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BÎCHHK Украгнсъког медичног' cm оматолог in ног' академИ'
УДК 617-002.3-073.173
LIQUID VOLUMETRIC VULNEROMETRY AND CRITERIA OF VULNEROMETRICAL ESTIMATIONS OF THE WOUNDS Gerych I.D., Dvorchyn O.M.,-Dvorchyn N.O., Stoyanovsky I.V.
1. Danylo Halytskyi Lviv National Medical University
2. Lviv Communal Emergency Care Clinical Hospital (LCECCH)
The method of liquid volumetric vulnerometry (LVV) is a modern standard of a quantitative estimation of volume of a complicated surgical wound. The volume of a wound was measured by the method of LVV at 32 patients. They were operated of the general surgery clinic concerning an acute purulent septic pathology. The developed method of LVV enables: to measure volume of a wound of different localization, the form, a configuration, the area and depth; to monitor dynamics of change of volume of a wound during healing process; to estimate quantitatively a wound for digital vulnerological criteria: "gradient changes of volume of a wound" (AV), "volumetric speed of healing of a wound " (bv).
Key words: volume of a wound, the area of a wound, gradient changes of volume of a wound, volumetric speed of healing of a wound, plane speed of healing of a wound, liquid volumetric .
Introduction.
Surgery is known to differ from other fields of medicine primarily in that it is based on the employment of operative methods of treatment. Surgery is a unique treatment which includes both infliction of a wound (Wd) and, on the other hand, the operation as means of treatment for various Wd's. Although this fact is of general acceptance, it allows to underscore the significance of Wd investigations and peculiarities of the course of wound process (WP) as both the cause and the results of the surgical treatment [1, 2].
The problem of Wd healing and treatment still remains as one of the most emerging problem in current surgery [3, 4]. Permanent attention to this problem can be explained by the fact that the WP concept has been changing with the development of surgery and adjacent sciences [5, 6, 7].
During the last year, the concept of Wd treatment has considerably changed under the influence of the following developments [4, 8, 9]:
1) Advancements in pathophysiology, histochemistry and electronic microscopy have made the notion of WP more profound and, in particular, have shown a significant role of different previously unknown biological substances in Wd necrosis and reparation processes;
2) Discovery and wide application of antibiotics have considerably extended possibilities of prevention and treatment of wound infection; however, biological properties of microbial agents have also undergone significant changes;
3) Extensive employment of xenobiotics, hormones, and other biologically active substances have changed protective reactions of the organism to trauma and wound infection.
These developments have underlined the necessity of a more profound, detailed investigation of the WP to be conducted according to the high standards of modern surgical sciences.
Another significant argument in favour of thorough vulnerological investigation of the WP is a steady high incidence of the specific subgroup of Wd's, caused by surgical infection, and unfavourable results of its treatment [3, 4].
At present 35 to 40 % of surgical patients are presented with purulent inflammatory diseases
[3, 10, 11]. Postoperative purulent complications develop in approximately 30 % of cases (from 2 % to 70 %, depending of the disease type). Mortality rate associated with infectious complications is a high as 42 - 60 % of the overall lethal cases in surgical departments [12, 13].
Increased numbers of purulent diseases and postoperative purulent complications, the ever growing incidence of generalized infection [15, 16] alongside with untisatisfactory results of treatment for this pathology signify that the problem of purulent infection in surgery remains unsolved, becoming the problem of a great social-economic significance in our country [17, 18, 19].
To estimate efficiency of treatment of the Wd's caused by various damaging factors and to determine the course of WP in different surgical pathologies, a lot of vulnerological methods are being currently employed, including: clinical, bacteriological, cytological, and instrumental [20, 21, 22]. However, these methods are mainly used for scientific purposes. In practical surgery, the WP is usually estimated ad oculus on the basis of generally accepted clinico-morphological criteria [16, 23]: perifocal inflammation, Wd cleaning, formation and filling of the Wd with granulations, contractation of the Wd, and Wd edge epithelization.
Even superficial analysis of the foresaid methods allows confirmation of their main pitfalls: they are qualitative indicators based on the number of subjective estimations of different WP components.
Objective parameters of the course of WP have been studied less thoroughly. They include: plani-metric methods [16, 22, 23, 24, 25]; definition of pH in the wound content [10, 16, 23, 24]; and cytological investigation of the Wd [16, 24, 25].
Historical reference.
Clinical methods that imply elucidation of the objective parameters of Wd healing estimation deserved considerable attention. Measurement of the Wd area, or planimetry, is a vulnerological method most frequently used for monitoring of the WP course. Many different planimetric methods are used in clinical practice [16, 23, 24].
Among the known methods used to measure the wound area is Wd measurement by Popova's test
(1942) as follows [16, 23, 26]. The Wd contours are run on a sterile cellophane film and the Wd area is calculated by means of millimeter paper. In 6 - 10 days, the Wd surface is measured again. Percentage of decrease in the Wd area is calculated by the formula: (S - Sn) ■ 100 / (S ■ t), (1) where S - value of the Wd area at the time previous measurement;
Sn - value of the Wd area at the moment of actual investigation; t - number of days between measurements. For planimetric estimation, Y.V. Kuleshov, K.V. Povorinskaya (1971) used the method of repeated photography of the Wd covered with a millimeter net [16, 24]. Having compared the repeated Wd photographs with the calculated area, the authors determined percentage of decrease in the Wd area by Popova's formula.
V.F. Chotinyan (1983) suggested the principle of Wd area measurement by the formula [16, 25]: S = (L / 4) ■ (K - C), (2) where S - area of the Wd; L - perimeter of the Wd measured by the KU-A curvimeter;
R - ratio of regression (for the Wd's, approximating by the form to square,
K = 1,013, forthe Wd's of irregular contours K = 0,62);
C - a constant (for Wd's approximating by the form to square, C = 1,29; for Wd's of irregular contours C = 84,3).
V.I. Rusakov (1977) used a sterile X-ray film on which the Wd was outlined with a pencil of the "glass-graphic" type, then part of the film with Wd contours was cut out and weighed [24, 25]. The Wd area was calculated by the mass of cut-out film. Daily speed of Wd healing was determined by Pop-ova's formula.
T.D. Zyryanova and co-authors (1977) developed the method based on dynamic weighing of Wd area outlined on a tough high-density polyethylene film (GOST 16338-70): stable mass of the cut-out Wd contours, due to the hydrophobic property of the film, permitted to reduce a probable error of the method to 3 % [16, 25].
V.S. Peshchanskiy (1977) and A.B. Shneider (1983) improved Popova's test, having suggested a mathematic model of the dynamics of Wd healing per unit of time, calculated by the formula [16, 24]: Y = (So - St) / So, (3) where Y - value of the relative healing;
So- initial area of the Wd;
St - area of the Wd on the day of measurement.
Multiplicity of Y values received during the entire period of investigation in the system of rectangular co-ordinates made of a multiplicity of dots which, af-
ter the graphic processing, acquired form of the curve of functional dependence between Y and t values. This correlation was interpreted by the authors as a specific mathematic model of Wd healing.
For complex investigation of the WP course, A.A. Yefimov (1975) suggested a method of "indian ink plates", consisting of several rows of marks made by sterile indian ink on the skin around the Wd at a definite distance from its edges [16, 25]. The speed of decrease in the distance between the marginal marks and center of the Wd served as an index of the actual rate of contraction dependent of the transition of intact surrounding skin and the included growth of cells. The speed of epithelization was determined by the dynamics of increase in the distance between marginal marks and central edge of regenerating epithelium.
All the enumerated methods have a significant disadvantage in that only the Wd area in dynamics was taken into account whereas changes in the Wd depth volume in the process of healing were impossible to assess.
To improve the quantitative estimate of Wd area of any size and form, new methods were developed where not only changes in the Wd area but also alterations of the Wd depth were addressed [27, 28]. Such is the method of Wd volume measurement by means of a three-dimensional ruler that implies application of the probe, designed for this specific purpose and computer processing of the numeric and graphic data (computer program "Wound-graph", @ I.D. Gerych , D. Korshevnyuk, 1994). The defect of this method is its limited applicability: it can be used only for monitoring of the Wd's of geometrically regular forms.
The Wd volume measurement by means of computer scanning is also employed [23, 29, 30]. This method, however, is inapplicable for measurement of deep Wd's of large areas and tissue defects localized on the convex surfaces of the body.
Since current methods of vulnerology are far from perfect and methods of precise objective measurement of the Wd's of any size and form are absent, the purpose of our research was determined by the necessity of developing a new method of quantitative estimation of the complicated Wd volume and to monitor applicability and efficiency of the method for objective evaluation of the Wd and the course of Wd healing.
Materials of the research.
Thirty-two patients, treated for acute purulent-septic pathologies from August 1, 2002 to May 1, 2003 at the second surgery department of LCECCH, were entered into the research.
Grouping of the assessed patients by the age and sex is presented in Table 1.
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Table 1
Age and sex of the patients
Age (years) Males Females Total number Male / female correlation
n % n % n %
18-20 2 6.3 1 3.1 3 9.4 2 : 1
21-30 1 3.1 6 18.8 7 21.9 1 : 6
31 - 40 4 12.5 4 12.5 8 25 1 : 1
41- 50 5 15.6 - - 5 15.6 -
51 - 60 4 12.5 - - 4 12.5 -
over 60 2 6.3 3 9.4 5 15.6 1 : 1.5
Total 18 56.3 14 43.7 32 100.0 1.3 : 1
As listed in the table, males outnumbered females (18; 56.3 %) among the assessed patients. The male-female correlation was 1.3:1. The patients' ages ranged between 18 and 74 years (males - from 18 to 74 years, females - from 20 to 72 years). Mean age in males was 44.8 ± 3.51 years (min - 18, max - 74), in females - 37.0 ± 4.63 years (min - 20, max - 72), in the whole group
- 41.4 ± 2.87 years (min - 18, max - 74). It should be noted that in the age group of 21 to 30 years, females outnumbered males with the correlation of 6:1. The peak morbidity fell on the age periods from 21 to 30 and from 31 to 40 years.
Data on the duration of the disease by the time of admission are summarized in Table 2.
Table 2
Duration of the disease by the time of admission
Duration of the disease (days) Number of patients
n %
up to 3 5 15.6
4 - 7 13 40.6
8 - 14 7 21.9
over 14 7 21.9
Total 32 100.0
In general, mean duration of the disease by the time of admission was 10.6 ± 1.29 days. Data listed in the table show that only 5 (15.6 %) of patients were hospitalized within three days from the onset of the disease that enabled a timely initiation of treatment. Almost half of the assessed (43.8 %) were hospitalized 7 days later, including 7 (21.9 %) of patients admitted two weeks past the onset.
All the patients were hospitalized for purulent-septic pathologies. Summarized data on the structure of purulent-septic pathology of the patients are presented in Table 3.
Table 3
Structure of purulent-septic pathology
Nosology Number of patients
n %
Abscess 18 56.25
Phlegmon 4 12.5
Carbuncle 3 9.375
Abscessing lymphadenitis 2 6.25
Purulent bursitis 2 6.25
Others 3 9.375
Total 32 100.0
As it is shown in the table, abscesses (18; 56.25 %) were prevailing in the structure of purulent-septic pathology (PSP). Of them, most frequent were postinjection abscesses which incidence was as high as every other case (9 patients; 50 %). Their genesis was mainly associated with the pre-muscular injections of antiinflammatory agents (sodium diclofenac), magnesium sulphate, vitamins (B1, B6, B12, PP). As to place of origin, they were localized as follows: abscesses of the left buttock - in 5 (27.8 %) of patients, abscesses of the right buttock - in 5 (27.8 %) cases, abscesses of the abdominal wall - in 4 (22.2 %), abscesses of other lo-
calizations - in 4 (22.2 %) patients.
In the structure of purulent-septic diseases (PSD), phlegmons and carbuncles ranked second and third, respectively; with phlegmon localized in the areas of the right forearm, right upper arm, left buttock and right foot (4 cases; 12.5 %) and carbuncles - on the back, right thigh and left buttock (3; 9.375 %). Other pathologies encompassed purulent bursitis of the right and left knee joints (2 patients; 6.25 %), dextral purulent inguinal lymphadenitis and abscessing lymphadenitis of the left thigh (2; 6.25 %), dextral purulent mastitis (1; 3.125 %), acute hypodermic paraproctitis (1; 3.125 %) and a
purulent wound in the lumbar-sacral area (1; 3.125
After the conventional preoperative examination and standard preoperative medication aimed at correction of significant disorders in the homeostasis
Postoperative treatment was conventional and encompassed: infusion detoxication therapy; antibiotic therapy (most frequently - 3rd generaton cefa-losporins, namely, cefotaxim, ceftriaxon and others, fluorine-chinolons: ciprofloxacin, pefloxacin and others, or combination of the drugs of cepha-losporin series with fluorine-chinolons); non-steroid anti-inflammatory preparations (sodium diclofenac, naclofen and others); anesthetics (ketorolac, analgin, tramadol and others); disaggregants (pentoxi-fillin, aspirin etc.).
Local treatment for the postoperative Wd's correlated with the phase of WP course:
1) in the phase I - daily sanation of wounds with the solutions of antiseptics, in particular, furacillin, 3 % solution of H2O2, solutions of preparations with iodine as an active principle (iodinedicerine) and polyvinylpyrolidon-iodine (betadin, iodobac), and ointments on the water-soluble basis (levosin, levomecol, dioxisole, oflocain);
2) in the phase II - ointments on the liposoluble basis (tetracycline, gentamicin, polymixin) and preparations stimulating metabolic processes and tissue regeneration (methyluracil, mefenate, ac-tovegin, solcoseril);
3) in the phase III - ointments stimulating and regulating reparative processes in the wound that provide optimal conditions for reorganization of the scar (pantestin, pantenol, dermopanten, septalan).
In 2 (6.1 %) of patients who had been primarily operated on for prepatellar purulent bursitis and purulent Wd of the lumbar-sacral area, respectively, after the Wd cleaning, surgical intervention was repeated for plasty closing of the Wd defect.
Major pathology in the assessed group was not accompanied by local complications. No lethal outcomes were observed.
After the treatment had been completed, all patients were given corresponding instructions and discharged from the hospital in a satisfactory condi-
system, all patients were operated on under the intravenous anesthesia.
Findings on the type and volume of operations in the assessed patients are listed in Table 4.
Table 4
Structure of surgical interventions
tion. Mean bed day index was 17.2 ± 2.55 (min - 5, max - 40) in males, 12.0 ± 1.65 (min - 4, max - 24) in females, and in the assessed group as a whole -14.9 ± 1.65 (min - 4, max - 40).
Methods of the research. T he following methods were used: general clinical methods (complaints, anamnesis of the disease, common clinical symptoms, routine physical examination: palpation, percussion, auscultation and others, classic clinical signs of the PSP), laboratory-biochemical tests (general blood analysis and uri-nalysis, blood sugar, biochemical blood analysis, coagulogram), instrumental investigations (ultrasonography, scanning radioscopy, scanning radiography of the thoracic organs, electrocardiography, reovasography, dopplerography, determination of the external respiratory function), vulnerological methods (estimation of the WP course by the standard clinico-laboratory criteria, determination of pH in the Wd excudate by virtue of indicator papers of the "Lachema" firm, cytological examination of Wd's by D.M. Shteinberg's method, wound area measurement by the modified Popova's test), and statistical methods of investigation.
Volume of the Wd was measured by the method of liquid volume vulnerometry - the LVV method invented by the author.
Method of LVV.
The essence of LVV is measurement of the Wd volume by the amount of liquid injected into the cavity of Wd sealed hermetically with a sticky film.
The procedure was performed as follows. In the dressing ward, aseptic bandage was taken off the Wd of a given localization, form, area and depth (Fig.1) and newly bandaged in a standard way.
Volume of surgical interventions Number of interventions
n %
ISD of abscess 17 53.1
ISD of phlegmons 4 12.5
ISD of carbuncle + necrectomia 3 9.4
ISD of purulent bursitis 2 6.25
ISD of abscess + lymphadenectomy 2 6.25
Other operations 4 12.5
Total 32 100.0
Note. ISD - incision, sanation, drainage.
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Fig.1 Schematic representation of the typical explored Wd
Skin around the Wd was treated with a cotton ball soaked in alcohol. Pathological exudate was evacuated from the Wd surface. The Wd cavity was bathed with the solution of antiseptics (hydrogen peroxide, furacillin) and dried with a sterile gauze napkin. Colour of the skin edges, presence of local edema, character of pathological exudate, degree of focal necroses, presence of granulations in the Wd, activity of epithelization processes were evaluated ad oculus.
Having taken into account localization and size of the Wd, degree of the skin edge afflictions, and character of Wd exudate, from the uniform package of "Duoderm", a piece of sterile transparent sticking film was cut out by the configuration of the Wd to overlap it completely in length and width. In case of contra-apertures alongside with the major Wd, similar segments were cut out for them too, thereby overlapping additional incisions. After the protective covering was taken off from the film, the latter was tightly stuck to the skin by the Wd perimeter. The stage of hermetical sealing with a sticking film is pictured schematically in Fig.2.
Fig.2 Stage of hermetical Wd sealing with a sticking film
In the central part of the film, in Wd projection, an opening of up to 4 mm in diameter was cut out with sterile scissors. A sterile polychlorvinyl tube of 20 to 40 cm long (dependent of the Wd depth) and 3 to 4 mm in diameter was introduced into the Wd cavity through the opening in the film.
In the central part of the film, in Wd projection an additional opening of 3 mm in diameter was cut out at the distance of 2 cm from the previous one. Another sterile polychlorvinyl tube was introduced into
the Wd (2 cm deep from the surface of the film) to let the air out. Fig.3 presents a schematic picture of the Wd with both drainage tubes introduced.
Fig.3 Schematic representation of the Wd with both drainage tubes introduced
To fill up the Wd cavity with the solution, a sterile syringe of 20 to 50 ml capacity was used. For precise measurement of a small volume Wd, a sterile insulin syringe of 1 ml capacity, graduated in 0.1 ml was employed. The syringe with sterile 0.9 % physiological solution of natrium chloride was connected to the polychlorvinyl tube and the Wd cavity filled up with the solution. Appearance of a liquid meniscus in the tube for air passage indicated that the Wd was completely filled with the solution. Volume of physiological solution of natrium chloride in the Wd cavity was noted and treated as a numerical analogue of the Wd volume. After the measurement was completed, construction elements were taken away and an appropriate agent of local therapy and corresponding dressing material used for the Wd to be bandaged. Monitoring was performed in dynamics at definite periods of time after the operation, with the indexes of dynamics being statistically and graphically analyzed. Absolute volume of a Wd (V -cm3), gradient changes of volume of a Wd (AV) and volumetric speed of healing of a Wd (uV) were measured.
So, AV was determined in our research as the difference between the absolute values of the previous and succeeding measurements of the Wd and calculated by the formula:
AV = V1- V2, (1)
where AV - gradient changes of volume of a Wd;
V1 - volume of the Wd at time of previous measurement;
V2 - volume of the Wd at the moment of actual measurement.
Since AV applies to one interval of time between the previous and the following measurements, this index can be treated as a specific volumetric speed of Wd healing, calculated per one period of the investigation.
uV of the Wd healing was determined as the ratio of AV expressed in cm3 to the length of time between the two successive measurements of the volume (T) - in days. This index calculated by the formula:
Uv= AV / T, (2)
where uV- volumetric speed of healing of a Wd;
AV - gradient changes of volume of a Wd; T - interval of time between the two successive measurements: T = t1 - t2, where t1 - time of the previous measurement;
t2- time of the following measurement. Variation-statistical processing of the anamnestic, clinical, laboratory-biochemical data and results of additional investigations was curried out with a personal computer by means of the sets of applied programs for statistical analysis of the data of medico-biological examinations: "Statgraphics" (Manu-gistics, Inc.,1992) and "Instat" (GraphPad Software Inc., 1993).
Results and discussion. Results of the Wd volume measurement are plotted in Graph 1. Graph 1
Volume of the wound (cm3)
Postoperative days
As shown in the graph, mean value gradient changes of volume of a Wd in the assessed patients was high during the 1st - 4th day and equaled: 13.3 ± 0.86 cm3 (min - 6, max - 20) on the 1st day, 11.0 ± 0.84 cm3 (min - 4, max - 18.5) - on the 4th day. Within the 7th - 10th days, the Wd volume reduced: 8.6 ± 0.77 cm3 (min - 2.5, max - 16) - on the 7th day, 6.7 ± 0.71 cm3 (min - 1.5, max - 14) -on the 10th day. Thus, within the 1st - 10th days the Wd volume decreased that was evidence of the healing process efficiency. Within the 13th - 16th days, gradient changes of volume of a Wd decreased more gradually: 6.1 ± 0.73 cm3 (min - 0.5, max - 10) on the 13th day, 5.2 ± 0.54 cm3 (min -2.5, max - 8.5) - on the 16th day that indicated the reduced rate of reparative processes in the Wd. Within the period of from the 16th to the 21st day, another noticeable decrease was monitored in the gradient changes of volume of a Wd: 5.2 ± 0.54 cm3 (min - 2.5, max - 8.5) - on the 16th day, 3.9 ± 0.59 cm3 (min - 1.5, max - 6) - on the 19th day, 2.7 ± 0.57 cm3 (min - 0.8, max - 4) - on the 21st day.
On the whole, characterizing results of the research, we can state that during the healing process the curve of the Wd volume change declined in a plateau-like manner: it displayed a 50 % decrease by the 10th day, and 80 % decrease - by the 21st day.
Results of measurement of the Wd area are plotted in the Graph 2.
Graph 2
the Wd area in the assessed patients was high during the1st - 4th days and equaled: 1394.2 mm2 on the 1st day, 1202.8 mm2 - on the 4th day. Within the period of from the 7th to the 10th day, gradual decrease in the Wd area was observed: 1005.2 mm2-on the 7th day, 854.9 mm2 - on the 10th day. From the 10th to 13th day, a slight increase in the numeric values of the Wd area was monitored: 854.9 mm2 -on the 10th day, 911.9 mm2 - on the 13th day that was evidence of the reduced rate of reparation processes. Within the 16th - 19th days, numeric values of the Wd area remained almost unaltered: 757.7 mm2 - on the 16th day, 724.4 mm2 - on the 19th day. From the 19th to 21st day, the Wd area reduced intensely: 724.4 mm2 - on the 19th day, 203 mm2 - on the 21st day that reflected a high rate of Wd healing, apparently at the account of the process of spontaneous contractation [7, 10].
On the whole, evaluating results of Wd area measurements it is necessary to underscore that during the process of healing the curve of changes in the Wd area was sinusoidal by character: it declined from the 1st to the 10th day (1394.2 - 854.9 mm2), rose insignificantly from the 10th to 13th day (854.9 - 911.9 mm2), declined from the 13th to the 16th day (911.9 - 757.7 mm2), remained at the same level - from the 16th to the 19th day (757.7 -724.4 mm2), and declined intensely from the 19th to the 21st day (724.4 - 203 mm2).
Comparing the WP peculiarities, determined by the volumetric and planimetric metods, with those determined by means of planimetric methods, the following principal differences were established: reparative processes in the Wd assessed by the Wd volume were of linear-regressive character whereas their interpretation by the Wd area was of sinusoidal character.
Results of measurement of volumetric speed of healing of a Wd per period of time are presented in the Graph 3.
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Graph 3
Volumetric speed of healing of a wound (cm3/period)
-•—Mean • Minimum index A ' Maximum index
1-4 4-7 7-10 10-13 13-16 16-19 19-21
Postoperative days
As the given graph shows, mean volumetric speed of healing of a Wd per period of time was high in the assessed patients during the 1st - 4th days and 7th - 10th days and equaled: 2.2 ± 0.17 cm3/period (min - 1, max - 5) from the 1st to 4th day; 2.4 ± 0.18 cm3/period (min - 1, max - 5) -from the 4th to 7th day; 2.3 ± 0.17 cm3/period (min -0.8, max - 5) - from the 7th to 10th day, that was evidence of the intense Wd healing. During the 10th - 13th days and 13th - 16th days, the volumetric speed of Wd healing was monitored to decrease: 2.2 ± 0.2 cm3/period (min - 0.5, max - 4) on the 10th - 13th days, 2.1 ± 0.17 cm3/period (min - 1, max - 3) on the 13th - 16th days that manifested the reduction of reparative processes in the postoperative Wd. During the periods of 16th - 19th days and 19th - 21st days the index of Wd healing volumetric speed remained at a constant level: 2.1 ± 0.18 cm3/period (min - 1.5, max - 3) on the 16th - 19th days, 2.0 ± 0.38 cm3/period (min - 0.7, max - 3) on the 19th - 21st days.
In general, evaluating results of the measurement of the volumetric speed index of Wd healing per period of time, it can be stated that during Wd healing the curve of the volumetric speed change was of linear character: it was high from the 1st to the 10th day (2.2 - 2.4 cm3/period), slowed down - from the 10th to the 16th day (2.2 - 2.1 cm3/period), and remained at the same level - from the 16th to the 21st day (2.1 - 2.0 cm3/period).
Results of measurement of the plane speed of healing of a Wd per period of time are plotted in the Graph 4.
Graph 4
As can be seen from the graph, mean plane speed of healing of a Wd per period of time was high in the patients during the 1st - 4th days, the 4th - 7th days, the 7th - 10th days and 10th - 13th days and equaled: 181.4 mm2/period within the 1st - 4th
days, 184.8 mm2/period within the 4th - 7th days, 164.9 mm2/period within the7th - 10th days, 187.6 mm2/period within the10th - 13th days that was evidence that the course of reparative processes in the Wd was intense. During the periods of from 13th - 16th days and 16th - 19th days, the mean plane speed of Wd healing was observed to decrease (187.6 - 128.1 mm2/period) that was indicative of the reduction of healing process. Within the 16th - 19th days and 19th - 21sfdays the given index rapidly decreased: 108.3 mm2/period - within the 16th - 19th days and 41.0 mm2/period - within the
19th - 21st days
Thus, summarizing the expounded, we can state that during the period of Wd healing, the curve of change in the plane speed was sinusoidal by character: it was high from the 1st to the 7th day (181.4 -184.8 mm2/period), slowed down from the 7th to 10th day (184.8 - 164.9 mm2/period), intensified again from the 10th to the 13th day (164.9 - 187.6 mm2/period), reduced from the 13th to 16th day (187.6 - 128.1 mm2/period), and sharply decreased
from the 16th to the 21st day (128.1 - 41 mm2/period).
Results of measurement of the volumetric speed of healing of a Wd per day are presented in the Graph 5.
Graph 5
st
Volumetric speed of healing of a wound (cm /day)
2 1,5
1
0,5 04
—Mean
Mnimumindex A ' Maximumindex
1-4 4-7 7-10 10-13 13-16 16-19 19-21
Postoperative days
As it is shown on the graph, mean volumetric speed of healing of a Wd per day in the assessed group of patients was high within the 1st - 4th, 4th -7th and 7th - 10th days and equaled: 0.75 ± 0.06 cm3/day (min - 0.3, max - 1.7) from the 1st - 4th day, 0.81 ± 0.06 cm3/day (min - 0.3, max - 1.7) within the 4th - 7th days, 0.77 ± 0.06 cm3/day (min -0.3, max - 1.7) within the 7th - 10th days that on the whole confirmed a specific dynamics of reparative processes in the Wd, determined by the LVV method. Within the 10th - 13th and 13th - 16th days the volumetric speed of Wd healing remained at the same level: 0.72 ± 0.06 cm3/day (min - 0.2, max -1.3) within the 10th - 13th days, 0.7 ± 0.06 cm3/day (min - 0.3, max - 1) within the 13th - 16th days that reflected spontaneous reduction of the intensity of reparative processes in the postoperative Wd. Within the 16th - 19th and 19th - 21st days the volumetric speed of Wd healing was observed to increase: 0.69 ± 0.06 cm3/day (min - 0.5, max -1.0) within the 16th - 19th days, 0.74 ± 0.15 cm3/day
- within the19th - 21st days.
Special emphasis should be laid on the dynamics of change in the Wd healing volumetric speed under two, typical of clinical practice, variations of the WP course: favourable and unfavourable.
Thus in the favourable course of Wd reparation processes (classic duration of WP stages, absence of inflammatory-infectious Wd complications), the indexes of Wd healing volumetric speed within the 1st - 10th days were the highest and remained at the level of 1.7 cm3/day. Then during the period of from the 10th to 16th day, the volumetric speed of Wd healing was determined to display linear decrease of from 1.7 to 1.0 cm3/day and this index remained unaltered by the time the reparative processes in the Wd completed (16th - 21st days).
In the case of unfavourable course of Wd healing
- altered duration of classic stages of the Wd healing process, development of perivulnerary complications - the dynamics of change in the Wd healing volumetric speed was radically different. Thus, from the 1st to the 13th day, the Wd healing volumetric speed was not high, ranging between 0.3 and 0.2 cm3/day and displaying the tendency to a slight decrease. After the WP transition to the reparation phase, a peak-like increase in the Wd healing volumetric speed was observed to occur from the 16th to the 19th day (from 0.2 to 0.5 cm3/day) with a rapid decrease in the period of final healing (19th -
21st days).
Results of measurement of the plane speed of healing of a Wd per day are presented in the Graph 6.
Graph 6
Plane speed of healing of a wound (mm/day)
80 70 60 с 50 8 40 S 30 20 10 0
4-7 7-10 10-13 13-16 16-19 19-21 Postoperative days
As it is shown on the graph, the mean plane speed of healing of a Wd per day was high in the
assessed patients during the 1st - 4th and 4th - 7th
days and equaled: 60.5 mm2/day within the1st - 4th days, 58.5 mm2/day within the 4th - 7th days. Within the 7th - 10th days and 10th - 13th days, numerical data of the plane speed of Wd healing were observed to increase: 54.9 mm2/day within the 7th -10th days, 62.5 mm2/day within the 10th - 13th days that was evidence of the intense process of Wd healing. During the 13th - 16th, 16th - 19th and 19th -21st days, index of the plane speed of Wd healing decreased: 42.7 mm2/day within the 13th - 16th days, 36.1 mm2/day within the 16th - 19th days, 20.5 mm2/day within the19th - 21st days that was indicative of the reduction of reparative processes
in the Wd.
In general, evaluating the results of measurement of the plane speed index of Wd healing per day, it should be noted that during the Wd healing the curve of the plane speed change was of sinusoidal character: high - from the 1st to the 7th day (60.5 -58.5 mm2/day), reducing from the 7th to the 10th day (58.5 - 54.9 mm2/day), reintensifying - from the 10th to the 13th days (54.9 - 62.5 mm2/day), reducing intensely - from the 13th to the 16th days (62.5 -42.7 mm2/day), gradually decreasing - from the 16th to the 21st days (42.7 - 20.5 mm2/day).
Since current vulnerological methods are lacking objective criteria for evaluation of the WP course, we broadened their range by working out the method that allows to objectively generalize and improve vulnerological parameters and criteria, and therefore, to obtain significant data from monitoring of the Wd healing process. The LVV method enables determination of a number of precise digital vulnerological criteria (V - cm3, AV, uV), which facilitate evaluation of quantitative changes in the Wd in the process of healing. Obtained data and results of the research allow us to conclude that the method of LVV is applicable for the objective estimation of the Wd because it is safe to use, simple to reproduce and technologically accessible to perform, well-tolerated by the patients, capable of high precision measurement and significant estimate of the parameters of any complicated Wd independently of its localization, form, configuration, area and depth. The LVV method is not competing and syn-ergetic to the medical treatment, it is economically accessible for all the medical institutions and sections of population.
Conclusions.
1. The developed method of LVV allows precise measurement of the volume of complicated Wd's (of different localization, form, configuration, area and depth).
2. The suggested method of LVV enables to determine the WP dynamics by virtue of mathematic, statistical and graphical means.
3. Definition of the Wd volume in dynamics by the LVV method permits to monitor the speed of Wd healing by the principally new vulnerological parameter - uVthat on an average equals to 0.74 cm3 per day.
4. During the process of healing, the Wd volume decreases linearly by 50 % by the 10th day and by the 80 % by the 21st day.
5. The difference in dynamics between the plane and volumetric characteristics of the Wd permits to confirm that developed method of LVV is much more objective and efficient than recognized plani-metric methods of Wd measurements.
6. Reported data are the basis for outline of the critical term of Wd healing, investigation of the effect of the known forms of ointments and local antiseptics on the speed of Wd healing, development of new components of local therapy of the Wd, ration-
BÎCHÈK Укpaïнcъкoï ме0ичног' cm омшполо г in ног' auadeMiï
alization of the surgical methods of treatment and choice of the optimal terms for plastic closing of the Wd.
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Реферат.
Р1ДИННА ОБ'еМНА ВУЛЫНЕРОМЕТР1Я ТА КРИТЕРИ ВУЛЬНЕРОМЕТРИЧНО! ОЦ1НКИ РАН Герич 1.Д., Дворчин О.М., Дворчин Н.О., Стояновський 1.В.
Ключов1 слова: об'ем рани, площа рани, фадюнт змши об'ему рани, об'емна швидкють загоення рани, площинна швидкють загоення рани, рщинна об'емна вульнерометрт.
Метод рщинноТ об'емно! вульнерометрп (РОВ) е сучасним стандартом ктькюно! оцшки об'ему складно! рани. Об'ем рани методом РОВ було вим1ряно в 32 пацюнтш клЫки загальноТ х1рургп, яю перебували на стацюнарному лкуваны та були проопероваы з приводу гостроТ гншно-септичноТ патологи. Розпрацьований спосЮ РОВ дае змогу: вим1ряти об'ем рани рЬноТ локалЬаци, форми, конф1гураци', площ1 та глибини; вщстежити динамку змЫи об'ему рани в процеа 11' загоення; ктькюно оцЫити рану за цифровими вульнеролопчними критертми: "фадюнтом змЫи об'ему рани" (∆^), "об'емною швидкютю загоення рани" (aз^).
Реферат .
ЖИДКОСТНАЯ ОБЪЁМНАЯ ВУЛЬНЕРОМЕТРИЯ И КРИТЕРИИ ВУЛЬНЕРОМЕТРИЧЕСКОЙ ОЦЕНКИ РАН. Герич И.Д., Дворчин О.М., Дворчин Н.О., Стояновский И.В.
Ключевые слова: объём раны, площадь раны, фадиент изменения объёма раны, объёмная скорость заживления раны, плоскостная скорость заживления раны, жидкостная объёмная вульнерометрия.
Метод жидкостной объёмной вульнерометрии (ЖОВ) - это современный стандарт количественной оценки объёма сложной раны. Объём раны методом ЖОВ измерялся у 32 больных клиники общей хирургии, которые находились на стационарном лечении и были прооперированы по поводу острой гнойно-септической патологии. Разработанный способ ЖОВ даёт возможность: измерить объём раны различной локализации, формы, конфигурации, площади и глубины; проследить динамику изменения объёма раны в процессе её заживления; количественно оценить рану за цифровыми вульнерологическими критериями: "Градиентом изменения объёма раны" (∆^, "объёмной скоростью заживления раны" (ύ^.
