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9THE EFFECTIVENESS OF COMPLEX THERAPY FOR THE REGENERATION OF POSTOPERATIVE WOUNDS (EXPERIMENTAL STUDY)
T.B. Uzakov
Kyrgyz State Medical Institute for Retraining and Advanced Training named after S.B. Daniyarov
Abstract
Summary: The study was carried out on 60 white Wistar rats, simulating a surgical wound. The rats were divided into 5 groups of 10 rats each. Group 1 is control - rats from this group were made an incision on the sidewall, abdominal wall, followed by natural healing within 10 days; Group 2 - an incision followed by the use of chitosan ointment; Group 3 - the wound was exposed to photostimulation treated with methylene blue; Group 4 - physical activity in the postoperative period on a treadmill for 30 minutes; Group 5 - complex application ofchitosan, photostimulation, andphysical activity. Wound healing was recorded by determining the area, photo-fixation of the wound, and histological examinations of the skin and internal organs were performed.
Outcomes obtained: The best wound healing according to planimetry and histological studies was significant observed in group 5 with the complex treatment of the surgical wound.
Conclusions: The rehabilitation complex for large surgical wounds should include previously local effects of physiotherapeutic procedures andphysical activity. Key words: surgical wound, rehabilitation, photomodulation, and physical exercises.
ЭФФЕКТИВНОСТЬ КОМПЛЕКСНОЙ ТЕРАПИИ ДЛЯ РЕГЕНЕРАЦИИ ПОСЛЕОПЕРАЦИОННЫХ РАН (ЭКСПЕРИМЕНТАЛЬНОЕ ИССЛЕДОВАНИЕ)
Т.Б. Узаков
Кыргызский государственный медицинский институт переподготовки и повышения квалификации имени С.Б. Данияров
Аннотация
Актуальность: Исследование выполнено на 60 белых крысах линии Вистар, имитирующих хирургическую рану. Крысы были разделены на 5 групп по 10 крыс в каждой. 1-я группа контрольная - крысам этой группы сделали разрез на боковой стенке, брюшной стенке с последующим естественным заживлением в течение 10 дней; 2 группа - разрез с последующим нанесением хитозановой мази; 3-я группа - рана подвергалась фотостимуляции обработкой метиленовым синим; 4 группа -физические нагрузки в послеоперационном периоде на беговой дорожке 30 минут; 5-я группа - комплексное применение хитозана, фотостимуляция, физическая нагрузка.
Заживление ран фиксировалось определением площади, фотофиксацией раны, гистологическими исследованиями кожи и внутренних органов.
Полученные результаты: Наилучшее заживление раны по планиметрическим и гистологическим исследованиям достоверно наблюдалось в 5-й группе при комплексном лечении операционной раны.
Выводы: реабилитационный комплекс при больших хирургических ранах должен включать предварительно локальные воздействия физиотерапевтических процедур и физических нагрузок.
Ключевые слова: хирургическая рана, реабилитация, фотомодуляция, физические упражнения.
ПОСТОПЕРАТИВДУУ ЖАРАНДАРДЫ РЕГЕНЕРАЦИЯЛОО УЧУН КОМПЛЕКСТУУ ТЕРАПИЯНЫН ЭФФЕКТИВДУУЛУГУ (ЭКСПЕРИМЕНТАЛДЫК ОКУУ)
Т.Б. Узаков
С. Данияров атындагы Кайра даярдоо жана квалификациясын жогорулатуу боюнча Кыргыз мамлекеттик медициналык институту
Аннотация
Ылайыктуулугу: Изилдее хирургиялык жараны туураган 60 ак Wistar келемиштеринде жYргYЗYлгвн. Келемиштер ар бири 10 келемиштен турган 5 топко бвлYнгвн. 1 -квзвмвл тобу - бул топтун келемиштери 10 кYндYн ичинде каптал дубалына, курсагынын дубалына кесYY жасашкан, андан кийин табигый айыгуу болгон; 2 -топ - кесYY, андан кийин хитозан майын колдонуу; 3 -топ - жараат метилен квк менен дарылоо аркылуу фотостимуляцияга дуушар болгон; 4 -топ - операциядан кийинки мезгилде чуркоо жолунда 30 мYнвттYк физикалык активдYYЛYк; 5 -топ -хитозанды комплекстYY колдонуу, фотостимуляция, физикалык активдYYЛYк. Жараларды айыктыруу жерди аныктоо, жараны сYрвткв тартуу, теринин жана ички органдардын гистологиялык изилдввлврY аркылуу жазылды.
Алынган натыйжалар: Планиметрикалык жана гистологиялык изилдввлвр боюнча эц жакшы жараат айыгуусу хирургиялык жараны комnлекстYY дарылоо менен 5 -топто ишенимдYY тYрдв байкалган.
Жыйынтыктар: чоц хирургиялык жаралар YЧYн реабилитациялык комплекс физиотерапевттик процедуралардын жана физикалык активдYYЛYктYн алдын ала жергиликтYY эффекттерин камтууга тийиш.
Ачкыч свздвр: хирургиялык жара, реабилитация, фотомодуляция, физикалык квнYгYYЛoр.
Introduction
The problem of effective healing of postoperative wounds is clear to every surgeon. Inflammation of the wound up to the suture line disruption is very common and often negates the effectiveness of the operation itself. Many ointments and surgical dressings are offered to prevent inflammation, in particular, based on chitosan [1, 2, 4, 6]. In addition, a proven fact is the effectiveness of the use in the early rehabilitation period of local exposure to the wound of physiotherapeutic procedures, in particular laser light therapy, polarized light, and photomodulation of the wound surface with stains with tropism to certain microbes [3, 5, 7]. There is evidence of an antiinflammatory effect of low-intensity physical exercises in surgical wounds, while high-intensity exercises do not accelerate wound healing, at least against the background of diabetes mellitus. It has been shown that photomodulation enhances the anti-inflammatory effect of chitosan. The above is most clearly reflected in surgical interventions on the abdominal wall.
The aim of the work is to evaluate the e ffe c t o f a c o m p l e x o f c hi to s an , photomodulation with methylene blue, and physical exercises on the postoperative wound healing in white rats in comparison with a natural process and an isolated action.
Material and Methods
The effect of a complex of chitosan, photomodulation with methylene blue, and physical exercises on the postoperative wound healing was studied in an experiment with 60 white rats of both sexes weighing 130-189 g. The animals are divided into 5 groups of 10 rats. Group 1 is control - rats from this group were made an incision on the sidewall, abdominal wall, followed by
natural healing within 10 days; Group 2 - an incision followed by the use of chitosan ointment; Group 3 - the wound was exposed to photostimulation treated with methylene blue; Group 4 - physical activity in the postoperative period on a treadmill for 30 minutes; Group 5 - complex application of chitosan, photostimulation, and physical activity. Wound healing was recorded by photographing by determining the area and speed of wound healing. On day 10, the animals were killed under hexenal anesthesia. The severity of lympho-leukocyte infiltration, plethora was determined, and the presence of dystrophy of internal organs was also observed on histological skin sections stained with hematoxylin and eosin. The cellular composition of the separated wound was determined on Pap smears stained according to Romanowsky-Giemsa.
Outcomes Obtained and their Discussion
There were no deaths of rats. The initial area of the wound with a line disruption by 3 mm and an incision length of 30 mm was 90 mm2. On the second day, the wound area slightly increased in all groups. Wound serous drainage was observed. The edges and bottom are edematous, hyperemic. Neutrophils in the experimental group are from 20 to 37%, lymphocytes - 38 - 39%, macrophages - 25 - 42%. On day 10, neutrophils remain the main cellular component (45%) in the wound fluid in control rats, with slightly fewer lymphocytes, which indicates the chronicity of the process, and macrophages are a minor fraction. In the group with the combined effect of three factors, a significantly lower number of leukocytes are found than in the groups with an isolated action.
Conclusions: Thus, the data obtained indicate that moderate physical activity enhances the anti-inflammatory effect of chitosan and photomodulation. Extrapolating to the clinic, we can say that the rehabilitation complex for large surgical wounds should include early local impact of physiotherapy procedures and physical exercises on the wound.
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