Experimental-clinical justification of dosed dermotension application in the first phase of wound process
Objectives. To shorten the treatment terms of patients with extensive purulent wounds of soft tissues by expanding indications for the dosed hardware apparatus dermotension. Methods. Influence of the dosed dermotension on the morphological characteristics of the structural wound components was studied in experiment on the model of the infected wound in rats. Changes occurring distantly from the area of tension were studied, directly in the area of the primary wound defect. Hypothesis was that tension of the paravulvar area tissues resulted in the production of inflammation mediators, cytokines and this in its turn led to the reparative process stimulation in the wound area. Criterion letting estimate the correctness of the hypothesis was the speed of wound healing and terms of epithelialization. Dosed hardware apparatus dermotension was applied in the clinic in 12 patients at the first stage of wound process; in 18 patients a traditional method of purulent wounds treatment "under dressing" was applied. Objective control of soft tissues state while applying hardware apparatus dermotension was carried out using the laser Doppler flowmetry method. Results. Investigations which were done on the model of the infected wound in rats show that dosed dermotension of the paravulvar tissue influences positively the tissue qualitative composition which is formed at infected wound healing; it is proved by the ratio of granulated tissue and fibroblasts, acceleration of the wound cleaning processes and scar forming. In the clinic, using the dosed hardware apparatus dermotension, purulent wounds from 7 up to 16 cm in width were closed and after suturing wound healing according to the type of primary tension was achieved in 11 out of 12 patients. Conclusions. Use of the dosed hardware apparatus dermotension to close extensive purulent wounds at the first stage of the wound process expands indications for application of active surgical tactics and it reduces terms of treatment of this category of patients.