Gross formula
C 20 H 28 O 2Pharmacological group of the substance Methandienone
Nosological classification (ICD-10)
CAS code
72-63-9Characteristics of the substance Methandienone
Anabolic steroid. Crystalline powder, white or white with a yellow tinge. We will dissolve very little in water, we will slightly dissolve in ether, we will easily dissolve in ethyl alcohol and chloroform.
Pharmacology
pharmachologic effect- anabolic, hematopoietic.Penetrating into the cell nucleus, it activates the genetic apparatus of the cell, which leads to an increase in the synthesis of DNA, RNA and structural proteins, activation of enzymes of the tissue respiration chain and increased tissue respiration, oxidative phosphorylation, ATP synthesis and the accumulation of macroergs inside the cell. Stimulates anabolic and inhibits glucocorticoid-induced catabolic processes. Leads to an increase in muscle mass, a decrease in fat deposits and a negative nitrogen balance. Hematopoietic action is associated with an increase in the synthesis of erythropoietin. The antiallergic effect is due to an increase in the concentration of C 1 fraction of the inhibitor complement and a decrease in the content of C 2 and C 4 complement fractions. Androgenic activity (low) can contribute to the development of secondary sexual characteristics in the male pattern.
It is rapidly and completely absorbed from the gastrointestinal tract, low bioavailability is due to the presence of the "first pass" effect through the liver. In the blood, it binds to specific globulins-carriers by 90%. Undergoes final biotransformation in the liver with the formation of inactive metabolites. Excreted by the kidneys. Duration of action - up to 14 hours.
Application of the substance Methandienone
Cachexia, impaired protein metabolism (after severe injuries, operations, burns, radiation therapy); severe infectious diseases accompanied by protein loss; progressive muscular dystrophy, glucocorticoid-induced myopathy; diabetic angiopathy; the need to accelerate regeneration in case of fractures, injuries; retardation of the growth of children (Shereshevsky-Turner syndrome, pituitary dwarfism); delayed puberty (sexual infantilism) and physical development in boys; encephalopathy against the background of alcoholic hepatitis.
Contraindications
Hypersensitivity, breast cancer (in men), breast cancer, hepatic and / or renal failure, prostate adenoma, hypercalcemia, nephrosis, glomerulonephritis (nephrotic stage).
Restrictions on use
Chronic heart failure, coronary atherosclerosis, myocardial infarction (including a history), diabetes mellitus, pregnancy, breastfeeding (no data on penetration into breast milk), old age, childhood and adolescence (risk of premature closure of the epiphyseal growth zones , early puberty in boys and virilization in girls). Acceleration of the epiphyseal growth of tubular bones can be observed in children both during treatment and within 6 months after its termination.
Application during pregnancy and lactation
Contraindicated in pregnancy. During treatment, breastfeeding should be discontinued.
Side effects of the substance Methandienone
From the digestive tract: dyspeptic symptoms (nausea, vomiting, diarrhea, abdominal pain), abnormal liver function, jaundice.
On the part of the cardiovascular system and blood (hematopoiesis, hemostasis): hypocoagulable state with a tendency to bleeding, leukemoid syndrome (leukemia, pain in long bones), iron deficiency anemia.
Others: the progression of atherosclerosis (an increase in LDL concentration and a decrease in HDL concentration), peripheral edema.
With long-term therapy - hepatonecrosis (dark feces, vomiting mixed with blood, headache, discomfort, respiratory failure), hepatocellular carcinoma, hepatic purpura (dark urine, discoloration of feces, urticaria, punctate or macular hemorrhagic mucous membranes on the skin and or tonsillitis), cholestatic hepatitis (yellow staining of the sclera and skin, pain in the right hypochondrium, dark urine, discolored feces), increased secretion of the sebaceous glands, chills, increased or decreased libido, diarrhea, feeling of full stomach, flatulence, convulsions, sleep disturbance. In women: virilization (enlargement of the clitoris, coarseness or hoarseness of the voice, dys- and amenorrhea, hirsutism, steroid acne, oily skin), hypercalcemia (CNS depression, nausea, vomiting, increased fatigue). In men: in the prepubertal period - manifestations of excessive androgenic activity (acne, penis enlargement, priapism, the formation of secondary sexual characteristics), idiopathic hyperpigmentation of the skin, slowing or cessation of growth (calcification of the epiphyseal growth zones of tubular bones); in the postpubertal period - bladder irritation (increased frequency of urge), mastodynia, gynecomastia, priapism, decreased sexual function; old age - hyperplasia and / or carcinoma of the prostate gland.
The first intake of steroids is the most memorable, because you have not yet encountered this and you are very interested in how it works. In order to have a little idea of what kind of substance will be inside you, this article was written. Below you will find the answers to two eternal questions. What is Danabol and what is it for?
Danabol itself is a trade mark, and its active ingredient is methandienone. This drug is an anabolic steroid, when it enters the body, it causes significant changes. Reception of danabol is a personal matter for everyone, but the first acquaintance is best done under the supervision of knowledgeable people.
There are two forms of the substance on the market in solid and liquid form. Beginners try to choose pills because they do not know all the charms of injections and at first they are afraid to give injections.
Effects of taking
Although Danabol is a mild anabolic, its use can greatly affect your internal processes.
Pros:
- Able to increase muscle mass;
- Accelerates protein synthesis several times;
- Accelerates the recovery process;
- Increases appetite;
- Strengthens the skeleton, ligaments and joints;
- Increases strength indicators;
- Slows down catabolism in the body;
Minuses:
- It sucks out all the nutrients from your body;
- Retains water in the body;
- Aromatizes in the body, forming decay products;
- Causes skin rashes;
- Headaches are possible.
Now you shouldn't have any questions about what danabol is, let's move on to the next question.
What is danabol for?
With the help of methandienone and other anabolic steroids, you can easily gain muscle mass. Of course, this drug was originally developed with the goal of helping seriously ill patients recover from serious illnesses, but later the positive qualities were noticed by bodybuilders.
Athletes of different levels use it as an assistant, not only to build muscle, but also to increase the strength and endurance of their body. An increase in strength results in an even larger set of muscle fibers. But for this you need to observe a few more components - sleep, nutrition, and a training plan.
Danabole reviews
There are a lot of reviews on the Internet, from the most absurd ones to those that elevate the action of the drug to heaven. Often newbies complain about the rollback after the course, but when it comes to analyzing the reasons, everyone makes the same mistake. In order for the mass to remain, you need to improve your diet (increase bju).
Professional athletes have no complaints, with the exception of fake preps that are found in the steroid market. Proper preparation and planning will keep stock drainage to a minimum. In addition, the low price of danabol allows conducting budget courses, and this is one of the main criteria in our country.
How to take it right
The preparation of the course should be based on the individual characteristics of the organism, and this is possible only after passing tests for free and bound testosterone, estrogen, prolactin and globulin binding hormones.
The standard regimen includes only danabol (s) and nothing else. Reception begins with an even background of 30 mg per day, throughout the course. You need to throw methandienone in the morning, at lunchtime and in the evening after meals, 10 mg each.
After the course therapy is carried out with tamoxifen, 20 mg per day, for 2 weeks. During this time, the level of its own testosterone manages to rise to the average level.
Price
The average price on the market for 1 pack fluctuates around 900 rubles. It's about danabol from Balkhan. If you want even cheaper, you can find methandienone from other popular companies, such as British or Golden Dragon, which will cost about 700 rubles per package.
Output
Now you know what danabol is and why you need it. If you are a beginner, then methane can lead you to the world of anabolic steroids like no other. If you still have questions, be sure to ask in the comments. Happy weight gain!
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Currently, there are no specific treatments for cicatricial changes in the uterus. Obstetric tactics and the preferred method of delivery are determined by the state of the scar area, the characteristics of the course of the gestational period and childbirth. If during ultrasound it was determined that the ovum was attached to the wall of the uterus in the area of the postoperative scar, the woman is recommended to terminate the pregnancy using a vacuum aspirator. If the patient refuses to have an abortion, regular monitoring of the state of the uterus and the developing fetus is ensured.
Spontaneous childbirth with a scar on the uterus is recommended for women with one previous cesarean section performed through a transverse incision. Prerequisites for choosing in favor of natural delivery are uncomplicated pregnancy, the consistency of scar tissue, the normal functioning of the placenta and its attachment outside the zone of cicatricial changes, cephalic presentation of the fetus, its compliance with the size of the mother's pelvis. In such cases, the pregnant woman is hospitalized at 37-38 weeks of gestation for a comprehensive examination. To improve the prognosis with the onset of labor, the appointment of antispasmodics, antihypoxic and sedative drugs, and drugs to improve placental blood flow is indicated.
Operative delivery is recommended for patients at high risk of re-rupture. Direct indications are:
Longitudinal scar. The probability of divergence of scar tissue after dissection of the uterine wall in the longitudinal direction is several times higher than with transverse incisions.
More than one scar. If a woman has had more than one caesarean section, the pregnancy is terminated surgically.
Some gynecological interventions. Conservative myoectomy of the node on the posterior wall of the uterus, reconstructive plastic surgery for abnormalities in the development of the uterus and surgery for cervical pregnancy are contraindications to natural childbirth.
Previously suffered rupture of the uterus. If the previous birth was complicated by a rupture of the uterine wall, the next pregnancy is completed by a cesarean section.
Scar failure. When identifying diagnostic signs of the predominance of coarse fibrous connective tissue in the area of the scar, the operation is performed.
Placental pathology. Surgical delivery is indicated when placenta previa or its location in the scarring area.
Clinically narrow pelvis. The loads arising from the passage of a fetus whose dimensions do not correspond to the mother's pelvis, as a rule, provoke a repeated rupture.
If, during a spontaneous birth, a woman in labor with a scar on the uterus is threatened with rupture, a cesarean section is performed on an emergency basis. After the operation, the defect of the uterine wall is sutured. Extirpation of the uterus is carried out only with extensive damage with the impossibility of suturing or the occurrence of massive intraligamentary hematomas.
RCHRH (Republican Center for Healthcare Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Clinical protocols of the Ministry of Health of the Republic of Kazakhstan - 2014
Radiation-related disease of skin and subcutaneous tissue, unspecified (L59.9), Keloid scar (L91.0), Unspecified complication of surgery and therapy (T88.9), Open wound of head, unspecified (S01.9), Open wound other and unspecified part of the abdomen (S31.8), Open wound of the other and unspecified part of the shoulder girdle (S41.8), Open wound of the other and unspecified part of the pelvic girdle (S71.8), Open wound of the unspecified chest (S21.9) , Open wound of unspecified part of forearm (S51.9), Open wound of unspecified part of neck (S11.9), Separation of scalp (S08.0), Consequences of other specified injuries of upper limb (T92.8), Consequences of other specified head injuries (T90.8), Sequelae of other specified injuries of lower limb (T93.8), Sequelae of other specified injuries to the neck and trunk (T91.8), Sequelae of complications from surgery and therapy, not elsewhere classified (T98.3), Sequelae
thermal and chemical burns and frostbite (T95), Cicatricial conditions and fibrosis of the skin (L90.5), Phlegmon of the trunk (L03.3), Chronic skin ulcer, not elsewhere classified (L98.4), Ulcer of the lower limb, not classified elsewhere (L97)
Combustiology
general information
Short description
Recommended
Expert Council of the Republican State Enterprise on REM "Republican Center for Health Development"
Ministry of Health and Social Development of the Republic of Kazakhstan
dated December 12, 2014 Minutes No. 9 Consequence of thermal burns from frostbite and wounds
The main outcomes of the above conditions are scars, long-term non-healing wounds, wounds, contractures and trophic ulcers.
Scar is a connective tissue structure that has arisen at the site of skin damage by various traumatic factors to maintain homeostasis of the body.
Cicatricial deformities- a condition with limited scars, cicatricial masses localized on the head, trunk, neck, limbs without restriction of movements, leading to aesthetic and physical inconveniences and limitations.
Contracture- This is a persistent limitation of joint movement caused by a change in the surrounding tissues, due to the influence of various physical factors, in which the limb cannot be fully bent or unbent in one or more joints.
Wound- This is damage to tissues or organs, accompanied by a violation of the integrity of the skin and underlying tissues.
Long-term non-healing wound- a wound that does not heal during a period that is normal for wounds of this type or location. In practice, a long-term non-healing wound (chronic) is considered to be a wound that exists for more than 4 weeks without signs of active healing (with the exception of extensive wound defects with signs of active repair).
Trophic ulcer- a defect of integumentary tissues with a low tendency to healing, with a tendency to recurrence, which has arisen against the background of impaired reactivity due to external or internal influences, which in their intensity go beyond the adaptive capabilities of the organism. A trophic ulcer is a wound that does not heal for more than 6 weeks.
I. INTRODUCTORY PART
Protocol name: Consequences of thermal and chemical burns, frostbite, wounds.
Protocol code:
Code (s) ICD-10:
T90.8 Consequences of other specified head injuries
T91.8 Consequence of other specified neck and trunk injuries
T92.8 Consequence of other specified injuries of upper limb
T93.8 Consequence of other specified injuries of lower limb
Т 95 Consequences of thermal and chemical burns and frostbite
T95.0 Consequences of thermal and chemical burns and frostbite of the head and neck
T95.1 Consequences of thermal and chemical burns and frostbite of trunk
T95.2 Consequences of thermal and chemical burns and frostbite of the upper limb
T95.3 Consequences of thermal and chemical burns and frostbite of the lower limb
T95.4 Consequences of thermal and chemical burns, classified only according to the area of the affected area of the body
T95.8 Consequences of other specified thermal and chemical burns and frostbite
T95.9 Consequences of unspecified thermal and chemical burns and frostbite
L03.3 Phlegmon of trunk
L91.0 Keloid scar
L59.9 Radiation-related disease of skin and subcutaneous tissue
L57.9 Skin change due to chronic exposure to non-ionizing radiation, unspecified
L59.9 Radiation-related disease of skin and subcutaneous tissue, unspecified
L90.5 Cicatricial conditions and fibrosis of skin
L97 Ulcer of lower limb, not elsewhere classified
L98.4 Chronic skin ulcer, not elsewhere classified
S 01.9 Open head wound, unspecified
S 08.0 Separation of the scalp
S 11.9 Open wound of the neck, unspecified
S 21.9 Open chest wound, unspecified
S 31.8 Open wound of the other and not specified part of the abdomen
S 41.8 Open wound of the other and unspecified part of the shoulder girdle and shoulder
S 51.9 Open wound of an unspecified part of the forearm
S 71.8 Open wound of another and not specified part of the pelvic girdle
T88.9 Complications of surgical and therapeutic interventions are not specified.
T98.3 Consequences of complications of surgical and therapeutic interventions, not elsewhere classified
Abbreviations used in the protocol:
ALT - Alanine aminotransferase
AST - Aspartate Aminotransferase
HIV - Human Immunodeficiency Virus
ELISA - enzyme-linked immunosorbent assay
NSAIDs - non-steroidal anti-inflammatory drugs
KLA - complete blood count
OAM - general urine analysis
Ultrasound - ultrasound examination
UHF therapy - ultra high frequency therapy
ECG - electrocardiogram
ECHOX - transthoracic cardioscopy
Date of protocol development: year 2014.
Protocol users: combustiologists, traumatologists-orthopedists, surgeons.
Classification
Clinical classification
Scarring classified according to the following criteria:
Origin:
Post-burn;
Post-traumatic.
By the nature of growth:
Atrophic;
Normotrophic;
Hypertrophic;
Keloid.
Wounds are divided depending on the origin, depth and extent of the wound.
Types of wounds:
Mechanical;
Traumatic;
Thermal;
Chemical.
There are three main types of wounds:
Operating rooms;
Random;
Firearms.
Accidental and gunshot wounds depending on the wounding object and the mechanism of damage, they are subdivided into:
Chipped;
Cut;
Chopped;
Bruised;
Smashed;
Torn;
Bitten;
Firearms;
Poisoned;
Combined;
Penetrating and not penetrating into the body cavity. [7]
Contractures classified according to the type of tissue damage that caused the disease. Contractures are mainly classified according to the degree of restriction of movement in the damaged joint.
After burns, skin and cicatricial contractures (dermatogenic) most often occur. According to the severity, post-burn contractures are divided into degrees:
I degree (mild contracture) - limitation of extension, flexion, abduction ranges from 1 to 30 degrees;
II degree (moderate contracture) - limitation from 31 degrees to 60 degrees;
III degree (sharp or severe contracture) - restriction of movement more than 60 degrees.
Classification of trophic ulcers by etiology:
Post-traumatic;
Ischemic;
Neurotrophic;
Lymphatic;
Vascular;
Infectious;
Tumor.
In terms of depth, trophic ulcers are distinguished:
I degree - superficial ulcer (erosion) within the dermis;
II degree - an ulcer reaching the subcutaneous tissue;
III degree - an ulcer that penetrates to the fascia or subfascial structures (muscles, tendons, ligaments, bones), into the cavity of the articular bag or joint.
Classification of trophic ulcers by the affected area:
Small, up to 5 cm2;
Medium - from 5 to 20 cm2;
Vast (giant) - over 50 cm2.
Diagnostics
II. METHODS, APPROACHES AND PROCEDURES OF DIAGNOSTICS AND TREATMENT
List of basic and additional diagnostic measures
Basic (mandatory) diagnostic examinations carried out at the outpatient level:
Additional diagnostic examinations carried out on an outpatient basis:
Coagulogram (determination of clotting time, duration of bleeding).
The minimum list of examinations that must be carried out when referring to planned hospitalization:
Coagulogram of blood (determination of clotting time, duration of bleeding);
Determination of blood group
Determination of the Rh factor;
Bacterial culture from wounds (according to indications).
X-ray if indicated (affected area);
Basic (mandatory) diagnostic examinations carried out at the inpatient level: According to indications, at discharge, control tests:
Additional diagnostic examinations carried out at the stationary level:
Biochemical blood test (glucose bilirubin total, alanine aminotransferase, aspartate aminotransferase, urea, creatinine, total protein);
Bacterial culture from wounds according to indications;
Diagnostic measures carried out at the stage of emergency emergency care: not carried out.
Diagnostic criteria
Complaints: For the presence of post-traumatic or burn scars with functional impairments, pain or aesthetic inconvenience. For the presence of wounds of various origins, their soreness, limitation of movements in the joints.
Anamnesis: A history of trauma, frostbite or burns, as well as concomitant diseases that caused pathological changes in the tissues.
Physical examination:
In the presence of wounds describes their origin (post-traumatic, post-burn), the prescription of the origin of the wound, the nature of the edges (even, torn, crushed, callous), their length and size, depth, bottom of the wound, the mobility of the edges and cohesion with the surrounding tissues.
In the presence of granulations describes:
Character;
The presence and nature of the discharge.
When describing contractures their origin is indicated:
Post-burn;
Post-traumatic.
Localization, degree and nature of changes in the skin (description of scars, if any, color, density, nature of growth - normotrophic - without elevation above the surrounding tissues, hypertrophic - rising above the surrounding tissues), the nature of restriction of movements, flexion, extensor and degree of restriction of movements. [ eight]
When describing scars they are indicated:
Localization;
Origin;
Prevalence;
Character, mobility;
The presence of an inflammatory reaction;
Areas of ulceration.
Laboratory research:
UAC(with long-term non-healing wounds, trophic ulcers, especially giant ones): moderate decrease in hemoglobin, increased ESR, eosinophilia,
Coagulogram: an increase in the level of fibrinogen up to 6 g / l.
Blood chemistry: hypoproteinemia.
Indications for consultation of narrow specialists:
Consultation with a neurosurgeon or neuropathologist in the presence of a neurological deficit due to the progression of the underlying or concomitant disease.
Consultation with a surgeon in the presence of an exacerbation of concomitant pathology.
Consultation with an angiosurgeon with concomitant vascular damage.
Consultation with a urologist in the presence of concomitant urological pathology.
Consultation of a therapist in the presence of concomitant somatic pathology.
Consultation of an endocrinologist in the presence of concomitant endocrinological diseases.
Consultation with an oncologist in order to exclude oncological diseases.
Consultation with a phthisiatrician in order to exclude tuberculous etiology of diseases.
Differential diagnosis
Differential diagnosis of contractures
Table 1 Differential diagnosis of contractures
|
Sign |
Postburn contracture | Post-traumatic contracture | Congenital contracture |
| Anamnesis | burns | Post-traumatic wounds, fractures, tendon and muscle injuries | Congenital developmental anomaly (cerebral palsy, amniotic constrictions, etc.) |
| The nature of the skin | The presence of scars | Normal | Normal |
| Duration of the appearance of contracture | After 3-6 months. after the burn | After 1-2 months. after the injury | From birth |
| X-ray picture | Picture of arthrosis, bone hypotrophy | A picture of osteoarthritis, an incorrectly fused fracture, narrowing and homogeneous darkening of the joint space | Underdevelopment of joint elements |
table 2 Differential diagnosis of wounds and pathologically altered tissues
|
Sign |
Scarring | Long-term non-healing granulating wounds | Trophic ulcers |
| The nature of the skin | Dense, hyperpigmented, with a tendency to grow | The presence of pathological granulations without a tendency to close the wound defect | Bonded to underlying tissues, with callous edges and a tendency to recur |
| How long ago wounds appeared | Immediately after physical impact for a period of 3 to 12 months without the presence of a wound surface or with limited areas of ulceration | From 3 weeks or more after the injury | For a long time without the presence of a traumatic agent |
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Treatment
Treatment goals:
Increased range of motion in damaged joints;
Elimination of an aesthetic defect;
Restoring the integrity of the skin.
Treatment tactics
Non-drug treatment
Diet - 15 table.
General regimen, in the postoperative period - bed.
Drug treatment
Table 1. Medicines used in the treatment of the consequences of burns, frostbite, and wounds of various etiologies(except for anesthetic support)
Postburn scars and contractures
|
№ |
Drug, release form | Dosage | Duration of use |
| Local anesthetic drugs: | |||
| 1 | Procaine | 0.25%, 0.5%, 1%, 2%. No more than 1 gram. | 1 time when a patient is admitted to a hospital or when contacting an outpatient clinic |
| Antibiotics | |||
| 2 |
Cefuroxime Or Cefazolin Or amoxicillin / clavulanate Or Ampicillin / sulbactam |
1.5 g i.v. 3gr i / v |
1 time 30-60 minutes before skin incision; additional administration is possible during the day |
| Opioid analgesics | |||
| 3 |
Tramadol solution for injection 100mg / 2ml 2 ml ampoules 50 mg capsules, tablets Metamizole sodium 50% |
50-100 mg. in / in, through the mouth. the maximum daily dose is 400 mg. 50% - 2.0 intramuscularly up to 3 times |
1-3 days |
| Antiseptic solutions | |||
| 4 | Povidone iodine | Bottle 1 liter | 10 - 15 days |
| 5 | Chlorhexedin | Bottle 500 ml | 10 - 15 days |
| 6 | Hydrogen peroxide | Bottle 500 ml | 10 - 15 days |
| Dressings | |||
| 7 | Gauze, gauze bandages | meters | 10 - 15 days |
| 8 | Medical bandages | PCS. | 10 - 15 days |
| 9 | Elastic bandages | PCS. | 10 - 15 days |
Medicines for wounds, trophic ulcers, for extensive post-burn wounds and wound defects
|
№ |
Drug name (international name) | Quantity | Duration of use |
| Antibiotics | |||
| 1 |
Cefuroxime powder for solution for injection 750 mg, 1500 mg Amoxicillin / clavulanate powder for solution for injection 1.2g |
5-7days | |
| Analgesics | |||
| 2 | Tramadol solution for injection 100mg / 2ml 2 ml ampoules 50 mg capsules, tablets | 50-100 mg. in / in, through the mouth. the maximum daily dose is 400 mg. | 1-3days |
| 3 | Metamizole sodium 50% | 50% - 2.0 intramuscularly up to 3 times | 1-3days |
| 4 | 1500 - 2000 cm / 2 | ||
| 5 | Hydrogel coatings | 1500 - 2000 cm / 2 | |
| 6 | 1500 - 2000 cm / 2 | ||
| 7 | Allogeneic fibroblasts | 30 ml with at least 5,000,000 cells | |
| 8 | 1500 - 1700 cm / 2 | ||
| Ointments | |||
| 9 | Vaseline, ointment for external use | 500 gr. | |
| 10 | Silver sulfadiazine, cream, ointment for external use 1% | 250 - 500 gr. | |
| 11 | Combined water-soluble ointments: chloramphenicol / methyluracil, topical ointment | 250 - 500 gr. | |
| Antiseptic solutions | |||
| 12 | Povidone iodine | 500 ml | |
| 13 | Chlorhexedin | 500 ml | |
| 14 | Hydrogen peroxide | 250 ml | |
| Dressings | |||
| 15 | Gauze, gauze bandages | 15 meters | |
| 16 | Medical bandages | 5 pieces | |
| 17 | Elastic bandages | 5 pieces | |
| Infusion therapy | |||
| 18 | Sodium chloride solution 0.9% | Bottle ml. | |
| 19 | Glucose solution 5% | Bottle ml. | |
| 20 | SZP | ml | |
| 21 | Erythrocyte mass | ml | |
| 22 | Synthetic colloidal preparations | ml | |
Outpatient drug treatment:
With post-burn scars and contractures... Onion extract liquid, sodium heparin, allantoin, gel for external use
With trophic ulcers
Antibiotics: Strictly according to indications, under the control of bacterial culture from the wound.
Disaggregants
Pentoxifylline - solution for injections 2% - 5ml, 100mg tablets.
Inpatient drug treatment:
Cicatricial contractures and deformities
Antibiotics:
Cefuroxime powder for solution for injection 750 mg, 1500 mg
Cefazolin powder for solution for injection 1000 mg
Amoxicillin / clavulanate, powder for solution for injection 1.2g,
Ampicillin / sulbactam powder for solution for injection 1.5g - 3g
Ciprofloxacin, solution for infusion 200 mg / 100 ml
Ofloxacin, solution for infusion 200 mg / 100 ml
Gentamicin, solution for injection 80 mg / 2 ml
Amikacin powder for solution for injection 0.5 g
List of additional medicines(less than 100% probability of use).
Non-steroidal anti-inflammatory drugs:
Ketoprofen - solution for injections in ampoules of 100mg.
Diclofenac solution for intramuscular, intravenous administration 25mg / ml
Ketorolac solution for intravenous, intramuscular administration 30mg / ml
Metamizole sodium 50% - 2.0 / m
Low molecular weight heparins
Nadroparin calcium syringe form 0.3ml, 0.4ml, 0.6
Enoxaparin solution for injection in syringes 0.2ml, 0.4ml, 0.6ml
Solutions for infusion therapy
Sodium chloride - isotonic sodium chloride solution 400 ml.
Dextrose - glucose 5% solution 400ml.
Disaggregants
Pentoxifylline - solution for injections 2% - 5ml.
Acetylsalicylic acid tablets 100mg
Medical treatment provided at the stage of emergency emergency care: not carried out, hospitalization is planned.
Other treatments:
Compression therapy;
Balneological treatment (hydrogen sulfide applications, radon);
Mechanotherapy;
Ozone therapy;
Magnetotherapy;
Imposition of immobilization agents (splints, soft bandages, plaster splints, circular plaster cast, brace, orthosis) early after surgery.
Other outpatient treatments:
Magnetotherapy;
Compression therapy;
Balneological treatment;
Mechanotherapy.
Other types provided at the stationary level:
Hyperbaric oxygenation.
Other types of treatment provided at the stage of emergency emergency care: not carried out, hospitalization is planned.
Surgical intervention:
In the absence of positive dynamics of the main surgical interventions or as an addition to them, transplantation of cultured allogeneic or autologous skin cells is possible, as well as the use of biodegradable dressings [2]
Outpatient surgery: not performed.
Inpatient surgery
With post-burn, post-traumatic scars and contractures:
Plastic surgery with local tissues; in the presence of linear scars, contractures with formed "sail-shaped scar cords", in the presence of limited skin defects.
Plastic flaps on the feeding leg; In the presence of scars, tissue defects in the area of large joints, when tendons, bone structures are exposed along the length, with defects in the tissues of the hands and on the supporting surfaces of the feet, in order to reconstruct defects in the head, neck, trunk, pelvic area.
Free plastic grafts on vascular anastomoses; In the presence of scars, tissue defects in the area of large joints, with exposure of bone structures throughout, with defects in the tissues of the hands and on the supporting surfaces of the feet, in order to reconstruct defects in the head, trunk, pelvic area.
Plastic grafts with axial blood supply; In the presence of tissue defects with exposed joints, bone structures, defects in supporting surfaces (hand, foot).
Combined dermal plastics; In the presence of scars or tissue defects in the area of large joints, with exposure of tendons, bone structures throughout, with defects in the tissues of the hands and on the supporting surfaces of the feet, in order to reconstruct defects in the head, neck, trunk, pelvic area.
Plastic surgery with extension flaps (using endoexpanders); In the presence of extensive cicatricial lesions of the skin.
The use of external fixation devices; In the presence of bone fractures, arthrogenic contractures, correction of the length or shape of bone structures.
Transplant or movement of muscles and tendons; If there are defects along the muscles or tendons.
Endoprosthetics of small joints. With the destruction of articular components and without the success of other methods of treatment.
Long-term non-healing ulcers and scars:
Free autodermoplasty; in the presence of limited or extensive skin defects.
Surgical treatment of granulating wounds: in the presence of pathologically altered tissues.
Skin allotransplantation; in the presence of extensive skin defects, extensive ulcers of various origins.
Xenotransplantation in the presence of limited or extensive skin defects, for the purpose of preoperative preparation.
Transplantation of cultured skin cells in the presence of extensive skin defects, extensive ulcers of various origins.
Combined transplantation and the use of growth factors in the presence of extensive skin defects, extensive ulcers of various origins.
Plastics with local tissues: in the presence of limited skin defects.
Plasty with flaps on the feeding pedicle: In the presence of scars or tissue defects in the area of large joints, when tendons, bone structures are exposed along the length, with defects in the tissues of the hands and on the supporting surfaces of the feet, in order to reconstruct defects in the head, neck, trunk, pelvic area ...
Preventive actions:
Rehabilitation of residual wounds and scars;
Reduction of scar area;
Absence of inflammatory processes in the wound;
For wounds and trophic ulcers:
Healing of a wound defect;
Restoring the integrity of the skin
Preparations (active ingredients) used in the treatment
| Allantoin |
| Allogeneic fibroblasts |
| Amikacin (Amikacin) |
| Amoxicillin |
| Ampicillin |
| Acetylsalicylic acid |
| Biotechnological wound dressings (cell-free material or material containing living cells) (xentransplantation) |
| Vaselin |
| Hydrogen peroxide (Hydrogen peroxide) |
| Gentamicin |
| Heparin sodium |
| Hydrogel coatings |
| Dextrose |
| Diclofenac (Diclofenac) |
| Ketoprofen (Ketoprofen) |
| Ketorolac |
| Clavulanic acid |
| Bulb onion extract (Allii cepae squamae extract) |
| Metamizole sodium (Metamizole) |
| Methyluracil (Dioxomethyltetrahydropyrimidine) |
| Nadroparin calcium |
| Sodium chloride |
| Ofloxacin |
| Pentoxifylline |
| Plasma, fresh frozen |
| Film collagen coatings |
| Povidone - iodine (Povidone - iodine) |
| Procaine |
| Synthetic wound dressings (Foamed polyurethane, combined) |
| Sulbactam |
| Sulfadiazine silver salt |
| Tramadol (Tramadol) |
| Chloramphenicol |
| Chlorhexidine |
| Cefazolin |
| Cefuroxime |
| Ciprofloxacin (Ciprofloxacin) |
| Enoxaparin sodium |
| Erythrocyte mass |
Groups of drugs according to ATC used in treatment
Hospitalization
Indications for hospitalization with an indication of the type of hospitalization.
Emergency hospitalization: No.
Planned hospitalization: Patients who have suffered frostbite, thermal burns of various origins with long-standing wounds or trophic ulcers, scars, contractures are subject.
Information
Sources and Literature
- Minutes of the meetings of the Expert Council of the RCHRH MHSD RK, 2014
- 1.Yudenich V.V., Grishkevich V.M. 2.S. Kh. Kichemasov, Yu. R. Skvortsov Skin grafting with flaps with axial blood supply for burns and frostbite. St. Petersburg 2012 3.G. Chaby, P. Senet, M. Veneau, P. Martel, JC Guillaume, C. Meaume, et al. Dressings for the treatment of acute and chronic wounds. Systematic review. Archives of Dermatology, 143 (2007), pp. 1297-1304 4.D.A. Hudson, A. Renshaw. An algorithm for the release of burn contractures of the extremities / Burns, 32. (2006), pp. 663–668 5.N.M. Ertaş, H. Borman, M. Deniz, M. Haberal. Double opposing rectangular advancement elongates tension line as much as Z-plasty: an experimental study in the rat inguinal. Burns, 34 (2008), pp. 114-118 6 T. Lin, S. Lee, C. Lai, S. Lin. Treatment of axillary burn scar contractures using opposite running Y-V plasty. Burns, 31 (2005), pp. 894-900 7 Suk Joon Oh, Yoojeong Kim. Combined AlloDerm® and thin skin grafting for the treatment of postburn dyspigmented scar contracture of the upper extremity. Journal of Plastic, Reconstructive & Aesthetic Surgery. Volume 64, Issue 2, February 2011, Pages 229-233. 8 Michel H.E. Hermans. Preservation methods of allografts and their (lack of) influence on clinical results in partial thickness burns // Burns, Volume 37. - 2011, P. - 873–881. 9 J. Leon-Villapalos, M. Eldardiri, P. Dziewulski. The use of human deceased donor skin allograft in burn care // Cell Tissue Bank, 11 (1). - 2010, P. - 99-104. 10 Michel H.E. Hermans, M.D. Porcine xenografts vs. (cryopreserved) allografts in the management of partial thickness burns: Is there a clinical difference? Burns Volume 40, Issue 3, May 2014, pp. 408-415. 11 Alekseev AA, Tyurnikov Yu. I. Application of the biological dressing "Xenoderm" in the treatment of burn wounds. // Combustiology. - 2007. - No. 32 - 33. - http://www.burn.ru/ 12 Ryu Yoshida, Patrick Vavken, Martha M. Murray. Decellularization of bovine anterior cruciate ligament tissues minimizes immunogenic reactions to alpha-gal epitopes by human peripheral blood mononuclear cells. // The Knee, Volume 19, Issue 5, October 2012, pp. 672-675. 13 Celine Auxenfansb, 1, Veronique Menetb, 1, Zulma Catherinea, Hristo Shipkov. Cultured autologous keratinocytes in the treatment of large and deep burns: A retrospective study over 15 years. Burns, Available online 2 July 2014 14 J.R. Hanft, M.S. Surprenant. Healing of chronic foot ulcers in diabetic patients treated with a human fibroblast derived dermis. J Foot Ankle Surg, 41 (2002), p. 291.15 Steven T Boyce, Principles and practices for treatment of cutaneous wounds with cultured skin substitutes. The American Journal of Surgery. Volume 183, Issue 4, April 2002, Pages 445–456. 16 Mitryashov K.V., Terekhov S.M., Remizova L.G., Usov V.V., Obydeinikova T.N. Evaluation of the effectiveness of the use of epidermal skin growth factor in the treatment of burn wounds in a "humid environment". Electronic journal - Combustiology. 2011, no. 45.
Information
III. ORGANIZATIONAL ASPECTS OF THE PROTOCOL IMPLEMENTATION
List of protocol developers with qualification data:
1. Abugaliev Kabylbek Rizabekovich - National Scientific Center of Oncology and Transplantology JSC, chief specialist of the department of reconstructive plastic surgery and combustiology, candidate of medical sciences, chief freelance specialist in combustiology of the Ministry of Health and Social Development of the Republic of Kazakhstan
2. Mokrenko Vasily Nikolayevich - GKP on REM “Regional Center of Traumatology and Orthopedics named after Professor Kh.Zh. Makazhanov "Health Department of the Karaganda region, head of the burn department
3. Khudaybergenova Mahira Seydualievna - JSC "National Scientific Center of Oncology and Transplantology", chief expert clinical pharmacologist of the department of examination of the quality of medical services
No Conflict of Interest Statement: no.
Reviewers:
Sultanaliev Tokan Anarbekovich - Advisor - Chief Surgeon of JSC "National Scientific Center of Oncology and Transplantology", Doctor of Medical Sciences, Professor
Indication of the conditions for revision of the protocol: Revision of the protocol after 3 years and / or when new diagnostic / treatment methods with a higher level of evidence appear.
Attached files
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Rough scars and scars on the face or body today no longer serve as an adornment for real men and, even more so, women. Unfortunately, the possibilities of modern medical cosmetology do not allow to completely get rid of cicatricial defects, suggesting only to make them less noticeable. The scar correction process takes persistence and patience.
"Scar" and "scar" are synonymous words. A scar is a household name for a scar. Scars on the body are formed as a result of the healing of various skin lesions. Exposure to mechanical (trauma), thermal (burns) agents, skin diseases (post-acne) lead to disruption of the physiological structure of the skin and its replacement by connective tissue.
Scars sometimes behave very insidiously. With normal physiological scarring, the skin defect shrinks and turns pale over time. But in some cases, scarring is pathological in nature: the scar acquires a bright purple color and increases in size. In this case, immediate specialist assistance is needed. The problem of scar correction is dealt with in the community of dermatocosmetologists and plastic surgeons.
Scar formation.
In its formation, the scar goes through 4 stages successively replacing each other: I - the stage of inflammation and epithelialization.It lasts from 7 to 10 days from the moment the injury occurs. It is characterized by a gradual decrease in swelling and inflammation of the skin. Granulation tissue is formed, bringing the edges of the wound closer together, the scar is still absent. If there is no infection or dehiscence of the wound surface, then the wound heals by primary intention with the formation of a barely noticeable thin scar. In order to prevent complications at this stage, atraumatic sutures are applied, sparing tissues, daily dressings are performed with local antiseptics. Physical activity is limited to avoid dehiscence of the wound edges. II - stage of formation of a "young" scar.
Covers the period from the 10th to the 30th day from the moment of injury. It is characterized by the formation of collagen-elastin fibers in the granulation tissue. The scar is immature, loose, easily stretchable, bright pink in color (due to increased blood supply to the wound). At this stage, secondary wound trauma and increased physical exertion should be avoided. III - stage of "mature" scar formation.
Lasts from the 30th to the 90th day from the day of the injury. Elastin and collagen fibers grow into bundles and line up in a specific direction. The blood supply to the scar decreases, which causes it to thicken and turn pale. At this stage, there are no restrictions on physical activity, but repeated injury to the wound can cause the formation of a hypertrophic or keloid scar. IV - stage of the final transformation of the scar.
Starting from 4 months after injury and up to a year, the final maturation of the scar occurs: the death of blood vessels, tension of collagen fibers. The scar thickens and turns pale. It is in this period that the doctor understands the condition of the scar and the further tactics of its correction.
It is not possible to get rid of scars once and for all. With the help of modern techniques, you can only make a rough, wide scar more cosmetically acceptable. The choice of method and the effectiveness of treatment will depend on the stage of scar defect formation and on the type of scar. In this case, the rule applies: the earlier you seek medical help, the better the result will be.
A scar is formed as a result of a violation of the integrity of the skin (surgery, trauma, burns, piercing) as a result of the processes of closing the defect with new connective tissue. Superficial damage to the epidermis heals without scarring, that is, the cells of the basal layer have good regenerative capacity. The deeper the damage to the layers of the skin, the longer the healing process and the more pronounced the scar. Normal, uncomplicated scarring results in a normotrophic scar that is flat and the color of the surrounding skin. Violation of the course of scarring at any stage can lead to the formation of a rough pathological scar.
Types of scars.
Before choosing a method of treatment and the optimal timing of a particular procedure, you should determine the type of scars.Normotrophic scars usually do not cause great distress to patients. They are not so noticeable, so their elasticity is close to normal, they are pale or flesh-colored and are at the level of the surrounding skin. Without resorting to radical methods of treatment, such scars can be safely removed using microdermabrasion or chemical surface peeling.
Atrophic scars can occur as a result of acne or poor-quality removal of moles or papillomas. Stretch marks (striae) are also this type of scar. Atrophic scars are located below the level of the surrounding skin, characterized by tissue laxity resulting from a decrease in collagen production. Lack of skin growth leads to the formation of pits and scars, creating a visible cosmetic defect. Modern medicine has in its arsenal many effective ways to eliminate even fairly extensive and deep atrophic scars.
Hypertrophic scars are pink in color, limited to the damaged area and protrude above the surrounding skin. Hypertrophic scars can partially disappear from the surface of the skin within two years. They respond well to treatment, so you shouldn't wait for them to disappear spontaneously. Small scars can be treated with laser resurfacing, dermabrasion, chemical peeling. The introduction of hormonal drugs, diprospan and kenalog injections into the scar area leads to positive results. Electro- and phonophoresis with kontubex, lidase, hydrocortisone give a stable positive effect in the treatment of hypertrophic scars. Surgical treatment is possible, in which scar tissue is excised. This method gives the best cosmetic effect.
Keloid scars have a sharp border, protrude over the surrounding skin. Keloid scars are often painful, itching and burning are felt in the places of their formation. This type of scars is difficult to treat; recurrence of even larger keloid scars is possible. For all the complexity of the task, aesthetic cosmetology has many examples of a successful solution to the problem of keloid scars.
Features of keloid scars.
The success of the treatment of any disease largely depends on the correct diagnosis. This rule is no exception in the case of the elimination of keloid scars. To avoid mistakes in treatment tactics, it is possible only by clearly defining the type of scar, etc., in terms of external manifestations, keloid scars often resemble hypertrophic scars. A significant difference is that the size of hypertrophic scars coincides with the size of the damaged surface, while keloid scars extend beyond the boundaries of the injury and in area may exceed the size of the traumatic skin injury. The usual places of occurrence of keloid scars are the chest area, auricles, less often the joints and the face area. Keloid scars go through four stages in their development.Epithelialization stage. After injury, the damaged area is covered with a thin epithelial film, which thickens, coarsens, becomes pale in color within 7-10 days and remains in this form for 2-2.5 weeks.
Swelling stage. At this stage, the scar enlarges, rises above the adjacent skin, and becomes painful. In the course of 3-4 weeks, the painful sensations weaken, and the scar acquires a more intense reddish color with a cyanotic shade.
Compaction stage. There is a compaction of the scar, in some places there are dense plaques, the surface becomes bumpy. The external picture of the scar is a keloid.
Softening stage. At this stage, the scar finally acquires a keloid character. It is characterized by pale color, softness, mobility and painlessness.
When choosing treatment tactics, one proceeds from the age of the scars. Keloid scars from 3 months to 5 years of existence (young keloids) are actively growing, they are distinguished by a smooth shiny surface, red in color with a cyanotic shade. Scars older than 5 years (old keloids) turn pale, acquire a wrinkled uneven surface (sometimes the central part of the scar sinks).
Keloid scars can be caused by surgery, vaccinations, burns, insect or animal bites, and tattoos. Such scars can occur even without traumatic injury. In addition to significant aesthetic discomfort, keloid scars give patients unpleasant sensations of itching and soreness. The reason for the development of this particular type of scars, and not hypertrophic ones, has not been established by doctors at the moment.
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