Development of local treatment approaches for trophic ulcers.

ABSTRACT

Trophic venous ulcers are a serious medical and economic issue. Despite a large number of proposed methods for treatment of trophic ulcers, it is not always possible to achieve their complete healing. All this dictates the expediency of further search for more efficient, costeffective and accessible means and methods of trophic ulcer treatment. AIM: The aim of the study was to develop approaches that increase the effectiveness of treatment of patients with trophic ulcers, by constructing a system of sanogenesis in a given pathology in the form of a scheme, analyzing this scheme and finding "weak links" in it, the strengthening of which will contribute to the achievement of the goal. MATERIALS AND METHODS: Modern foreign and domestic literature, Internet-resources and patent documentation were analyzed. The results of our earlier in vitro and in vivo experiments in which the role of neutrophils in wound healing had been studied, were taken into consideration. The deductive method was used in the development and the principle of the systematic approach to the phenomenon under study was implemented. RESULTS: We constructed a system of trophic ulcer sanogenesis in the form of a diagram. Guided by sanogenetic mechanisms, key strategic approaches to the local treatment of trophic ulcers were outlined. It is required to eliminate all factors supporting an inflammatory reaction, contributing to suppuration and create optimal conditions for the transformation and growth of regenerate cells. Certain treatments of the open wound surface at the first and second phases of the wound process were substantiated. It is proposed to moisten the surface of the ulcer with a liquid composition after cleansing the trophic ulcer from dead cells and microorganisms, applying a suspension of autoleukocytes obtained from the patient's venous blood to the wound surface.It contains components with high biocompatibility creating an optimal environment for tissue regeneration in the ulcer. The composition includes DMEM (Dulbecco's Modified Eagle's Medium) liquid medium + 10% of the patient's autosera + a combination of antibiotics active against both pathogenic and all nonpathogenic microorganisms vegetating in the patient's trophic ulcer, in the concentrations of 80-100 mcg/ml that do not interfere with the transformation of regenerate cells. The use of this liquid composition will accelerate the appearance of granulations, epithelialization, and the healing time of trophic ulcers. If a patient has an extensive wound surface, it can be prepared for autodermoplasty earlier. CONCLUSIONS: Based on the construction and analysis of the venous trophic ulcer sanogenesis system, approaches to the local treatment of trophic ulcers have been developed. It is required to eliminate all factors supporting an inflammatory reaction, contributing to suppuration and create optimal conditions for the transformation and growth of regenerate cells. Optimal conditions for the transformation and growth of cells in a trophic ulcer can be created by applying to the surface of the ulcer a liquid nutrient medium for cultivating DMEM cells with autoserum and antibiotics at concentrations that are not toxic to regenerated cells.