Hard healing wound and lymphedema treatment service
In 02.11.2017 in Erebouni MC was opened Hard healing wound and lymphedema treatment service. The service deals with the treatment of hard healing wounds of all etiology, lymphadenitis and lymphedema, based on saving limbs and reducing amputations risks.
The work of the service is divided into two main parts, which simultaneously are separate pathologies but often accompany each other.
Treatment of hard-healing wounds such as pressure sores, diabetic foot, or post-burn injuries last for months. In the service modern methods of treating hard-healing wounds both in a moist environment and by Negative Pressure Wound Therapy method are based on rules developed by leading specialists of the world's leading clinics.
In the treatment of patient in the department the wound dressings are used, which are based on modern( moist) model of wound treatment and have the following properties, that ensures the effectiveness of treatment.
Characteristics of an ideal wound dressing:
• Maintains an appropriate moist environment on the wound surface,
• removes the excess exudate and toxic components
• Thermally isolates the wound,
• provides protection against bacterial infections and microorganisms,
• does not contain toxic substances,
• protects newly formed tissues,
• easily removed from the wound surface, does not cause damage
For effective treatment you need to understand with what kind of wound we are dealing with. With long healing wounds, a consultation of the department specialist is required, which will determine the actual cause of the problem and give individual recommendations for the treatment of the wound. In addition, periodically the treatment process should proceed under the direct supervision of a specialist, in order to make changes in the treatment regimen, if necessary.
Negative Pressure Wound Therapy(NPWT)
One of the most effective methods currently used in the world's leading clinics and already in MC Erebouni in the treatment of wounds of all origins is the local controlled long-term use of negative (subatmospheric) pressure or, in other words, a technical vacuum.
Negative Pressure Wound Therapy (NPWT, literally translated- treatment of wounds by negative pressure) is widely used in European clinics.
At present, vacuum therapy has already received a comprehensive scientific justification and recognition from specialists in the field of healing wounds of various etiologies. It is known that the use of NPWT contributes significantly to healing, since the effect of negative pressure on the wound leads to an increase in the intensity of cell proliferation, increased synthesis of the basic substances of the connective tissue and structural proteins of the wound tissues.
Controlled negative pressure is currently used in:
-acute traumatic wounds,
- thermal damage,
- necrotizing fasciitis,
- purulent wounds
- trophic ulcers,
- diabetic destructive lesions of feet,
- complications after cavitary operations and endoprosthetics
In addition, NPWT is used in maxillofacial, spinal, thoracic, reconstructive and plastic surgery, pediatrics, as well as with open abdominal trauma, peritonitis and unformed intestinal fistula.
Scientific evidence and basis have already received the following effects of local exposure to prolonged negative pressure on the wound:
• active drainage of the wound, which ensures the permanent removal of excess wound detachable;
• effective maintenance of a moist wound environment that stimulates healing;
• removal of biofilms and prevention of its formation on the wound surface;
• Reducing the time of bacterial decontamination of wound tissues;
• rapid reduction of localized interstitial edema of tissues;
• Significant increase of blood circulation in the wound area;
• micro- and macrodeformation of tissues of the wound bed, stimulating tissue proliferation;
• Reduction of the area and / or volume of the wound;
• stimulation of full granulation tissue growth through the mechanism of wound hypoxia;
• reliable prophylaxis of exogenous wound infection;
• strengthening the effect of systemic drug treatment;
The above effects of the method provide a significant reduction in the financial costs of both the clinic and the patient for the treatment of hard healing wounds.
Lymphadenitis is a nonspecific or specific inflammation of lymph nodes. Lymphadenitis is characterized by local pain and enlarged lymph nodes, headache, malaise, weakness, fever.
The causes of lymphadenitis:
The causative agents of nonspecific lymphadenitis, often are streptococci and staphylococci. In nonspecific lymphadenitis, the primary lesion can be a furuncle, a purulent wound, panaritium, carbuncle, phlegmon, caries and other.
The cause of specific lymphadenitis are the causative agents of syphilis, tuberculosis, actinomycosis, tularemia, anthrax, plague and other infectious diseases.
The diagnosis of lymphadenitis is carried out with the help of anamnesis and physical examination; the etiology is defined by altered lymph node biopsy.
Treatment of lymphadenitis is carried out taking into account the isolated pathogen and includes antibiotic therapy, physiotherapy. When forming an abscess or adenophlegmon, their opening and draining is performed.
Treatment and prognosis of lymphadenitis
Catarrhal and hyperplastic lymphadenitis is treated conservatively. It is necessary to create rest for the affected area, to conduct adequate antibiotic therapy on the basis of sensitivity of microbial flora, UHF- therapy, and vitamin therapy. In a purulent process, an autopsy of purulent lymphadenitis, adenophlegmons, drainage and sanitation of the leison according to the principles of purulent wounds management is indicated. Active detoxification and antibacterial therapy is given.
In chronic nonspecific lymphadenitis, elimination of the underlying disease is required that supports inflammation in the lymph nodes.
Specific lymphadenitis is treated according to the etiological agent and the primary process (syphilis, gonorrhea, tuberculosis, actinomycosis, etc.).
Timely etiotropic therapy of lymphadenitis avoids the spread and generalization of the process.
The outcome of chronic lymphadenitis can be scarring of the lymph node with connective tissue replacement of lymphoid tissue. In some cases, the impairment of lymph flow and lymphedema can develop.
Prevention of lymphadenitis requires the prevention of microtrauma, infection of wounds and abrasions, scuffs of the skin. Also timely treatment of foci of infection (sore throat, dental caries), dissection of purulent lesions (panariciums, furuncles) is necessary.
For effective treatment of lymphadenitis and avoidance of complications, you need timely visit to a specialist.
Lymphostasis is a pathology of the lymphatic system, accompanied by the impairment of lymphatic circulation and lymphatic fluid retention in tissues. With lymphostasis there is a tightening of the tissues, persistent edema and a noticeable thickening of the limb (lymphedema), ulcers on the skin. Determining the cause of lymphostasis requires ultrasound of the pelvis, abdominal cavity, vessels of the extremities, chest radiography, lymphography, and lymphoscintigraphy.
In the department the treatment of lymphostasis is carried out by non-surgical (manual lymph drainage, instrumental lymphatic drainage, compression therapy, hirudotherapy, medications) and surgical (reconstruction of lymphovenous anastomoses) methods.
Treatment of lymphostasis
The purpose of treatment of lymphostasis is to restore the outflow of lymph from the limbs or other organs. With lymphostasis in MC Erebouni is carried out:
- manual lymphodrainage
- hardware lymphodrainage,
- individual selection for the patient of compression jersey.
The patient is recommended to follow a diet with salt restriction, exercise therapy, swimming, Scandinavian walking. From drug therapy in the department, phlebotonics with lymphotropic action, enzymes, angioprotectors, immunostimulants are used. With trophic ulcers and eczema the local treatment is carried out.
With lymphostasis, careful foot care is needed in order to prevent the development of lymphangitis. With this goal it is better to perform a medical hardware pedicure with the use of special means for hygienic and therapeutic foot care. With the development of fungal infection, antimycotics are prescribed, and foot treatments with antifungal agents.
The basis for surgical treatment of lymphostasis can be the inefficiency of complex conservative therapy, the progression of lymphedema, the presence of severe fibrosis and deforming lymphatic sacs. With lymphostasis microsurgical lymphovenous anastomoses are created, resort to liposuction and dermato-fasciolectomy.
Premium AIR Relax- Compressible Limb. Sleeve System (USA)- hardware lymphodrainage;
Medela Avance Negative Pressure Wound Therapy (Germany)
KCI V.A.C. ULTA (NPWT) Negative Pressure Wound Therapy System ;
BASIC AND PRIORITY DIRECTIONS OF THE SERVICE
In the department, patients with the following pathology are examined and treated.Moist wound healing and negative pressure therapy are carried out.
Wounds of all etiologies:
- pressure sores,
- trophic ulcer,
- thermal damage,
- necrotizing fasciitis,
- purulent wounds,
- diabetic destructive lesions of feet,
- complications after cavitary operations and endoprosthetics.
• Lymphadenitis and lymphostasis (lymphedema), in which manual and instrumental lymph drainage , banding of limbs are performed.
The examination of patients can be carried out both in hospital and outpatient settings.