Сучасні погляди на лікування хронічних ран

Abstract

Лікування хронічних ран є значущою проблемою в повсякденній практиці хірурга. Незважаючи на багаторічний досвід, лікування таких ран є трудомістким та дорогим. Майже кожен випадок потребує міждисциплінарного підходу для отримання позитивних результатів. Такі рани називають «мовчазною епідемією», від якої страждають 1-2% населення в розвинених країнах світу. Нами вивчені та проаналізовані дані літературних джерел з сучасних методів лікування хронічних ран. Для пошуку інформації були використані методи системного і порівняльного аналізу та бібліосемантичний метод вивчення сучасного погляду на лікування хронічних ран. Опрацьовані наукові джерела в наступних базах даних: Web of Science, Scopus, PubMed, Google Scholar, eLIBRARY.ru за період з 2015 по 2020 рр. Таким чином, результатами нашого аналізу встановлено наявність безлічі даних про різні методи та засоби лікування хронічних ран. Незважаючи на таке розмаїття, та позитивні результати, більшість з них вимагає подальших досліджень механізмів, що впливають на процеси загоєння ран.

Treatment for chronic wounds is a significant problem in the daily practice of any surgeon. Despite long-term experience the treatment for such wounds is time consuming and expensive. Almost every case requires a multidisciplinary approach to obtain positive results. The term “chronic wound” was first used in the literature in the 1950s to refer to the wounds that were difficult to treat or they did not follow normal healing process. However, the term was criticized for its uncertainty as to the duration of the chronic process. Such alternative definitions were proposed as bad healing wounds, trophic ulcers, complex wounds. Even today the opinions of the authors differ. Some believe that “chronic wound” is any wound that has no signs of reducing its size by 20-40% after 2-4 weeks of optimal treatment or when there is no complete healing after 6 weeks. According to other authors’ opinion a “chronic” one can be called any wound that has not undergone a regulated and timely repair to develop anatomical and functional integration within 3 months. The goal of the research is to study and analyze current methods of treatment for chronic wounds based on the literature sources. The object and research methods. The methods of systematic and comparative analysis and bibliosemantic method of studying the modern view of treatment for chronic wounds were applied to search for the information. The following scientific sources were analyzed from the following databases: Web of Science, Scopus, PubMed, Google Scholar, eLIBRARY.ru from 2015 to 2020. There were used such key words as “chronic wounds”, “cleaning of a wound bed”, “modern dressing materials”, “collagen”, “growth factors”, “stromal vascular fraction”, “PRP therapy”, “vacuum technologies”. The search results are 250 sources, of which met the terms of the request. The results of the study and their discussion. There are a lot of factors that affect the process of wound healing. Appropriate systems are formed to help the surgeon to analyze the causes of failure in their healing. One of these systems was named TIME-H. An important and one of the first steps in the healing process is wound bed preparation – debridement. It is performed in five ways: surgical, mechanical, autolytic, enzymatic and/or biological. Another important element in wound bed preparation for healing is local bandage care. The most commonly used modern dressing materials in clinical practice are hydrogels, hydrocolloids, alginates, foam dressings, film dressings. The last type of modern wound dressings is bioactive dressings; at the same time the most up-to-date and promising dressing materials are “Smart” dressings that also deserve interest. The surgeons use the following modern methods of wound treatment such as human skin equivalents that are bioengineered structures (skin substitutes) consisting of a cellular component (cultured human skin cells) and a substrate (matrix). They are used to treat both acute and chronic wounds. There is one more thing that is collagen. Numerous studies have proven that collagen preparations are bioactivators and they promote their own tissue regeneration integrating into the surrounding natural tissues. Growth factors also play an important role in wound healing. Recently, stromal vascular fraction (SVF) that is derived from adult fat has opened new directions in wound healing. Platelet-rich plasma (PRP therapy) is also widely used. At the present stage vacuum therapy is an innovative method of wound treatment of different etiology which accelerates the course of the wound process. We can identify the use of hyperbaric oxygen therapy, extracorporeal shock-wave electrostimulation, laser and magnetic therapy from treatment options of chronic wounds. An important role is played by immobilizing-unloading systems and proper nutrition. We can distinguish free skin plastic surgery with a split auto graft, the use of full-layer skin grafts between modern surgical methods of treatment for chronic wounds. To replace the defects of soft tissues with exposing deep anatomical structures the transplantation of tissue complexes with axial type of circulation is considered as a method of choice; there may be used perforated flaps, propeller flap. One of the techniques for reconstructive surgery may be keystone island flap technique. Free transplantation of tissue complexes using a microvascular suture may also be used. Conclusions. The treatment for chronic wounds remains an urgent problem to date requiring the surgeon to seek an individual approach to each patient and each wound. Thus, there is a wealth of data on various methods and method of treatment for chronic wounds based on the literature we have learned. Despite such diversity and positive results most of them require further investigation of the mechanisms that influence wound healing processes.