Decubituses at the spinal patient

[laska]

The patient, 1935 of a birth. Has transferred or carried 3 (three) surgical interventions on a back a brain, in occasion of an intraspinal dermoid cyst at level Th3-Th7. After first two operations (1968, 1985) restoration excellent or different (independently moved, drove a car), though and with an easy or a light;a mild bottom spastic paraparesis. After the third surgical intervention (1998) - the expressed bottom spastic paraparesis with disturbances of functions tazovyh organs. Regenerative treatment of results has not brought, the patient is confined to bed, moves on a carriage.

Since autumn of 2000 there were trophic frustration in the form of decubituses in the field of a sacrum, and since summer of 2001 - in the field of sciatic bugra at the left.

Spent treatment: surgical elimination of necrotic tissues in the field of sciatic bugra, an antibioticotherapia, daily processing by antiseptics and applying of bandages with use of Xeroformium, Acidum boricum, Kuriozina, Levosina, Levomekolja. Preparations on mazevoj do not approach or suit a basis, as conduct to augmentation of a maceration of a dermal surface. Treatment with variable success. Since December, 2001 a ulcer in the field of a sacrum with expansion and with an excavation, despite of spent treatment. To difficulty in treatment represents expressed moknutie ranevoj surfaces.



I understand, that treatment of such patients represents appreciable difficulties and the uniform standard does not exist, but it would be desirable to learn or find out:

1. Experience of conservative treatment of decubituses in other clinics;

2. Than it is really possible to reduce moknutie ranevoj surfaces and surrounding tissues;

3. Whether use of a quartz lamp, an ozon plant, if yes, on what distance, frequency and duration of exhibiting of a wound is effective.



I thank you.

[The jackal]

Good afternoon, actually you almost on all the questions have responded.

Fortunately, the problem of decubituses in my daily practice meets extremely seldom, therefore all my advice or councils have some retrospective shade (from those times when it was actual):

1) it is Completely conservative (i.e. up to a cuticularization) it is possible to treat only rather small superficial decubituses. All the others demand this or that hir.aktivnosti at the certain stages

2) Salve dressings for *quot; ??OUNu*quot; prlezhnja are counter-indicative

3) If the decubitus activly becomes wet, the most effective way of its or his leaving or care is frequent change sterile wet (but not wet) bandages with physiological rasstrvorom (these bandages change each 2-4 hours). Edges or territories of a skin thus are necessarily processed by solutions of antiseptics. If the reason of an exsudate are vegetans granulations - it is necessary to cauterize them any of existing chemical methods (a spirituous iodine, kontsentr.margantsovka, an argentum nitricum, etc.)

4) Ozone and quartz most likely can affect or influence on *quot; oU?O??oa??N*quot; wounds, but I do not know exact references

5) it is strange, what is it all happens suddenly and quickly progresses, though the patient chronic - whether pojavlsja at it or him a diabetes mellitis???

6) Obligatory is the control over fibers of plasma and a high-grade delivery

7) If a bottom or fundus of a decubitus - a bone without the big operation to not manage

8) the Main thing in struggle against decubituses - et their prophylaxis. To change position of the patient follows not less often 1 r 40 minutes



Yours faithfully,

[Hopo Galina]

I agree with all offered Jury Vadimovichem. How much or as far as I understand the patient the patient *quot is confined to bed and efficiency of treatment with variable success possibly svjaza that; nalezhivaet and ?a????oaNO*quot;, therefore it is desirable to create conditions that he did not lay on already formed decubituses (turns, a lining *quot; iOi??o*quot; and platens in position on a back and sitting if the last is impossible iskljuchiit in general, - ---it is better than them sshit from O a tissue, leaky to fill the calcinated groats (millet, rice) and to move them) down to suspension of the patient. In general, in treatment of decubituses 2 :1. a decubitus 2. educations of new decubituses. After achievement 1 and 2 it is possible to think of closing defect though in purulent surgery there are methods of treatment allowing in one stage to excise and close practically any is purulent-necrotic decubitus. By way of conservative treatment-is quite good or -not bad to make crop ranevogo contents on sensitivity to and-that there for flora such?? On those parts of is purulent-necrotic masses which it is impossible, and in some cases it is unnecessary, to remove surgically not bad to put bandages with enzymes (himopsin, Trypsinum) vsezhe on mazevoj to a basis (5 % dioksidinovaja ointment) .mozhno to use collagenic algenatnye sponges *quot; Ci?aeAAE*quot; .pri its or her application except for antiseptic action, effect from a collagen is available still -decreases plazmopoterja. Fresh macerations of an epithelium do not need to be cauterized anything, application of spray Pantenol and is much more effective than analogues. The partial necretomy and enzymes possible to clear a decubitus is more often, to achieve the beginning of body height of granulations. Except for it or this the patient accepts preparations of fiber, various sorbents mestno, immunostimuljatory, for example UFO to a blood and t.d, ferment or enzymatic preparations inside (kreon) .estestvenno audit of a wound should be full for exceptions *quot; ?aONo*quot; .kstati the bone on a sacrum is almost always covered with granulations, with a trochanter it is more complex or difficult... Application of antibiotics unessentially if the general or common status comes nearer to satisfactory and is not present displays of an intoxication, parameters of a blood quiet. The greatest difficulties in treatment are connected with treatment of chronic decubituses with omozolelymi edges or territories, vjalogranulirujushchimi if the situation is those-search the expert of the purulent surgeon. And the last. At adequate care of the patient, even with a full anatomic break of a spinal cord at any level, decubituses to arise should not!!!!!







Yours faithfully, Pejker And.

[infinit]

Unfortunately they arise. To vyshcheopisannomu I would add one important factor as a protein diet. It is More to drink milk easier speaking.

[Bulba]

Still I shall add.

For prophylaxis of decubituses it is necessary to wipe a back and a sacrum an admixture of vodka and shampoo (on a bottle of vodka - 2 table spoons).

[greguar]

Unfortunately, THEY TO ARISE SHOULD not, THIS EVERYTHING, EXCUSE, DEFECTS of LEAVING or CARE. And the talker-it or -this;-thus 1\2 a part of vodka and 1\2 a part of liquid shampoo. It is necessary for her to wipe all body, for hygiene 2 times a day.

[urudnik]

If the decubitus deep also grows, practically unique method of treatment is the wound repair a second intention. For this purpose around of a decubitus the seam of type kisetnogo is imposed and periodically edges or territories of a wound are tightened. Undoubtedly, daily hirurgichekaja processing of a wound with application of various antiseptic agents. Application kuriozina on the crude wound feeds an infection. Are very good laserotherapy (local) and quartz. Certainly it is necessary to exclude either Diabetum, or a -infection. At enough well-timed ochistkah wounds about pullings up of edges or territories of 6*7 sm can be tightened or delayed a decubitus for 3-4 weeks.

[ybr]

Misters, it is not necessary to forget, that the given situation otjagoshchena disturbance of an innervation of the given area, that too can lead nejrotroficheskim to disturbances so to speak only about disturbance of leaving or care it is impossible. And about prophylaxis of decubituses I would recommend (from the practice): it is obligatory to turn the patient with a side sideways (if he lying) and to pound or triturate area of breeches camphoric or camphor alcohol. (it is natural in those places where there are no decubituses)



:cool:

[tanechka_123]

Hello.

I too have questions. Around of a decubitus the seam of type kisetnogo is imposed and periodically edges or territories of a wound are tightened you heard about an old-goods or -kind method of treatment pararektalnyh fistulas - *quot; ??uaOOO??*quot;? Tissues are wonderfully cut. How you with it or this struggle? (if certainly you used really this method)

In purulent surgery there are methods of treatment allowing uniinstantly or in one stage to excise and close practically any is purulent-necrotic decubitus

If it is possible a little bit more in detail about a decubitus above trohanterom with the sizes, for example, 128. At the exhausted patient, a bottom or fundus of a wound - the thin layer of a necrosis covering t a joint?

[23]

Still time hello.



Certainly - week at the bed patient with decubituses - a drop in the sea, even it is good - were cleared better, but all: how practically to avoid prorezyvanija a ligature at *quot; ???NO??*quot; a way of closing of defect and how to avoid purulent complications, at uniinstantly or one-stage excising or coretraction and closing of a decubitus on 4-5 $ all in day? Or it already other history...

[Intriga]

Yes naverna full prorezyvanija to avoid it will not be possible never, use any tubules- or not... Some times used the dosed out tension: a thick thread you stitch edges or territories of a wound, zavjazyyvaesh on *quot; ia?O?*quot; also you tighten sometimes if prorezalsja-new you put... The truth opinion neodnaznachnoe about a method, but the chief ingda asks them to treat...