Internal therapy and rational nutrition in wounds and postoperative sutures

Rational nutrition.

In addition to proper care of wound surfaces and postoperative sutures, it is necessary to know that patients should receive adequate nutrition in the postoperative period, since a lack of vital substances received by the body from the outside can have an adverse effect on the skin reparation processes. Nutrition should be easily digestible, rich in proteins, vitamins, microelements, antioxidants. fiber, but with limited salt. Water intake is also important. Patients should consume at least 1.5-2 liters of fluid per day. However, if surgical dermabrasion was performed on the entire face or in the perioral area, the patient is forced to eat pasty or liquid food almost until the bandages are removed or the crusts come off. Otherwise, when chewing, they can injure the crusts, into the cracks of which an infection will get, which can lead to deepening of the inflammation and the formation of scars.

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

Internal therapy.

Includes a number of treatment areas to accelerate reparation processes, improve the results of surgical interventions, and reduce the visibility of scars.

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

Adaptogens: ginseng, eleutherococcus, purple echinacea, magnolia vine, zamaniha, pantacrine, etc.

Means and methods for improving microcirculation

Synthetic and proliferative activity of cells involved in skin restoration is impossible without sufficient oxygen supply to tissues. One of the main areas in postoperative rehabilitation of patients, as well as in preoperative preparation, are methods, means and technologies that improve microcirculation in the surgical area, strengthen the vascular wall, saturate tissues with oxygen, etc. In this regard, drugs that improve microcirculation (theonikol, complamine, nicotinamide, ginkgo biloba extract, capilar), dietary supplements containing vasoactive drugs are essential in both the preoperative and postoperative periods.

Hardware technologies that promote activation of blood circulation are also indicated for the management of such patients. One of these areas is hypoxic therapy.

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

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

Results of the impact of IHT on the body.

Chemoreceptors respond to a decrease in oxygen tension in arterial blood, the impulses from which have an exciting effect on the centers of the medulla oblongata, the reticular formation and the overlying parts of the brain. The central parts of the sympathetic nervous system and the functions of the endocrine glands are stimulated: the content of thyroid hormones, insulin, catecholamines in the blood increases. The hemoglobin content in the blood increases and its oxygen capacity increases, the number of erythrocytes in the circulating blood increases, the number of mitochondria and cristae in the mitochondria increases; the number of capillaries in the tissues increases. Thus, IHT helps to increase immunity, improve blood supply to tissues and skin, relieve hypoxia, which improves reparative processes in the wound in the postoperative period, helps to accelerate epithelialization and prevent pathological scars. To implement IHT, a modern hypoxicator device from TRADE MEDICAL was created, converting ordinary room air into hypoxic gas mixtures with the desired oxygen content. For comprehensive diagnostics of the patient's body condition before and after the IHT course, the device is equipped with a pulse oximeter, a volume meter and a gas analyzer. Small dimensions, compactness, and the ability to easily move to the desired location make the hypoxicator an easily and reliably functioning device for the therapy and rehabilitation of burn patients, patients after dermabrasion and plastic surgery. In addition, it can be used in 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 prescribe essential microelements, which include Cu, Zn, Se, Fe, Mn, K, Ca, Si, etc.

Rare earth metals are an essential ingredient for normal wound healing and are given either in tablet form or as dietary supplements.

Iron. Found in mitochondria and other organelles of skin cells, where it is part of oxidative enzymes (peroxidase, cytochrome oxidase, etc.) that ensure cellular respiration. Participates in the synthesis of collagen, is part of hemoglobin, thereby participating in the saturation of the body with oxygen. Necessary for the successful hydroxylation of proline residues. Better absorbed in the form of iron lactate.

Preparations: actiferrin (iron sulfate), actiferrin compositum, hemofer prolagngatum (iron sulfate), additiva with iron (complex effervescent tablets containing iron gluconate, ascorbic acid, vitamin B12), Gino-Tardiferon (complex of iron and folic acid).

Copper. As a coenzyme, it is included in many enzymes. It takes part in the processes of iron absorption, is necessary for the synthesis of melanin, collagen, and has antioxidant properties. There is evidence of antagonism between copper and zinc, and therefore it is undesirable to prescribe them together.

Preparations: Copper sulfate (copper sulfate) is prescribed orally at 5-15 drops of 0.5-1% solution for 1-2 months. Copper-containing multivitamin complexes ("Multivitamins with minerals", "Unicap", etc.)

Potassium. Necessary for the vital activity of any cell in the body, present in large quantities in the intracellular fluid, participates in the synaptic transmission of nerve impulses, helps to normalize the drainage function of organs and tissues.

Preparations: panangin (a complex preparation of potassium and magnesium), potassium orotate, asparkam, kalinor, kalipoz prolongatum (potassium chloride).

Magnesium. It is an activator of many enzymes: cholinesterase, phosphatase, etc. It is a part of more than 300 enzyme complexes, ensuring their activity. It promotes protein synthesis, is necessary for maintaining the normal state of cell membranes, reduces the excitability of the neuromuscular systems. It has an antispasmodic effect, accelerates the course of glycolysis. The 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 aspartate), 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 extracellular. As part of phospholipids, it is part of the structure of cell membranes, lipoproteins. An absolutely essential element of macroergic compounds and their derivatives, cyclic nucleotides, coenzymes, which play a vital role in metabolism and regulation of physiological functions.

Preparations: Phosphaden. ATP.

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

Preparations: oxyrich (zinc aspartate), zinctheral, zincorotate. Zinc oxide or sulfate, use 0.02-0.05 g. 2-3 times a day, for at least a month. Multivitamin preparations containing zinc: "Stress Formula with Zinc", "Oligovit", "Centrum".

Selenium. Participates in the synthesis of glycoproteins and glycosaminoglycans, is a powerful antioxidant, a cofactor of the enzyme glutathione peroxidase. Without it, the enzyme is inactive, cannot restore oxidized glutathione 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 capacity of cells, normalizes skin hydration, increases the strength of elastic fibers, has an antiradical effect.

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

Antioxidant treatment.

During the inflammation process, destructive molecules and free radicals accumulate in the wound surfaces. Accordingly, the prescription of antioxidants is included in the mandatory program of patient management in the postoperative period and is also an element of complication prevention.

Histokhran (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, slight pain, temporary browning of tissues, and allergic reactions are possible.

Available in 0.02% concentration ampoules of 1 ml. Administered intramuscularly, intradermally and intravenously.

Emokatin (Russia).

It is a powerful antioxidant. It has antihypoxic, angioprotective, antiaggregatory, photoprotective activity.

Available in 1 ml and 5 ml ampoules in 1% concentration. Administered intramuscularly.

Mexidol (Russia).

It is a salt of succinic acid corresponding to emoxipine. It has a wide spectrum of biological activity. It is an inhibitor of free-radical processes (antioxidant). Its mechanism of action is similar to emoxipine, but it has a stronger antihypoxic effect.

It is produced as a 5% solution in 2 ml ampoules. It is administered intramuscularly.

Contraindicated in case of liver dysfunction and allergy to vitamin _B6!

Ascorbic acid.

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

Available in tablets and solution. 5, 10 and 20% solutions in ampoules of 2, 5 and 10 ml. Used intramuscularly and intradermally.

Kapilar (Russia).

Ingredients: dihydroquercetin - 10 mg, sorbitol - 240 mg. Pharmacological action of dihydroquercetin - antioxidant, angioprotective, hemorheological, antiplatelet.

Mechanism of action: Dihydroquercetin is a domestic drug, which is 3, 3, 4, 5, 7 - pentahydroxyflavone, which is obtained from crushed Siberian larch wood (Larix cibirica L). Reduces the viscosity of whole blood, weakens the aggregation of erythrocytes, improves blood microcirculation. Dihydroquercetin binds free radicals and limits the activation of lipid peroxidation processes in erythrocyte membranes, restores the lipid spectrum of erythrocyte membranes, reduces the proportion of transient degenerative forms of erythrocytes in the blood, which helps improve cellular rheology. Exhibits capillary-protective activity.

It is indicated during the period of preparation of patients for therapeutic and surgical dermabrasion, for plastic and other surgical interventions, as well as in the postoperative period. Prescribed 2 tablets 3 times a day.

Available in 0.25 g tablets.

Immunocorrective therapy.

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

Aflutop (Romania).

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

It is used for long-term non-healing wounds, for the correction of atrophic, hypotrophic scars, and stretch marks.

Available in 1 ml ampoules. Prescribed intramuscularly, intradermally under the scar.

Aloe extract (Russia).

It is an aqueous extract of preserved, aged in the cold, leaves. Refers to biogenic stimulants. Stimulates local immunity and regenerative processes.

It is used for poorly healing postoperative sutures in trophic ulcers, atrophic scars, striae, and secondary infection on wound surfaces.

Available in 1 ml solution with pH 5.0-6.8. If injections are painful, dilute with lidocaine or novocaine. Administered intramuscularly or intradermally.

Immunal (Slovenia).

Available in tincture and tablet form. Active ingredient: purple echinacea juice in 20% ethanol solution, or in dried and tablet form.

It has an immunostimulating effect. Increases the number of granulocytes, phagocytosis activity, suppresses the reproduction of microorganisms, including the herpes and flu viruses.

Prescribed per os, 20 drops with a small amount of water or 1 tablet 3 times a day for 1-6 weeks.

Immunofan (Russia).

It is a hexapeptide (arginine-alpha-aspartyl-lysyl-valyl-tyrosine-arginine). It has immunoregulatory, hepatoprotective, detoxifying, antioxidant effects, activates phagocytosis, stimulates the formation of IgA, and metabolic processes.

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

Available in 1 ml ampoules of 0.005% solution.

Vitamin and microelement complexes.

Perfectil (UK).

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

Pregnaxal (UK).

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

Menopace (UK).

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

Gerovital (Germany).

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

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