 0.9 days). According to the results of our research, filling the wound with granulation tissue was observed in the animals of group 1 to the beginning of the 4th week (23.6 ± 1.1 day), the 2nd group — to the beginning of the third week (15.1 ± 0.9 days) in group 3 — on the 9th day (8.8 ± 0.9 days), and in the rats of group 4 — to 7th day (7.1 ± 0.3 days) from the start of treatment.
As can be seen from the above data, the animals of group 4 of the wound surface area decreased more rapidly contracting and granulation wounds observed faster than in the other groups. This proves that the combined application of traditional methods of treatment sessions with C02 laser and photodynamic therapy is the most effective, as compared to other methods studied separately.
The results suggest greater effectiveness of this method of exposure to destructive purulent wounds as compared to other treatments studied. When exposed to light of a specific wavelength and photo sensitizers energy begin to produce singlet oxygen and other reactive oxygen species that cause oxidative damage to various molecules (proteins, unsaturated fatty acids, nucleic acids), and cell structures (membranes, enzyme systems, genetic apparatus, and etc.), that entails inactivation of pathogens [9; 10; 11]. Experimental and clinical studies have shown that primary target of PDT in vivo is the vascular system, namely the endothelial cells of the capillary network [7; 8; 11]. It can be assumed that the violation of perfusion with hypoxemic subsequent necrosis is an important goal of cell death in addition to the direct damage to cellular structures [13; 14].
Conclusions
1. Photodynamic therapy in a complex with C02 laser was not sufficiently effective invasive treatment of purulent wounds and al-
lows recommending its use in clinical practice for the treatment of local purulent-destructive diseases of soft tissues.
2. The results showed that the planimetric study with the use oflaser photodynamic therapy photo sensitizer methylene blue and
C02 laser contributes to shortening of clearance of the wounds from necrotic deposits, the appearance of granulation, epithelialization beginning.
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DOI: http://dx.doi.org/10.20534/ESR-16-9.10-114-116
Murodov Alijon Salimovich, Tashkent Medical Academy Department of surgery for GP E-mail: saodat.us@mail.ru
Application of photodynamic therapy and laser in the treatment of infected and purulent wounds
Absctract:
Objective: to evaluate the complex action of photodynamic therapy and C02 laser in the treatment of infected and purulent wounds.
Materials and methods. Depending on the treatment, the patients were divided into 3 groups: group 1 (control group) included 26 patients who were held traditional conventional methods; in the 2nd group (main group) of 30 patients, which in combination with traditional methods applied PDT treatment with 0.05% methylene blue buffered saline and C02 laser (if necessary).
Results. Photodynamic therapy in a C02 laser complex was not sufficiently effective invasive treatment of purulent wounds and allows to recommend its use in clinical practice for the treatment of local purulent-destructive diseases of soft tissues. Complex application of PDT and C02 laser leads to an earlier cleansing from the pus, the active formation of granulation tissue and shortening deadlines complete epithelialization of the wound surface.
Conclusions: Complex treatment with C02 laser and photodynamic therapy is the most effective, as compared to other methods studied separately.
Keywords: purulent wounds, infected wounds, laser, photodynamic therapy.
Treatment of purulent — inflammatory processes of soft tis- The primary structure of the total consulting in general surgery
sues is one of the long-studied topic in Medicine, however, still re- frequency surgical skin and soft tissue infections reaches 20 to 70% mains an urgent problem surgery [4]. According to the literature, the [5; 8].
number of patients with acute purulent soft tissue diseases is among Despite the fact that the history of the issue of treatment of
the surgical patients 30-60% [1]. these pathologies has more than one decade, and to date has
