Internal therapy and rational nutrition in wounds and postoperative sutures

Balanced diet.

In addition to competent care for wound surfaces and postoperative sutures, it is necessary to know that patients should receive adequate nutrition in the postoperative period, since the lack of vitally important substances received by the body from the outside can have an adverse effect on the processes of skin repair. The food should be easily digestible, rich in proteins, vitamins, microelements, antioxidants. Fiber, but with the restriction of salt. The water diet also matters. Patients should consume at least 1.5-2 liters of fluid per day. However, if operative dermabrasion was performed on the entire face or in the perioral region - practically before the dressings are removed or the crusts are removed, the patient is forced to take food in pasty or liquid form. Otherwise, with the act of chewing, they can injure the cortex, which cracks the infection, which can lead to a deepening of the inflammation and the formation of scars.

Rational nutrition is an important point in the management of patients in the postoperative period, but the creation of optimal conditions for tissue repair also requires the continued use of the internal therapy prescribed in the preoperative period

Internal therapy.

Includes a number of treatment options to accelerate the repair process. Improve the results of surgical interventions, reduce the visibility of scars.

Biologically active additives (BAA): a series of dietary supplements Litovit (Rossiaia), Avena (Russia), Biovit (Russia), Irwin Naturals (USA). Nature Sunshine Products Inc (USA).

Adaptogens: ginseng, eleutherococcus, echinacea prpurnaya. Lemongrass, zamaniha, pantakrin, etc.

Means and methods for improving microcirculation

Synthetic and proliferative activity of cells involved in the restoration of the skin is impossible without sufficient supply of tissues with oxygen. One of the main directions in the postoperative rehabilitation of patients, as well as in preoperative preparation, are methods, tools and technologies that help improve the microcirculation of the operating area, strengthen the vascular wall, saturate the tissues with oxygen, etc. In this regard, drugs that improve microcirculation (theonikol, nicotinamide, extract of gingo-biloba, capillar), supplements containing vasoactive drugs are necessary tools, both in the preoperative and postoperative period.

The hardware technologies that promote the activation of blood circulation are also shown for the management of such patients. To one of these directions is hypoxic therapy.

Interest in hypoxic therapy, existing for decades, led to the creation of a method of treatment called "normobaric interval hypoxic training" (IHT). Its meaning is that the patient breathes air with a low oxygen content (16-9%) at intervals during which he breathes ordinary air containing 20.4-20.9% O. "Training" means a process during which physiological compensatory mechanisms are trained to hypoxia.

During the course of IHT, external respiration organs, blood circulation, hematopoiesis, tissue and molecular mechanisms are trained, which ensure the delivery of oxygen to cells and the utilization of oxygen in the mitochondria. The body systems that compensate for the decrease in the partial pressure of oxygen in the inspired air, its stresses in the arterial blood and in the tissues are being trained.

Results of exposure to the body IHT.

To reduce the tension of oxygen in the arterial blood, chemoreceptors react, the impulses from which exert a stimulating effect on the centers of the medulla oblongata, on the reticular formation and overlying parts of the brain. Stimulate the central parts of the sympathetic nervous system and the functions of the endocrine glands: the content of thyroid hormones, insulin, catecholamines in the blood increases. The hemoglobin content in the blood increases and its oxygen capacity rises, the number of erythrocytes in the circulating blood increases, the number of mitochondria and the crista in the mitochondria; the number of capillaries in tissues increases. Thus, IHT contributes to the increase of immunity, improvement of blood supply to tissues and skin, removal of hypoxia, which improves reparative processes in the wound in the postoperative period, facilitates the acceleration of epithelization and the prevention of pathological scars. For the implementation of the IHT, a modern hypoxicator device of the firm "TRADE MEDICAL" was created, which converts ordinary room air into hypoxic gas mixtures with the desired oxygen content in them. For complex diagnosis of the patient's condition before and after the course of IHT, the device is equipped with a pulse oximeter, a meter and a gas analyzer. Small size, compactness, simple possibility of moving to the right place makes the hypoxicator an easy and reliable functioning device for the therapy and rehabilitation of burn patients, patients after dermabrasion and plastic surgeries. In addition, it can be used in the preoperative preparation of patients and in many areas of restorative medicine.

To improve the general and local immunity of patients in the postoperative period, it is useful to designate essential trace elements, which include Cu, Zn, Se, Fe, Mn, K, Ca, Si, etc.

Rare earth metals are an essential ingredient for normal wound healing. Assigned either in tablet form or in the form of food additives.

Iron. It is found in mitochondria and other organelles of skin cells, which is part of oxidative enzymes (peroxidase, cytochrome oxidase, etc.) that provide cellular respiration. He takes part in the synthesis of collagen, is part of hemoglobin, thereby taking part in oxygen saturation of the body. It is necessary for the successful hydroxylation of proline residues. It is better absorbed in the form of iron lactate.

Drugs: actinferrin (iron sulfate), actinferrin compositum, hemofer prolagngatum (ferrous sulfate), iron additive (complex effervescent tablets containing iron gluconate, ascorbic acid, vitamin B12), Gyno-Tardiferon (complex of iron and folic acid).

Copper. How coenzyme enters into many enzymes. It takes part in the processes of iron absorption, which is necessary for the synthesis of melanin, collagen, and has antioxidant properties. There are data on the antagonism of copper and zinc, and therefore it is undesirable to appoint them together.

Preparations: Copper sulphate (sulfuric copper) is administered internally with 5-15 drops of a 05-1% solution for 1-2 months. Copper-containing multivitamin complexes ("Multivitamins with minerals", "Unicap", etc.)

Potassium. It is necessary for the vital activity of any cell of the body, being present in large quantities in the intracellular fluid, participates in the synaptic transmission of nerve impulses, contributes to the normalization of the drainage function of organs and tissues.

Preparations: panangin (complex preparation of potassium and magnesium), potassium orotate, asparcum, Kalinor, Kalypoz prolongongum (potassium chloride).

Magnesium. It is an activator of many enzymes: cholinesterase, phosphatase, etc. It is part of more than 300 enzyme complexes, ensuring their activity. It promotes the synthesis of proteins, is necessary to maintain the normal state of cell membranes, reduces the excitability of neuromuscular systems. Has spasmolytic effect, accelerates the course of glycolysis. Synthesis of steroid hormones is also carried out in the presence of magnesium. Potassium and magnesium are needed to ensure the activity of collagenase.

Preparations: Almagel, pamaton (potassium and magnesium asparaginate), magnesium orotate, magnesium peroxide, Magne B6.

Phosphorus. Contained in the skin mainly in the form of organic compounds: phosphoproteins, nucleoproteins, phospholipids, etc. The content of intracellular phosphorus is 40 times greater than that of extracellular. In the composition of phospholipids is included in the structure of cell membranes, lipoproteins. Absolutely necessary element of macroergic compounds and their derivatives, cyclic nucleotides, coenzymes, which play an important role in the metabolism and regulation of physiological functions.

Preparations: Phosphaden. ATP.

Zinc. It is an important auxiliary factor of wound healing, being an activator of cellular immunity. It is part of many enzymes, hormones, is necessary for proliferative processes in tissues. It helps stabilize blood sugar and speeds up glycolysis. Zinc ions have antioxidant, immunostimulating properties. Contribute to reparative processes in tissues. With age, the amount of zinc in tissues is sharply reduced, and with trauma, there is also a sharp decrease in the amount of zinc, which indicates the need for substitution therapy. Zinc-dependent are such vital hormones as insulin, corticotropin, somatotropin, gonadotropin. Deficiency of zinc is accompanied by a decrease in immunity, proliferative and synthetic activity of cells. Assign zinc preparations for long-term non-healing wounds, trophic ulcers, acne, skin condition after deep peeling and dermabrasion, aesthetic operations, as a preventive measure before surgery.

Preparations: oxirich (zincaaspartite), zincteral, zincorotate. Oxide or zinc sulfate, apply on 0,02-0,05 g. 2-3 times a day, at least a month. Multivitamin preparations containing zinc: "Stress formula with zinc", "Oligovit", "Centrum".

Selenium. Takes part in the synthesis of glycoproteins and glycosaminoglycans, is a powerful antioxidant, cofactor of the enzyme glutadione peroxidase. Without it, the enzyme is in an inactive state, can not restore oxidized glutadione and thus counteract oxidative stress.

Preparations: "Selmevit", "Multi-selenium", "Stress-formula with zinc", "Oligogal-selenium".

Silicon. Participates in the formation of collagen, glycosaminoglycans, elastin, stimulates cellular metabolism and proliferative ability of cells, normalizes skin hydration, increases the strength of elastic fibers, and has antiradical action.

Preparations: organic silicon (0.5%, 1%, 2% 5.0), conjunctil (0.5% -5.0) for intradermal and intramuscular injection.

Antioxidant treatment.

In the process of inflammation in the wound surfaces accumulate destructive molecules, free radicals. Accordingly, the appointment of antioxidants is included in the mandatory program for managing patients in the postoperative period and is also an element of preventing complications.

Histohran (Russia).

It is a powerful antioxidant, obtained from seafood of animal origin. The mechanism of action is associated with the ability to stabilize cell membranes, interact with active forms of oxygen. Free radicals. With intradermal administration, a slight soreness, a temporary staining of the brown tissue, possible allergic reactions.

It is produced in ampoules in 0,02% concentration of 1 ml. It is prescribed intramuscularly, intradermally and intravenously.

Emokatin (Russia).

It is a powerful antioxidant. Has antihypoxic, angioprotective, anti-aggregation, photoprotective activity.

Produced in ampoules of 1 ml. And 5 ml in 1% concentration. It is prescribed intramuscularly.

Mexidol (Russia).

Is the corresponding emoxipin salt of succinic acid. Has a wide range of biological activity. It is an inhibitor of free-radical processes (antioxidant). By the mechanism of action is close to emoxipin, but it has a stronger antihypoxic effect.

Produced in the form of 5% solution in ampoules of 2 ml. It is prescribed intramuscularly.

Contraindicated in the violation of liver function and allergy to vitamin _B!

Ascorbic acid.

It is known that vitamin C deficiency is one of the most common causes of poor wound healing. Ascorbic acid has strongly pronounced reductive, antioxidant properties. It is an angioprotective agent, participates in the regulation of oxidation-reduction processes of carbohydrate metabolism, tissue regeneration, the formation of steroid hormones, promotes neutralization of toxins in the body, serves as a cofactor in the hydroxylation of proline to the state of hydroxyproline during the synthesis of collagen. One of the important physiological functions of ascorbic acid is its participation in the synthesis of collagen and procollagen and the normalization of capillary permeability.

Produced in tablets and solution. 5,10 and 20% solutions in ampoules of 2, 5 and 10 ml. It is used intramuscularly and intradermally.

Kapilar (Russia).

Ingredients: dihydroquercetin - 10 mg, sorbitol - 240 mg. The pharmacological action of dihydroquercetin is antioxidant, angioprotective, hemorheological, antiaggregant.

Mechanism of action: Dihydroquercetin is a domestic preparation representing 3, 3, 4, 5, 7 - pentahydroxyflavone, which is obtained from crushed larch wood of Siberia (Larix cibirica L). Reduces the viscosity of whole blood, weakens aggregation of erythrocytes, improves blood microcirculation. Dihydroquercetin binds free radicals and limits activation of processes of lipid peroxidation in erythrocyte membranes, restores the lipid spectrum of erythrocyte membranes, reduces the share of transient degenerative forms of red blood cells in the blood, which contributes to the improvement of the parameters of cellular rheology. It shows capillaroprotective activity.

It is shown during the preparation of patients for therapeutic and operative dermabrasion, for plastic and other surgical interventions, and also for the postoperative period. Assign 2 tablets 3 times a day.

Produced in tablets of 0.25 g.

Immunocorrective therapy.

Against the background of postoperative and oxidative stress, the immunological reactivity of the organism as a whole and tissues in particular decreases. In this regard, patients with the phenomena of prolonged (inadequate) inflammation are recommended to prescribe immunocorrecting drugs.

Aflutop (Romania).

Extract of cartilage and bone marrow calves. Possesses biostimulating activity, stimulates local immunity, reparative processes in tissues, proliferative activity of cells. Due to the inhibition of hyaluronidase activity, it stimulates biosynthesis of hyaluronic acid. Has anti-inflammatory effect.

It is used for long-term non-healing wounds, for correction of atrophic, hypotrophic scars, striae.

Produced in ampoules of 1 ml. It is prescribed intramuscularly, intradermally under the scar.

Aloe extract (Russia).

It is a water extract of canned, aged in the cold, leaves. Refers to biogenic stimulants. Stimulates local immunity and regenerative processes.

It is used for poorly healing postoperative sutures with trophic ulcers, atrophic scars, striae, attachment of secondary infection to wound surfaces.

Produced in a solution of 1 ml with pH 5.0-6.8. When painful injections divorced lidocaine or novocaine. It is prescribed intramuscularly or intradermally.

Immunal (Slovenia).

Produced in the form of tinctures and tablets. The active substance is the juice of Echinacea purpurea in a 20% solution of ethanol, or in dried and tabletted form.

Has immunostimulating action. Increases the number of granulocytes, the activity of phagocytosis, suppresses the multiplication of microorganisms, including the herpes and influenza virus.

It is prescribed per os for 20 drops with a little water or 1 tablet 3 times a day for 1-6 weeks.

Imunofan (Russia).

It is a hexapeptide (arginine-alpha-aspartyl-lysyl-valyl-tyrosine-arginine). Has immunoregulating, hepatoprotective, detoxicating, antioxidant effect, activates phagocytosis, stimulates the formation of IgA, metabolic processes.

It is administered subcutaneously or intramuscularly. Single daily dose of 50 mcg in 1 ml.

Produced in ampoules of 1 ml. 0.005% solution.

Vitamin-microelement complexes.

Perfectil (Great Britain).

One gelatin capsule contains vitamins A, E, D, C, B1, B6, B12, folic, pantothenic, paraaminobenzoic acid, zinc, magnesium, iodine, potassium silicon, selenium, chromium, cystine. Take 1 capsule per day during or after a meal with a small amount of liquid. Has a pronounced dermatotropic effect!

Pregnaxal (Great Britain).

One gelatin capsule contains vitamins A, E, D, B1, B6, B12, K, folic acid, nicotinamide, iron, zinc, magnesium, copper, iodine. At the reception - 1 capsule per day during or after a meal with a small amount of liquid.

Menopace (Great Britain).

One gelatin capsule contains vitamins A, E, D, C, B1, B6, B12, K, folic, pantothenic, para-aminobenzoic acid, nicotinamide, iron, zinc, magnesium, manganese, iodine, potassium, chromium, selenium, boron. Take 1 capsule per day during or after a meal with a small amount of liquid. Has a pronounced dermatotropic effect!

Herovital (Germany).

Effervescent tablets contain iron lactate, retil, cholecalciferol, thiamine, riboflavin, pyridoxine, ascorbic acid, tocopherol, nicotinamide, dexpanthenol, cyanocobalamide, hawthorn extract, motherwort. Take 1 tablet or 1 teaspoon of tincture 2 times a day.

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