Treatment of purulent wounds

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Treatment of purulent wounds

The main thing in the treatment of purulent wounds is dressings used in combination with medicamental and physiotherapeutic treatment.

Bandages in the treatment of purulent wounds

There are about 2000 names of dressings. Choosing the appropriate material is not an easy task, especially when each manufacturer proves the undoubted advantages of its products. The dressing should meet two purposes: the wound should remain moist, the suction of the exudate should occur. Other important goals include the infrequent change of dressings (provided that the absorbent capacity is sufficiently high and the dressing material retains its stickiness); protection of the surrounding skin from maceration; minimizing skin damage by sticky dressings. It should be emphasized that no commercial dressing will accelerate healing more than wet gauze on a clean wound.

Traditional use of wet gauze and adhesive plaster is inexpensive. However, this requires frequent changes in the dressing due to its limited absorption capacity. Adhesive plaster can irritate the skin, and gauze can dry out. The traditional "wet and dry" dressing is a poor choice, because it allows the drying of the wound, worsening its healing. In intensive treatment of a wound with a large amount of exudate, a gauze bandage can be used in combination with an antibacterial cream.

Most dressings used to treat purulent wounds, apparently, belong to the class of hydrocolloids. They consist of hydrophilic materials combined with special glue. The surface covered with a polyurethane film protects the wound and ensures its wet healing. Adhesive is held by the skin until the absorptive capacity of the material is exhausted. This combination makes hydrocolloids an ideal material for the treatment of chronic wounds.

Local antibiotics

Despite the benefits of using local antibiotics, they often inappropriately replace many principles of good treatment of a purulent wound. Reduction of bacterial contamination of the wound is useful, but without effective removal of exudate, local antibiotics will only select the resistant microorganisms without reducing the overall bacterial load. For all currently used local antibiotics, there is a problem of allergic reactions. The use of local antibiotics based on ointments or creams allows you to maintain a moist environment in the wound. Sulfadiazine is the most effective local antibiotic of the first line. This drug has a wide spectrum, does not lead to the formation of bacterial resistance, rarely increases skin sensitivity and is relatively inexpensive. In addition, the complete removal of the white cream from the wound during each dressing provides easy observation of the cleaning of the wound.

Means for pharmacological necrectomy

Surgical removal of necrotic tissues is the fastest and most effective way to cleanse the wound. By means of enzymatic necrectomy (collagenases and other proteases derived from bacteria), one can achieve the same goal without surgery for a longer period. They should be used only at low probability of development of wound sepsis. A semi-hermetically sealed dressing left in place for several days can speed up the patient's own autolytic processes, providing a "natural" necrosectomy. However, this method is only relatively effective and time-consuming.

Growth Factors

Growth factors are always present in healing wounds. In animals, the addition of growth factors to poorly healing wounds speeds up their healing. In a large number of clinical trials, various results were obtained in the treatment of purulent wounds by growth factors. The reason for this may be the complexity and diversity of etiological factors and concomitant diseases, the complexity of conducting clinical trials in chronic wounds and the presence of proteases that destroy growth factors.

In 1997, after 7 years of PDGF (Regranex) studies for more than 1,000 patients, it was approved by the FDA for use in patients with diabetic foot ulcers. Currently, clinical trials continue on other areas of PDGF and other growth factors.

Artificial Leather Equivalents

The development of tissue engineering is used in the treatment of many diseases. Probably, in no other field has such progress been achieved, as in the use of skin obtained with the help of tissue engineering. To create temporary skin in patients with burns, a number of products were developed, consisting of a skin-like base with or without synthetic coating, serving as a water barrier.

Tissue engineering products have also been used in clinical trials on chronic wounds. An epigraph consisting of a synthetic epidermis derived from a fibroblast culture and a heterologous epithelium has been successfully used in the treatment of venous ulcers. In 1998, the Apligraph was approved by the FDA for the use of treatment-resistant ulcers.


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