Modern dressings. Dressing materials and how to use them The existing variety of dressings requires classification to better understand their purpose. Currently, there is no single generally accepted classification of dressings.

The main purpose of dressings is to protect wounds from secondary infection and drain it, that is, to create the necessary conditions for early healing. Suture materials are designed to tighten (converge) the edges of the wound, which also helps to speed up the healing process. Sutures are applied in order to suture the stump of the resected organ or part of it (suturing), to impose anastomosis (suturing). Various suture materials are used for suturing, and the process itself is carried out using special tools and devices.

DRESSING DEVICES

Dressings are made from organic materials - cotton, paper and cotton-viscose yarn, wood. Cotton fibers, gauze and gauze bandages are made from cotton fibers, alignin and viscose are made from wood. The main dressing materials and products made from them are mass-produced products and the requirements for them are determined by GOSTs.

Cotton wool. Medical cotton wool is hygroscopic and compressive. For dressings, medical absorbent cotton wool is used, made from the best varieties of cotton with an admixture of viscose, properly defatted, whitened and washed until a neutral reaction is obtained. Compress cotton wool is creamy in color, does not absorb water well and is used for warming compresses and when applying splints. It is packaged in bags of 50, 100, 250 and 500 g and packed in bales of 50 kg.

Quality indicators of medical absorbent cotton wool are determined by GOST 5556-75. Cotton wool should be well combed, have a high absorption capacity and capillarity, that is, it should absorb water well and draw moisture from the wound into the upper layers of the dressing, like a micro pump.

The absorbency, or the degree of water absorption of cotton wool, is determined by weighing dry cotton wool and the same cotton wool after having been in water for 10 minutes. The ratio of the mass of wet wool (when absorbing the limiting amount of water) to the mass of dry wool is called the coefficient of water absorption.

Cotton wool of standard quality has a water absorption coefficient of at least 19-20, that is, a sample of cotton wool with absorbed moisture should be 19-20 times heavier than a sample of dry wool. The test is carried out 3 times and the average of the three measurements is taken as the true water absorption coefficient of the cotton wool used.

Capillarity is determined by the height to which the liquid rises (eosin solution 1: 1000) in a glass tube with cotton wool placed in it. The inner diameter of the tube is 7 mm. A sample of cotton wool (0.5 g) is placed in a tube from 0 to 85 mm division. For reliability, the test is performed in 10 tubes and the average of 10 readings is taken. The capillarity of high quality cotton wool is in the range of 66-77 mm. When testing for 10 minutes, it is necessary to ensure that the lower end of the cotton swab is not immersed in water, but only touches its surface.

Absorbent cotton wool should be chemically neutral from t-, flax, so as not to affect the tissues of the body. The neutrality of the cotton wool is checked with litmus paper. A preliminary sample of cotton wool (20 g) is boiled for 15 minutes in 200 ml of distilled water, after which the water is squeezed out and the reaction is determined with litmus paper. You can determine the pH of water using a pH meter, the pH of the hoods should be in the range of 7.0-7.5.

The standard also regulates the humidity of the cotton wool, controlled by an electric moisture meter.

In accordance with the standard, cotton wool is made of three types:

I) medical eye - from cotton of the 1st grade; 2) surgical - made of pure cotton not lower than grade 3 and with viscose-staple fiber (up to 30%); 3) hygienic household - from cotton not lower than 5th grade. Table 6 shows the indicators of the quality of cotton wool.

Cotton wool is produced in bales of 20, 30, 40, 50 kg and in packages (rolls) of 25, 100 and 250 g. Cotton wool in rolls is made sterile and non-sterile (in parchment paper) for direct use. The packaging indicates the type and weight of cotton wool, sterility, opening method, standard number, manufacturer's name and its trademark.

Alignin. Alignin medical is produced in the form of thin crepe (having a wrinkled surface) paper. It is a complex organic substance that is part of wood and imparts strength to plant cells. Alignin is chemically separated from wood during the production of cellulose.

Alignin is produced in two grades: A - for dressings, B - for packaging medicines and medical instruments. Produced in the form of multilayer sheets 600-700 mm wide and 600 to 2600 mm long, stacked in packs of 5 kg, in which alignin is pressed and wrapped in wrapping paper. Each bundle is tied with twine. The mass of 1 m 2 of a creped alignin sheet is 37 g.

Alignin grade A has fairly high capillarity (85 mm in 30 min) and water absorption (12 g per 1 g of alignin). In the state of delivery, the moisture content of alignin is not more than 6%. Alignin is cheaper than cotton wool and is widely used in medicine. Its disadvantages: aging during long-term storage, destruction (turning into powder) and creeping when moisturized. Alignin is not elastic enough, therefore it is used for dressings in combination with cotton wool.

Gauze. Medical gauze is a rare mesh-like fabric. Available in two varieties: bleached hygroscopic and harsh. Each of these grades is of two types - pure cotton and with an admixture of viscose staple fabric (cotton in half with viscose or 70% cotton and 30% viscose). The difference is that cotton gauze is wetted within 10 seconds (it sinks in water), and gauze with an admixture of viscose is wetted 6 times slower (within 60 seconds). Its advantages are increased moisture capacity, high ability to absorb tissue exudate, better ability to absorb blood. However, gauze with an admixture of viscose retains medicinal substances worse than cotton gauze, and repeated washing reduces the absorption capacity. The strength of the cotton gauze is about 25% higher than the viscose-doped gauze. The capillarity of both types of gauze is high and is not less than 10-12 cm / h. With regard to neutrality, the same requirements are imposed on gauze as for cotton wool. Gauze is produced with a web width of 69-73 cm, 50-150 m per piece. Gauze cuts are produced with a length of 10 m and a width of 90 cm, three sections in a pack (for non-standard surgical dressings). Gauze, like cotton wool, is tested for absorbency (wettability), capillarity, and neutrality.

The wettability is checked by the immersion method. A sample of hygroscopic gauze (5x5 cm), lowered on the surface of the water, without touching the walls of the vessel, should be immersed in water in 10 s, and severe in 60 s.

Capillarity is checked by lowering a 5 cm wide gauze strip at one end into a Petri dish with eosin solution. Within an hour, the solution should rise from the liquid level by at least 10 cm.

Neutrality is checked with a water extract litmus test. Three pieces of gauze, 3 g each, from three of its samples are boiled for 15 minutes in 60 ml of distilled water. After removing the gauze, it is cooled and checked for neutrality. If you want to check the gauze for the absence of starch, then previously 10 ml of the water extract is poured into a test tube and one drop of 0.05 N is added to it. iodine solution. In the presence of starch, the solution turns blue.

Special types of gauze include hemostatic and hemostatic gauze.

Hemostatic gauze- obtained by treating ordinary gauze with nitrogen oxides. Such gauze has a hemostatic effect and dissolves in the wound without a trace within a month. Apply in the form of napkins (13x13 cm).

Hemostatic gauze- contains the calcium salt of acrylic acid. Stops blood quickly (after 2-5 minutes), but does not dissolve. Applied in the form of napkins, balls, tampons. Saves up to 15% of dressing material.

Cotton-gauze pads(GOST 22379-77) are intended for dressing wounds and burns. Produced sterile five rooms, differing in size: No. 1-32x29 cm; No. 2-25x25 cm;

No. 3-17x16 cm; No. 4-15x15 cm and No. 5-10x10 cm. The pads have one layer of cotton wool and two layers of gauze - one on each side of the layer. The layers are stitched with threads. The pads are folded in half (large - four times) and packaged in 2 pieces (No. 3-5 - 10 pieces each) in parchment paper bags. Pads No. 5 are packed, in addition, in a polyethylene or polyethylene cellophane film sheath, the edges of which are welded. Produced sterile; sterility lasts 5 years.

Cotton gauze tape for the manufacture of pads on site, it is produced non-sterile 29 cm wide and 2 m long in cylindrical packs, packed in parchment. Packing diameter 9 cm, length 30 cm.

Gauze bandages made from gauze tape 5, 7 and 10 m long and 3 to 16 cm wide, rolled up with a roller. According to GOST 1172-75, bandages are produced: sterile, 5 cm wide and 5, 7 and 10 m long, as well as 14 and 16 cm wide and 7-10 m long, respectively; non-sterile 5 m long and 3, 5, 7, 8.5 and 10 cm wide; 7 m long and 5, 7, 8.5, 10, 12 and 14 cm wide; 10 m long and 5, 7, 8.5, 10 and 16 cm wide. Sterile bandages are individually packed - parchment or film; non-sterile - individually wrapped in a wrapping or film shell and in multiples of five, but not more than 30, are placed in cardboard boxes or in bundles and fastened with a parcel post.

Bandages made of cotton-viscose gauze rather than regular gauze have better functional properties. Wounds heal faster with these bandages. The guaranteed shelf life of bandages is 5 years from the date of manufacture.

Non-sprinkling plaster bandages used for plastering in traumatology. Gypsum on gauze is fixed with methylcellulose; setting - 4-5 minutes. The dressing is more durable and has less weight than with conventional casting.

Elastic medical bandage(GOST 16977-71) is intended for applying squeezing bandages. Produced from harsh "cotton yarn. Allows stretching at least 50%. - They produce a bandage 3 m long, 50 and 100 mm wide. These bandages are very strong (breaking load of a bandage 50 mm wide at least 30 kgf). Bandages wrapped in a label, placed in cardboard boxes of 18 (100 mm) or 36 pieces (50 mm).

Medical tubular bandages intended for fixing medical dressings. They represent a knitted sleeve made of harsh viscose fabric. Release two;

numbers-no. 5 and no. 9; the number means the width of the sleeve in centimeters (tolerance ± 1 cm). Produced in rolls in film packaging, 25 m per roll. A piece of bandage (when cutting, the bandage does not dissolve), put on over the applied bandage and fix it well. Elongation is at least 450% for bandage No. 5 and 650% for bandage No. 9. This means that bandage No. 5 with a perimeter of 100 mm stretches into a ring with a perimeter of 450 mm and can fix the bandages on the upper and lower extremities. Bandage No. 9 can also be applied to the head and buttocks.

Elastic tubular medical bandages designed for the same purposes as knitted fabrics, however, their elongation is much higher - up to 800%. They belong to the "tepermat" type (knitted elastic dressing material). Made from elastomeric yarn, braided with synthetic fibers and cotton yarn. Having a mesh structure, they do not interfere with the aeration of the area of the body on which they are applied, and the observation of this area of the body. Bandages are made in seven numbers with a free sleeve width of 10, 20, 25, 30, 35, 40 and 75 mm. The weight of 1 m 2 bandage is 280 g. The use of tubular bandages saves dressing material and time when applying bandages. It should be noted that no synthetic detergents should be used when washing elastic bandages. Bandages are washed in soapy foam at a temperature not exceeding 40 ° C, followed by rinsing in warm water and wringing out in a towel without twisting. For drying, they are laid out on a horizontal plane.

Dressing bags are designed to provide self-and mutual assistance for injuries and burns. There are four types:

1) individual - consists of a gauze bandage (10cm x7 m), fixed and movable gauze pads (17.5x32cm);

2) ordinary - has the same composition as the individual. The only difference is in the packaging: the outer shell of the individual bag is rubberized, and the ordinary one is parchment.

Both types of bags are equipped with safety pins to secure the end of the bandage;

3) first aid with one pad - consists of a bandage (10 cm x 5 m) and one pad (11x13.5 cm);

4) first aid with two pads - has pads of the same size (11x13.5 cm), and gauze bandage 7 cm wide (narrow bandage) or 10 cm wide (wide bandage). First aid packages are wrapped in plastic foil.

Fixing contoured dressings use instead of a gauze bandage when applied to the limbs and trunk. Ready-made standard dressings (GOST 22380-77) significantly save staff time and dressings. They are produced in a set, which includes three bandages for the limbs: large (80x65x45 cm), medium (65x65x45 cm), small (55x35x25 cm) and a bandage for the trunk (30x78x45 cm). Packed in 2 sets in a pack. The dressings are produced non-sterile.

Gauze napkins are rectangular pieces of gauze folded in half. Their edges are wrapped inward so that the threads do not fall into the wound. Napkins are made in two sizes: large - 70x68 cm (sterile, 5 pieces per pack and non-sterile, 50 pieces per pack); medium - 33x45 cm (sterile 10 pieces per pack, non-sterile 100 pieces per pack); small - 14x16 cm (sterile 40 pieces per pack, non-sterile 100 or 200 pieces per pack). Pack the napkins in parchment paper. The wrapper must indicate: sterility, size, quantity, date of manufacture and the name of the manufacturer.

Styrofoam wipes are intended for the treatment of burns, postoperative wounds, trophic ulcers and pressure sores. Replace cotton wool in various types of dressings. They have high hygroscopic properties, effectively absorbing wound contents and not sticking to the wound. They are also used in the form of balls (2x2x1 cm).

Gauze balls released sterile (16x14 cm) unfolded and folded (7x4 cm). Sterile balls are produced in 40 pieces in a pack, non-sterile in 200 pieces.

Sterilization of dressings carried out in a steam sterilizer at a temperature of 120 ° C, at a pressure of 1.1 kgf / cm 2 for 45 minutes. Dressing materials are placed in metal boxes - bixes and, after sterilization, are stored in the same bixes. Sterility in filter bixes (see chapter VI) lasts at least 8-10 days.

Ready-made dressings are sterilized in factories, where they are tested for sterility in bacteriological laboratories.

Storage of dressings carried out in wooden boxes, in dry ventilated rooms, well protected from dust and rodents. Storage of non-sterile material in an unheated room is allowed. At the same time, one should strive to ensure a stable temperature, avoid dampness and mold formation. Sterile materials should be stored in a room where the temperature does not fluctuate too sharply so that the packaging does not "breathe" when the temperature changes. The fact is that when the temperature rises, the air expanding in the bag partially leaves it outside, and when the temperature drops, on the contrary, it enters the inside of the bag; microbial penetration is possible with the air stream.

When storing sterile dressings in a warehouse, it should be laid out according to the years of preparation, since after 5 years, with intact packaging, it is necessary to selectively check it annually for sterility. If broken or wetted packaging, the material is non-sterile.

SEAM MATERIALS

Suture materials or materials for a surgical suture are used during surgery to suture various tissues and to stop bleeding (dressing). Rarely, surgery is performed without suturing. Silk, catgut, paper and synthetic threads, metal staples, metal wire, horsehair, reindeer tendon threads, special nails and metal plates for connecting bones, etc. are used as suture material. their accretion. This requires materials of varying mechanical strength.

Surgical silk and catgut are most often used for sutures, which serve as the main suture material in surgical practice. The rest of the materials listed above are used only in special cases. The suture material must be strong, of the same diameter along the entire length, capable of tying into knots, have a smooth surface, have sufficient density (low capillarity) and be resistant to one of the types of sterilization.

Suture material is usually divided into two main groups: absorbable and non-absorbable. Catgut is referred to as absorbable materials; all other materials are not absorbed.

Catgut(from lat.catgut - cat's intestine) is widely used for stitching internal organs and tissues, which is explained by its ability to dissolve in the body after 2-4 weeks, depending on the thickness of the thread. Catgut is prepared from the intestines of small (mainly sheep) and cattle (neoketgut). For its manufacture, the submucous and partially muscular layer of the intestinal wall is used. The technological process of making catgut consists in removing unnecessary layers of the intestine and the formation of elastic bands, and from them threads of various diameters. The threads are pale yellow, strong enough, elastic, loosely tied in knots. The moisture content of the threads is about 20%, the fat content is up to 2%. Neoketgut is less durable than catgut, but cheaper.

Catgut is produced in paper bags (dry catgut), non-sterile and sterile (in ampoules). The length of the thread is from 1.5 to 2.5 m, the thickness is from 0.2 to 0.75 mm. Breaking strength from 1.4 to 11.5 kgf. The following catgut numbers are produced: No. 00, No. 0, No. 1, No. 2, No. 3, No. 4, No. 5, No. 6, No. 7 and No. 8. The smaller the number, the thinner the thread. Catgut No. 1 has a breaking force of at least 2.2 kgf, and catgut No. 4 - 7.2 kgf. Parchment paper bags contain 5-10 strands of catgut, depending on their size. Each ampoule contains only one thread of catgut. In addition to the usual catgut, chrome-plated catgut is produced in ampoules; having a longer resorption period.

During the factory production of catgut, a number of measures are taken to prevent infection. To this end, they strive to conduct the entire factory process aseptically, and the manufactured catgut is degreased and sterilized by chemical means, since the catgut cannot withstand boiling. Nevertheless, this catgut may contain pathogenic microflora, so much attention is paid to its sterilization. Many methods have been proposed for sterilizing catgut. Most often, iodine (Lugol's solution) is used for this purpose, in which the catgut is kept for at least eight days after preliminary defatting in ether for 24 hours.

Catgut in skeins is subjected to additional sterilization in a surgical facility, and catgut in ampoules is suitable for immediate use. In ampoules, it is in a solution of 70% alcohol with glycerin, and after treatment with iodine, it remains dry and, before use, is immersed in alcohol for a short time to increase its elasticity. It should be borne in mind that with long-term storage, the catgut thread gradually loses its strength and worsens tied into knots. Therefore, before use, it is checked for strength and sterility (in a bacteriological laboratory). Catgut should be stored in skeins at an even temperature, preferably at 15 ° C and normal humidity in a dry, ventilated room, protected from dust, moths and rodents.

Surgical silk possesses high strength and durability, as a result of which it is the most frequently used suture material. Surgical twisted silk threads are made in accordance with GOST 396-76 from natural raw silk, well bleached, boiled and washed with a fat and soap content in surgical threads of no more than 1.7% and a normalized moisture content of 9%.

Silk is produced in the form of long thin twisted threads of nine conventional numbers from 000 to 8 (thread diameter, respectively, from 0.13 to 0.73 mm on average).

The mechanical properties of the threads regulated by the standard are given in table. 7.

Silk is produced in skeins with a thread length of 50 m (for numbers 000-3) and 20 m (for numbers 4, 6 and 8) or in bulk bobbins weighing 200-400 g (thread length from 1000 m for numbers 000 to 50 m for No. 8). Bulk bobbins are easy to use: the thread is easily removed to the end, and the outer layers do not slip and do not get tangled. Since silk threads are produced non-sterile, the bulk bobbin is convenient for sterilization.

Linen threads serve as a good substitute for silk. They are superior to silk in resistance to disinfection by boiling, easily knotted, strong enough and give a reliable seam, so surgeons willingly use them. Dressed (starch-soaked threads) are not suitable as sutures, as starch can serve as a nutrient

environment for microbes.

Nylon and lavsan threads more and more widely used in recent years in surgery. Threads made of these materials in the form of a braided cord have high strength, are resistant to steam sterilization, and are perfectly tolerated by the tissues of the body, therefore, such threads are replacing silk threads. The thinnest threads from No. 0000 (or 4/0) to No. 3 are produced from nylon. In appearance, they differ little from silk. Lavsan thread is produced from No. 3/0 to No. 3. It is colored green, as a result of which it contrasts well in the wound. The yarns are produced in skeins 45 m long (from No. 4/0 to No. 3) and 9 m long from No. 4 and above.

Horse hair used as a suture material in plastic surgery, in particular in operations on the face, since the scars with such a suture are hardly noticeable. However, the centralized harvesting of horsehair is not carried out and it is going out of use.

Wire It is used for stitching the bone (with fractures of the lower jaw, popliteal) and in other cases when especially high demands are made on the suture material in terms of strength and durability.

For these purposes, ligature wire is produced from chromium-nickel stainless steel 12X18H9T with a diameter of 0.4 and 0.6 mm in coils of 50 mm. Coil diameter 50 and 70 mm, respectively.

This wire is significantly superior in chemical resistance to bronze-aluminum wire (90% copper and 10% aluminum), which is produced for dentistry and is more plastic. Air sterilization of the wire at a temperature of 160 ° C. The wire suture is removed after the bones are fused.

SURGICAL NEEDLE

The surgical suture is applied using a surgical needle. Sutures with a needle with a thread or catgut are applied not only to the skin, but also to various tissues of the internal organs, during operations on the eyeball and during other special surgical procedures, as well as during autopsies. In this regard, the range of surgical needles is quite extensive and includes more than 100 standard sizes.

The needles are distinguished by their shape - the degree of bending and are released from straight to strongly curved (0.6 circumference), by the size of the length of the needle (unfolded in a line), by the shape of the section - round (piercing) and triangular (piercing-cutting) and, finally, according to the shape of the eye of the needle - with a split and continuous eye (Fig. 6, A).

The designation of the needles reflects all their main features and sizes. In fig. 6 in isometric view on an enlarged scale shows a triangular needle with a cutting eye with the symbol ZB1-0.4x18. The first number characterizes the shape (in this case, a bend along 0.4 of a circle), the letter is the section and the second number is the shape of the ear. Further, through a dash, the dimensions are given: the diameter of the original wire in millimeters (in this case, 0.4 mm) and the unfolded length (in this case, 18 mm). The smallest sizes have needles for the eye and vascular suture, the largest - for suturing muscles and aponeurosis. The minimum dimensions are for needles 4B2-0.25x8, and the maximum size is 4B1-2.0x90.

The needles are made from the needle wire of the U7A or U8A tool steel, their working part is sharpened by cold stamping and subsequent sharpening. The needle is hardened, it should be sharp and easily pierce suede with a thickness of 0.4-0.7 mm. The needles are coated with a thin layer of chromium (1 micron), which protects them from corrosion. The split eye is very convenient, as it allows you to quickly thread the thread without wasting time getting the thread into the eye of the needle. When threading, the thread is placed in a recess in the middle of the eyelet and, when pressed, it spreads the walls of the eyelet and passes into it. In this case, the base material should not be torn or cut. The check is carried out by holding surgical silk in the ear in accordance with table. eight.

After testing, the suture material is checked visually. The needles are recommended to be sterilized by dry air at 180 ° C for 45 minutes. The needles are packed in 10 pieces in plastic bags, which are placed in 30 pieces in cardboard boxes.

Surgical needles, atraumatic. When stitching with surgical needles, a double suture is pulled through the tissues to be sutured, although the suture is applied in a single suture. This injures the tissue. During operations when such injuries are unacceptable (on the vessels, nerves, heart), the suture is applied using atraumatic needles, in which the end of the thread is embedded in a needle or a tube of braided thread, like a stocking, is put on the needle blank and is glued. The diameter of the needle in this case is slightly larger than the diameter of the thread. These needles are disposable. The assortment of atraumatic needles produced by the industry is quite wide. Atraumatic needles are produced with a thread from a braided nylon or lavsan cord. In fig. 6, B the marketable forms of atraumatic needles are presented. They are produced single and paired with a thread length of 450 and 750 mm. The needles themselves are made of needle steel wire (U7A or U8A steel) and nickel-plated. The needles are also produced from stainless steel wire of a special composition without coating, electropolished. The length of the needles from 8 to 9 mm for curved needles is calculated by the straightened (unfolded) length.

When ordering, you need to know the code of the needle, especially since atraumatic needles are produced by more than one factory, encrypting them in their own way.

One of the factories adds a hyphenated thread index (L - lavsan) and its number (from 3 / 0-000 to No. 3) to the surgical needle cipher, excluding the abalone shape index from the cipher. So, the code of a round needle, bent at 4/8 of a circle, with a diameter of 0.9 mm and a length of 50 .. mm with a thread of lavsan braided cord No. 3 looks like this: 4B-0.9x50-LZ. This plant produces single needles with a thread length of 700 mm. The nomenclature of needles produced by this plant includes hex needles, designated by the letter T : ZT-0.45x12-L2 / 0 and ZT-0.5x12-L2 / 0), as well as rectangular needles (anatomical) -ZK-0.35x10-L3 / 0; 51 standard sizes of needles are produced in triangular and 49 - round.

The second plant produces single needles only with round ones and encrypts them with three letters: AKP - round straight needle. Further, through a hyphen, put down: the length of the needle, the material of the thread (nylon - kp, lavsan braided-lp) and its number (from No. 0000 to No. 5). So, AKP-25lpZ - means: atraumatic needle, round, straight, 25 mm long with lavsan thread No. 3.

Paired needles are issued round (K), triangular (T) and crimped (P) and are designated by four letters. For example, APKP means: atraumatic needle, steam room, round, straight; APKI - atraumatic needle, steam room, round, curved. They also produce paired triangular curved needles (APTI) and crimped (APPI). So, APPI-8lpOO means: atraumatic needle, flattened, paired, curved, 8 mm long with lavsan thread No. 00.

Atraumatic needles are produced sterile and non-sterile. Sterilization of needles, already packed in double plastic bags, is carried out using the radiation method. For non-sterile needles, a thread with a needle is wound on a celluloid plate, the end is inserted into a slot on the plate. The needle is smeared with a mixture of petroleum jelly and petroleum jelly. The needles are packed in parchment bags of 20 or 40 pieces, the bags are placed in a cardboard box.

For storing and storing needles, I release a needle holder - a small flat metal box with a lid, which is made of nickel-plated brass or stainless steel. Dimensions 80X35X12 mm.

Ligature needles. General surgical (Fig. 7, A) are designed to bring the ligature (sutures) under the vessels that need to be bandaged. For this purpose, right (a) and left blunt needles of three numbers are produced, depending on the size of the working part (g and the plate in the figure). The working part of the needle (b) is similar in design to the eye of a surgical needle with a hole for a ligature. If, when the ligature is brought in, a puncture is required, for example, the mesentery, then sharp needles (c) are used, which produce two numbers, in sizes close to No. 2 and No. 3 of a blunt needle.

Blunt ligature needles are produced to connect bone fragments with a wire (Fig. 7, B) of three numbers with a bending radius of the working part of 14, 17 and 20 mm.

In ophthalmology, blunt needles are used for the lacrimal canal (Fig. 7, B), only 1 mm wide.

Produce sharp ligature needles for suturing the palatine arches No. 1 (Kulikovsky) and No. 2 with a double bend.

The needles are made of stainless steel 30X13; they must be well polished.

Ligature forks are a tool designed to lower the ligature knot when ligating vessels in hard-to-reach places and deep cavities. The knot, in this case, is preliminarily tied around the branch of the hemostatic clamp applied to the vessel, and then with a fork is lowered into the depth of the wound and tightened with its help on the vessel. In fig. 8 shows the forks and fork probes produced for this purpose, as they are sometimes called. Plugs are not produced in sets, they are supplied individually. Bogush's probe-fork is used to feed silk and catgut threads during pulmonary operations. Its working part is made in the form of a spherical button, in which there is a hole 1 mm wide and 2.5 mm long. A hole with a diameter of 1 mm is provided in the neurosurgical fork-needle.

Tools are made mainly of stainless chromium-nickel steel 12X18H9 or chromium steel 20X13. The main requirement for forks is a smooth, clean surface.

Clips and staples for stitching and bandaging(Table 9). For ligation of the cerebral vessels, silver clips are used. For the application of clips, a special set of instruments is produced, which includes three types of forceps: straight and curved horizontally and vertically, as well as a magazine on which clips are previously placed before the operation.

For the imposition of skin sutures, Michel braces are used, which are removed as the wound heals. To ligate the umbilical cord, you can use special staples to apply to the umbilical cord.

Similar information.

The history of its origin can be traced back to very ancient times. Around 460-377 BC NS. (in the time of Hippocrates), in order to firmly fix the dressing, they used an adhesive plaster, various resins and canvas. And in 130-200 years. BC NS. Roman physician Galen created a special manual. In it, he described a variety of dressing techniques.

The history of development

The use of dressings received the first widespread resonance thanks to the decree of the Roman Senate. It said that each soldier needs to be given a strip of canvas, with which he could, if necessary, provide first aid to himself or to his colleague. It is likely that the application of various materials to the affected area of the body has been used since prehistoric times. For this purpose, leaves and grass could be used, since they have such qualities as flexibility, softness, elasticity and smoothness of the cover. Some of the plants have healing properties and even pharmacological effects, such as astringent and analgesic effects.

It is also worth noting that certain plants are used in traditional medicine for dressing to this day. Among them: plantain and many others. The dressing material reached its peak in its development during the time of capitalist production. In the period from 1476 to 1492 in Europe, the adhesive bandage received wide publicity. In the 18th century and until the 1st half of the 19th century, special importance was given to the absorbent effect of funds. The dressing material was made using raw materials with high capillarity. For example, flax and hemp hemp, as well as lint (cotton rags torn apart on threads). From the second half of the XIX century. gauze, absorbent cotton and lignin were used instead.

General classification

Not so long ago, the types of dressings were limited to only a few points:

Adhesive plasters in coils, as well as bactericidal in the form of plates.
Medical bandages.
Medical pads.
Medical gauze napkins.

Compared to the past years, the modern choice of dressings has become noticeably richer. This was largely facilitated by the large-scale development of pharmacological production on the territory of our country, as well as the massive import of foreign products to the domestic market.

Classification by purpose

Conventionally, all dressings can be divided into four groups: sterile and non-sterile, simple and complex. However, their main distinguishing quality is the purpose - the purpose of the application. According to this principle, the following series of functions performed by dressings can be distinguished:

To cover the wounded surface. For this, wipes, a bactericidal plaster, wound dressings, and so on are used.
For compressing limbs or fixing joints.
For fixing the dressing material.
Compression coatings.

A mandatory requirement for any type of dressing material for closing a wound is sterility.

Product features

The production of dressings has entered a new stage of development thanks to the emergence of modern technologies. As a result of their application, highly elastic, perforated fabrics with a nonwoven structure were obtained, based on the use of polymer compositions and metallized coatings. The use of modern materials in medicine allows us to solve the following number of problems:

Achievement of a high rate of antimicrobial activity.
Long term of validity.
High absorbency combined with good air permeability, optimal wetting rate and capillarity.
Atraumatic.
Stability of antimicrobial treatment of agents under conditions of radiation and steam sterilization.

What to choose: traditional or modern dressing materials and means?

In fact, this question is only rhetorical. The use of modern materials in medicine creates favorable conditions for faster wound healing. This, in turn, insures against scarring on the wounded surface. The reason for their occurrence is often the long-term closure of the wound with traditional dressings.

As for the price issue, the difference in cost between modern and old materials is quite noticeable. It is this argument that is sometimes made in favor of the latter. However, when it comes to human health, cost is not always a decisive factor in making a choice. In addition, as practice shows, the use of modern medical materials is more economical than traditional ones. Due to their lower efficiency, they have to be used for a very long time. This statement can be considered in more detail using the example of the use of cotton-gauze dressings:

The fleecy structure causes particles of material to enter the wound. They irritate the tissue and prevent it from healing as quickly as possible.
Gauze is a fine-mesh material with increased mass capacity. These structural features cause an increase in the number of microorganisms in the wound. In addition, they lead to a decrease in air and vapor permeability under the dressing. This is especially true when overlapping multiple layers. In this case, the process of epithelialization and granulation of the wound is delayed, and as a result, the period of its healing becomes longer.
Adhesion, or more simply adhesion, is another disadvantage of using gauze dressings. The fact is that, impregnated with wound secretions, they harden when they dry. The granulation of the wound occurs through the dressing material, resulting in new surface trauma and painful sensations during removal. The surrounding skin also suffers. Damage to it also causes pain and slows down the overall healing process.
Cuts and napkins are usually packaged in several pieces. When it is opened, only the first remains without microbes. While the rest lose this quality.
To increase the absorbency and resize the gauze, you have to cut it and then fold it in several layers. This procedure violates antimicrobiality and causes certain inconveniences for the patient.
In order to fix the cotton-gauze bandage on the wound, it is necessary to use an auxiliary fixation. This leads to unnecessary spending and requires additional manipulations.

Thus, the use of conventional, traditional materials results in a long wound healing process. Modern devices are a good alternative, which are devoid of all the disadvantages described above. Advanced dressings are highly absorbent, non-invasive dressings. Their fixation occurs independently with the help of a hypoallergenic adhesive composition.

The advantages of modern products

The dressings have a non-woven or transparent film base, which allows you to monitor the progress of wound healing.
Water resistance is another plus. The patient has the opportunity to take water procedures without the risk of water getting into the wound.
Secure fit.
Modern dressings do not stick to the wound surface and do not injure it.
Removal is painless for the patient.
The self-adhesive side of the dressing is fixed by itself and does not require the use of additional funds.
There is a sorbing atraumatic tampon that collects wound exudate.
The applied bandage reliably protects the wound from secondary infection and mechanical irritation.
Hypoallergenic composition.
High levels of air and vapor permeability prevent the occurrence of maceration.
Modern dressings are ready-to-use and require no preparation.
Antibacterial.
The packaging is easy to open.

Medical tissue

Gauze is a fabric with a sparse, mesh-like structure. There are two types: harsh and bleached hygroscopic. They, in turn, are divided into two more different types: pure cotton and with the addition of viscose staple fabric (in the ratio of 50% cotton to 50% viscose or 70% cotton to 30% viscose). Their main difference is as follows: cotton soaks up liquid within 10 s, while gauze with viscose admixture does the same in 60 s, that is, 6 times slower.

The advantages of viscose are high moisture capacity, increased ability to absorb wound exudate and higher rates of blood absorption. However, compared with cotton gauze, the viscose analogue retains drugs worse. And also after repeated washings, the suction capacity decreases. According to the criterion of strength, cotton dressings are 25% higher than those of fabrics with an admixture of viscose. But the capillarity in both species is approximately the same, it ranges from 10-12 cm / h. In terms of neutrality, the same requirements are imposed on medical gauze as for cotton wool. The fabric is produced with standard fabric sizes: width - 69-73 cm, length from 50 to 150 m per piece.

For non-standard surgical dressings, cuts of 3 pieces are produced. in a pack. Each is 10 m long and 90 cm wide. Like cotton wool, gauze is tested for wettability (absorbency), neutrality and capillarity.

Fabric suitability test progress

In order to check the wettability, the immersion method is used. For this, a sample of hygroscopic gauze measuring 5 x 5 cm is lowered onto the surface of the water. According to the prescribed standards, it must immerse itself in water for 10 s without touching the walls of the vessel. A sample of harsh gauze needs to do this in 60 seconds.
To check the dressing for capillarity, a strip of tissue about 5 cm wide is dipped at one end into a special Petri dish filled with eosin solution. The sample is considered passed the test if, within 60 minutes, the solution rises from the liquid level by at least 10 cm.

Special types of fabric

Hemostatic dressing is obtained by treating ordinary gauze with nitric oxides. The resulting tissue not only stops the blood, but also completely dissolves in the wound within a month. It looks like napkins 13x13 cm in size.
Hemostatic tissue. It contains calcium salt It also stops the blood (on average, no more than 5 minutes), but does not dissolve. It can be used in the form of tampons, balls and napkins. The use of this type creates up to 15% savings.

DIY gauze bandage

First of all, before you start manufacturing, you need to decide on its future dimensions. A standard dressing, which is sold in pharmacies, has a length of no more than 15 cm and a height of 5 cm. If the product is intended for a child, then its dimensions depend on the patient's age. For example, for babies up to 6 years old, a bandage measuring 10 x 4 cm is suitable, but for a ten-year-old child, an adult version can be used. In order to independently sew a product on your face, you will need:

A piece of absorbent fabric measuring 17 x 7 cm - 4 pcs.
A strip of narrow bandage in the amount of 2 pcs. The length should be about 60-70 cm, width 5 cm.

After all the necessary elements of the future product are prepared, you can start making a gauze bandage. The following is the progress of the work.

You need to take a strip of bandage and roll it into 3 layers.
Then sew along the edges with a sewing machine or by hand with a fine stitch.
Repeat with the second bandage.
After this, the blanks need to be put aside for a while and do the gauze cuts. The four patches must be tied together and sewn over their entire length.
Then the edges of the resulting rectangle must be tucked inward by a centimeter and stitched again.
Now that you have prepared all three parts, they need to be assembled into a single bandage. To do this, you need to sew both strings along the fabric rectangle: one on top and the other on the bottom. This is how a gauze bandage is made with your own hands.

Stretchable fixation products

An elastic bandage is used for fixation. It is made from coarse cotton yarn. Strict requirements are imposed on the stretching of the bandage - it must be at least 50%. The bandage is produced in standard sizes: length - 3 m, width - 5 or 10 cm. Elastic bandage of this category has high strength indicators. One-piece flap 5 cm wide can withstand a load of at least 30 kgf. The package contains 18 wrapped in a separate label 10 cm wide products or 36 pieces of 5 cm each.
performs the same task as its knitted counterpart. However, the extensibility of the former is higher up to 800%. This type of bandage belongs to the category "tepermat", which means "knitted elastic dressing". It is made of which is braided with cotton yarn and synthetic fibers. Thanks to the mesh structure, the fixation of the elastic bandage does not impede air circulation and observation of the affected area. They can have 7 different sleeve width numbers: 75, 40, 35, 30, 25, 20 and 10 mm. Weight 1 sq. m is 280 g. The use of tubular products significantly saves dressing equipment and time spent. They are washed at a temperature not exceeding 40 ° C without the use of synthetic agents. This is followed by a warm rinse. Towels are used to squeeze out excess moisture. Unscrewing the bandages is not allowed.

Other products

A gauze pad is a rectangular patch of absorbent fabric folded in two layers. The edges of the product are wrapped on the inside so that the threads do not come into contact with the wound. There are such products in three sizes: small - 14 x 16 cm, medium - 33 x 45 cm, large - 70 x 68 cm.

Small non-sterile products are packaged in 100 and 200 pieces. in one pack. Sterile gauze napkins are folded in 40 pieces. Non-sterile medium products are packaged in 100 pieces. in a pack. Sterile - stacked in 10 pieces. Non-sterile large wipes are contained in the amount of 50 pieces. in one package. Sterile products of this group - 5 pcs. Each napkin is packed in parchment paper. The size, quantity, manufacturer's name and date of manufacture must be indicated on the wrapper.

Treatment

Carried out in specialized factories. After that, in bacteriological laboratories, they are tested for antibacteriality. The preparation of the dressing for further use is carried out within 45 minutes in a special steam boiler. In this case, the internal temperature is 120 ° C. After that, the dressing material is placed in bixes. These metal boxes continue to contain them. If a filter is installed in the bix, the purity of the materials is maintained for a longer period of time. In this case - at least 8-10 days.

Content requirements

The storage of dressings can also be carried out in wooden boxes located in dry, normally ventilated rooms, protected from rodents and dust. Non-sterile products may be kept in an unheated room. However, in this case, the temperature must be stable, without fluctuations. Also, it should avoid dampness and the formation of fungi, mold. To organize the correct maintenance of sterile dressings in the warehouse, they must be laid out according to the years of the last procedure. Since after 5 years, if the integrity of the package is not violated, the material should be selectively checked for antibacteriality. If the package is opened or wetted, the products inside it are no longer clean.

The material used during operations and dressings for draining wounds and the operating field, tamponade of wounds and the imposition of various dressings is called dressing.

The dressing material must have good hygroscopicity, dry quickly, be elastic, and be easy to sterilize.

Dressings, in the truest sense of the word, are:

Fabrics (matter);

Fibrous materials;

Dense materials for tightening bandages.

Fabrics

Fabrics are textiles made in such a way that the individual threads that make up them are intertwined in a certain way. Cotton, linen, hemp, jute, wool, silk, artificial fiber are used for their manufacture. The fabric is softer, the smaller the area is occupied by its fibers with the same density of weaving of threads in the fabric. Longitudinal threads are called warp, transverse threads are called wefts. The main types of weaving of threads in fabric are: plain, twill and satin. The choice of type is determined by the purpose of the fabric. For thin fabrics, the plain type of weaving is used (Fig. 1), when the weft alternately runs over all the odd warp threads. This makes the fabric look the same on both sides. With the twill type of weaving (Fig. 2), the weft ties the warp threads through one, forming an oblique pattern. In addition, more weft threads can be seen on one side of the fabric and warps on the other, which makes it possible to distinguish between the face and the wrong side of the fabric. The following fabrics are most commonly used as dressings:

Rice. 1. Plain type of weaving Fig. 2. Twill type of weaving

Of the many different dressing materials, gauze and cotton wool are the most widespread. Gauze is a cotton fabric made of sparsely intertwined threads, which has the ability to absorb blood, pus and other liquids well. Gauze is elastic, soft, does not clog the wound and therefore is the material from which bandages, napkins, and tampons are made.

Before use, the gauze is rolled up or folded in the form of napkins. This is mostly non-sterile material, but some can be sterilized. The most commonly used sizes of pieces of gauze are 80 ´ 50 cm or 80 ´ 100 cm, as well as strips 20 ´ 200 or 20 ´ 400 cm.

Napkins are made from pieces of gauze, folding them in such a way that the tousled edges formed during cutting are tucked inside the napkin. Usually such napkins are 4x4 or 8 ´ 8 cm in size. Large tampons are made of gauze cut into 16x16 cm squares, and small oval-shaped ones are made of 5 × 5 cm squares.

Impregnated gauze is a regular gauze soaked in a drug. Most often, dermatol (basic bismuth salt of gallic acid), iodoform or xeroform are used for this. Such dressings are used in the treatment of infected and festering wounds.

Absorbent gauze - gauze impregnated with various adsorbents. It is used to plug bleeding wounds and damage to parenchymal organs.

A harsh dressing cloth - calico is produced from cotton yarn, sometimes with an admixture of viscose. It differs from ordinary gauze in greater density and in that it does not bleach or degrease. Greater density is achieved by using tighter twisted yarns. The calico has a slightly reddish tint. The whiter the calico, the higher its quality. Unbleached and unfatted fabric is called harsh. Usually harsh tissue (and bandages made from it) is not used in cases of direct contact with the wound surface and is used for immobilization dressings or compaction of conventional ones - the formation of so-called tight dressings.

The triangular headscarf is made from a stern canvas or chintz. The kerchief has the shape of an oblique or isosceles triangle with dimensions 80 ´ 80 ´ 113 cm. It is widely used in first aid in various cases.

Bleached dressing is a normal harsh cloth after bleaching and moderate degreasing. It is used according to indications in cases requiring tighter dressings. Bleached starched dressing - a bleached and defatted dressing that is impregnated with a starch solution and dried. It is most often used for applying so-called starch dressings, as well as protecting the adhesive side of an adhesive plaster.

Tilexol is a special type of dressing material. Its specificity is determined by the way of weaving (Fig. 3), in which cells appear. Most often it is used in the form of the so-called ointment tulle, when the cut and rolled tulle is soaked with vaseline oil or other ointment base and then sterilized. In this form, Tilexol is used to close wound surfaces, most often for burns. Its advantages over other dressings are to ensure good drainage of the wound and the fact that it does not "dry up" to the wound surface.

Fig 3. Tilexol - tissue structure

Bandages

Hydrophilic bandages- are gauze cut into strips and rolled into a roll. The cut should be straight, smooth and not tousled. Bandages can be non-sterile and sterile (in special packaging). The bandages are rolled up into a compact tight roll, which, however, should be easy to unwind when used. The width of non-sterile bandages can be from 4 to 20 cm. Sterile bandages are wrapped in two layers of parchment paper. Before packing, the bandage is wrapped with a silk thread, the end of which remains outside after sealing the package and is used to open it before using the bandage. Bandages with "quality" edges are made from bleached rayon yarn, but due to the fact that they do not tolerate sterilization well, they are used in the overwhelming majority of cases unsterilized.

Harshweave Bandage- are made from rough, unbleached canvas and have the same dimensions as hydrophilic bandages. They are used mainly for tight dressings (they do not absorb liquid well) in a non-sterile form.

Bleached Linen Bandage- are made of bleached dressing cloth, cut into strips of the desired size. Compared to conventional gauze bandages, they are more dense and durable.

Elastic bandages are made of harsh cotton yarn, woven according to the plain type of weaving, into the basis of which rubber threads are woven, which sharply increase the elasticity of the bandage. Usually such bandages are made with a width of 6–14 cm and a length of 5–10 m. If the elasticity is lost, the bandage can be washed in warm soapy water to partially restore it. Elastic bandages are not sterilized and are used for non-rigid tightening of soft tissues. Some elastic bandages have an adhesive layer on one side to help form the dressing better.

Tubular bandages are a seamless tube made of hydrophilic material, the elasticity of which is ensured by the knitted type of weaving. The bandages have different diameters to be applied to different parts of the body. To fix the dressings, a special type of tubular bandages is used - elastic tubular bandages, which are often of the mesh type. They are especially useful for fixing bandages in the area of the hip and shoulder joints.

Individual packages made in such a way that their sterility is not disturbed during constant wearing. They are usually pinned and folded so that the core of the bag remains sterile even if the protective sheath is broken.

Adhesive plaster- is a type of dressing material, which consists of a cloth base with a sticky layer applied to it. The base must be firm enough. The sticky layer, to which various drugs are added, should not irritate the skin and dry out, since in this case the plaster will not adhere well to the skin and quickly fall off. The main function of the patch is to fix other dressings to the wound area. Fastening the dressing to the wound using adhesive strips 4–10 cm wide is convenient for periodic examination and treatment of the wound.

Cotton wool- fibers of the seed boll of cotton. In medicine, hygroscopic (fat-free) cotton wool is used, which has a high absorption capacity. Cotton wool is applied to the wound over gauze, which increases the absorption capacity of the dressing and protects the wound from external influences.

DRESSING DEVICES. GYPSUM.

Dressing conceptand dressings

According to statistical yearbooks, PS sales account for approximately 0.2% of the total retail turnover in Russia, 10% of drug sales, and 9.2% of sales of medical and chemical products.

According to 2004 data, the structure of the PS market is: bandages - 29%, cotton wool - 16%, gauze - 8%, plasters - 38%, other products (cotton balls, discs, etc.) - 9%.

Dressing are products that are fibers, threads, fabrics, films, non-woven materials and are intended for the manufacture of dressings by industrial enterprises or immediately before use by medical personnel and end users.

PM can have natural(e.g. cotton, viscose), synthetic(e.g. polymers) or mixed origin.

PM is used in operations and dressings to drain the operating field and wounds, tamponade wounds to stop bleeding and drainage, to apply dressings, to protect the wound and burned surface from secondary infection and damage.

Dressing is a medical device made of one or more dressings for the prevention of infection and for the treatment of wounds.

The main purposes of application of PM and PS:

Protection of wounds from the effects of environmental factors (cold, heat, dirt, dust, etc.);

Prevention of microorganisms entering the wound from the external environment;

Removal of tissue decay products, microbes, toxins, enzymes, allergens from the wound;

Providing a therapeutic effect on the wound process: antimicrobial, hemostatic, non-political, analgesic, regenerating, antioxidant, immunostimulating;

Fixation of dressings on the affected part of the body.

The main requirements for PM and PS are sterility and non-invasiveness. In addition, the PS should be etcnym, plastic, anti-adhesive, permeable (for air and pathological substrate) and impermeable to microorganisms should provide comfortable existence of patients, to be economical and convenient to use; shouldn't have allergic and toxic components.

In some cases, it becomes necessary to impart additional medicinal properties to PS by impregnating (impregnating) it with a medicinal substance or using PS as a substrate for drugs (composites).

Modern PS should be easy to use (simple applications), which facilitates the work of medical personnel and allows them to be used for self-medication and self-help.

Classification and characteristics of the dressing

The classification of the dressing is shown in Fig.

Depending on the physical structure, they are distinguished: woven, knitting and knitting-stitching, non-woven (non-woven stitched), fibrous, film (film), spongy.

Depending on the composition, the dressing cloth is cotton, linen, viscose, cotton-viscose, paper, etc.

The assortment of cotton dressings includes such items as:

Severe dressing cloth (calico),

Bleached dressing cloth,

Impregnated gauze,

The gauze is absorbent.

The nomenclature of dressings from other groups includes linen cloth, non-woven cloth-stitched threadless hygroscopic medical cloth, paper dressing material "Rigrill", etc.

Cloth dressing harsh (calico) It is produced from cotton yarn, sometimes with an admixture of viscose, has a higher density compared to ordinary gauze, a slightly reddish tint (the whiter the fabric, the higher its quality). Unbleached and unfatted fabric is called harsh, therefore it is used for immobilization dressings or tight bandaging.

Bleached dressing cloth is a normal harsh canvas after bleaching and medium degreasing. Used in cases requiring tighter dressings.

Tilexol- a special type of dressing material with a specific cellular weaving of the thread. Used as an ointment tulle (cut and rolled tulle is impregnated with vaseline or other oil and sterilized). It is used to close wound surfaces, most often with burns, it has an advantage over other types of dressings, because provides good drainage of brine and does not dry out to the surface.

Linen cloth- this is a fairly dense, durable fabric, it tolerates washing and sterilization well, it is used for operating towels and napkins.

Gauze is a rare mesh-like tissue for medical purposes. The gauze is bleached hygroscopic and harsh, pure cotton or with an admixture of viscose.

Impregnated gauze- this is gauze soaked in any drug. Most often, dermatol (basic bismuth salt of gallic acid), iodoform or xeroform are used for impregnation.

Absorbent gauze is a gauze impregnated with various adsorbents (Sorbatsel. Oxycel, Sargitsel). It is used to plug bleeding wounds and damage to parenchymal organs.

Hygroscopic medical non-woven canvas stitching threadless cloth is a new PM made on the basis of bleached viscose fiber with avivazh. It is a uniform fibrous canvas, held together by loops. The canvas has a high sorption capacity, softness, plasticity, is well modeled on any body surface, has a high vapor and air permeability. It is used as an absorbent material to replace absorbent surgical cotton when dressing burns and wounds, as well as for the production of dressings.

"Rigrill" dressing material is an atraumatic and microbial-proof PM with good hygienic properties (does not cause skin maceration); plastic, well modeled on wounds of any configuration, does not restrict movement in the joints and does not disturb blood circulation. It is used as a coating that protects against bacterial and household pollution in case of superficial injuries, abrasions, erosion, on wounds, incl. postoperative, graft sites, burns, bedsores, trophic ulcers. It is produced in the form of rolls, bandages, and also PS-napkins; in sterile packaging and in non-sterile form.

The main representative of fibrous PM is cotton wool.

Medical cotton wool is produced in two modifications: hygroscopic and compress, which is intended for warming compresses and splints. Absorbent cotton is intended for various dressings.

Cotton wool called PM, derived from natural cotton fibers. The industry produces unbleached compress cotton dressing and purified (hygroscopic) dressing cotton.

Wool bandaging unbleached compress(made of cotton fiber, without degreasing) is intended for linings when applying dressings, compresses and is not used for direct contact with the wound surface.

Cotton wool dressing cleaned hygroscopic(defatted) can be sterile and non-sterile; from such cotton wool hygienic cotton swabs are made.

Cellulose cotton wool called PM, the fibers of which are composed of pure cellulose (polysaccharide).

Viscose wool made from chemically treated cellulose.

Depending on the field of application, cotton wool is produced hygroscopic eye, hygienic and surgical. In recent years, surgical cotton wool is packaged in 100 and 250 g in the form of "zig-zag". Medical cotton balls and cotton pads for medical and cosmetic purposes also appeared on sale.

A new textile material has also been created for ENT, dentistry, treatment of burn wounds in the form of lintor powder with immobilized trypsin.

Films and sponges are considered in the dressing group.

Classification and characteristics of dressings

The classification of PS depending on the shape is shown in Fig. It includes such groups of PS as bandages, bags, napkins, plasters, tampons, aerosols (spray foams and spray films), wound coverings.

Bandages- a kind of dressings made of cotton-viscose gauze in the form of rolls of certain sizes; belong to the traditional, widely used PS.

Gauze bandages non-sterile are produced in both secondary and individual packaging.

Gauze bandages sterile are produced in individual packaging.

Plaster bandages contain plaster, which, after getting wet, is applied to the injured parts of the body in order to fix them; used mostly in traumatology. Produced in individual packaging.

Elastic bandage It is made of harsh cotton yarn, the base of which is woven with rubber threads, which sharply increase the elasticity of the bandage. Elastic bandages are not sterilized, they are used for non-rigid tightening of soft tissues.

Tubular bandage is a seamless tube made of hydrophilic material; its elasticity is provided by the knitted type of weaving. Produced for use on various areas of the upper and lower extremities.

A special type of tubular bandages are mesh bandages - a mesh tube of various diameters, which is rolled up in the form of a roll. A piece of the required length is cut from it in order to fix the surgical dressing on the wound.

Hydrophilic bandage has the ability to absorb water; available in two versions: sterile and non-sterile.

Starched bandage made from starched gauze or organza. It is used as a reinforcing material over hydrophilic bandages (it can "dry out" directly on the wound, damage the skin at the folds).

Zinc-containing adhesive bandage is an ordinary bandage on which a thin layer of paste is applied containing glycerin, gelatin, sodium chloride, zinc oxide, i.e. this type of bandage belongs to the medicinal PS. When dry, such a bandage "shrinks" and the bandage becomes very tight, so it is used where it is necessary to avoid tissue edema, for example, in case of skin inflammatory diseases.

In the group of napkins, there are actually dressing napkins (for example, gauze napkins) and medical napkins (for example, Koletex napkins).

Gauze napkins are two-layer gauze cuts. M.b erased. and nester.

Medical napkins is a composite dosage form, which is either a therapeutic biopolymer on a support (most often tissue), in which a medicinal substance is immobilized, or a tissue base impregnated with a medicinal substance.

Napkins "Koletex"- composite PS, which is a layer of a special textile material as a carrier of a biopolymer with a therapeutic effect, with a drug immobilized in it. They contain hemostatic, anti-inflammatory, anti-healing and analgesic substances (furagin, chlorhexidine, propolis, sodium alginate, urea, metronidazole) in various combinations. Designed for use as a therapeutic and prophylactic agent for the primary closure of injured tissues, sutured wounds, for the closure of infected and granulating wounds, trophic ulcers, burns, bedsores. Packaged in primary packaging in the form of a sterile (inside) paper bag and secondary packaging in cardboard boxes. They can also be used in oncology as a local application of a radiosensitizing agent for radiation therapy and post-radiation injuries.

Dressing bags are a ready-made dressing to be applied to a wound in order to protect it from contamination, infection and blood loss. Individual dressing bags include a sterile hydrophilic bandage, a cotton pad that can be sewn to the beginning of the bandage, and a pin to secure the ends of the bandage. Cotton-gauze pads are impregnated with mercuric chloride solution. There are two types of bags: small and large, in which there are one or two pads (one is sewn to the beginning of the bandage, the other is free). Individual dressing bags are made so that sterility is not impaired during constant wearing. If, nevertheless, the protective shell is broken, then the core of the bag remains sterile.

Currently, dressing pads are being made, which adhere poorly to the wound (they dry a little to exudating wounds).

Dressing tampons are a small piece of cotton wool or dressing used to close a wound or ulcer, or to stop bleeding.

Plasters, used as PS, taking into account the purpose of use, refer to fixing and covering patches. They may contain medicinal substance (cover patches), may not contain it (fixation patches)

Fixing plasters are used in surgery and traumatology to fix dressings; cover plasters - in dermatology for the treatment of a number of diseases or mechanical damage to the epidermis.

Usually, dressing plasters are combined under the code name "adhesive plaster". In appearance, they are subdivided into tape and stripes. As a rule, adhesive plasters have a sticky (adhesive) layer on one side; in the case of cover adhesive plasters, a gauze pad impregnated with drugs is attached to the sticky side (for example, a bactericidal plaster).

Firm "Veropharm" (Russia) produces a series of plasters Uniplast.

Uniplast Plus dressing strips provide reliable fixation of the dressing, protect the wound from germs, do not cause allergic reactions and skin irritation. They are flesh-colored and do not leave marks on the skin and clothes.

The patches are available in various sizes and configurations, incl. rectangular or round shape on adhesive fixing tape with or without perforation.

Varieties of dressing strips:

Waterproof;

Hypoallergenic;

Elastic (comfortable to use on the joint area).

Antimicrobial patch series Band Aid manufactured by Johnson & Johnson. It is made of non-woven material, does not stick to the wound, contains benzalkonium chloride antiseptic, transparent. The adhesive coating fixes the patch on the skin, does not cause irritation. In packs, sets of different sizes 24 pcs.

Types: antiseptic waterproof, antiseptic tissue - suitable for protecting wounds on the folds.

Healing sponges- This is a dosage or non-dosage dosage form, which is a porous mass of various sizes and shapes, containing medicinal and auxiliary substances (mainly polymeric materials). The jaws are in the form of plates of different sizes. Currently, sponges are obtained mainly from the skin or tendons of cattle, seaweed; released in sterile packaging.

Hemostatic sponge made from human blood plasma with the addition of calcium chloride and aminocaproic acid; is a dry, porous white substance with a yellowish tinge. It is applied topically, and gradually dissolves in the wound. Contains thrombin, fibrin, aminocaproic acid, hemostatic; available in vials. The hemostatic sponge can also be produced with collagen.

Absorbable gelatin sponge is a hardened sterile foam, soluble in water; undergoes resorption in body tissues. Designed to stop bleeding during surgical operations. A type of gelatinous sponge is a gelatinous-starch sponge, which serves the same purpose.

Collagen sponge is a sterile porous plate obtained from collagen; possesses resorptive, hemostatic and weak adhesive properties, due to which it is widely used for wound dressings. Collagen sponges are often combined with various natural polymers and medicinal substances (for example, with chitosan, pectin, antibiotics, etc.), which can significantly improve their consumer properties.

Algipor is a sponge made of a polymer substance (alginate), which is extracted from seaweed. A sterile sponge is applied to the wound and absorbs the discharge from the wound. Over time, this coating dissolves. The sponge itself contains medicinal substances that actively promote healing. It is used to treat trophic ulcers, bedsores; due to its complete resorption, it can be used for operations on internal organs.

Algimaf- modification of algipor, contains a different set of antiseptic substances, promotes accelerated wound healing.

Wound coverings are intended mainly for the treatment of chronic wounds. Their composition and types depend on the type of wound and the stage of the treatment process (the main stages of treatment: cleaning, removal of organic matter, granulation, vascularization, epithelialization). Alginate, spongy, hydrogel and hydrocolloid coatings are produced, from which dressings are made designed to absorb wound exudate and control the state of wound hydration. Vapor-permeable are also used as wound coverings. films and membranes.

Perforated absorbent film coatings Solve the problem of drying mesh dressings for wounds with low to moderate exudate.

The Austrian company "Nycomed" produces an absorbent wound dressing "Tachocomb", intended for hemostasis and tissue bonding, especially in surgical procedures. Tachocomb is a collagen plate covered with a special fibrin glue that contains fibrinogen, thrombin, riboflavin, etc. The Tachocomb plate applied to the wound is absorbed in the human body within 3-6 weeks. The coating is produced in a sealed package and is applied under strict sterility conditions.

Wound films are usually sterile perforated sheets of different colors (yellow, dark blue, colorless, etc.), depending on the antiseptics included in their composition.

Nomenclature of wound films.

Polyvinyl alcohol aseptic film "Aseplen" intended for the treatment of infected wounds, 1st degree burns, for the temporary closure of transplanted skin autografts and donor sites. Films are produced in three modifications: with dioxidine (Aseplen-D), with iodine (Aseplen-I), with katapol (Aseplen-K). They are hydrophilic, easily modeled on the wound, thanks to the perforated holes, they do not impede the outflow of wound discharge, provide a prolonged antimicrobial effect, are easily removed from the surface of the wound, create a gentle scab and favorable conditions for regeneration processes in the wound, prevent the development of infectious complications. The transparency of the film provides visual control over the condition of the wound.

Polyvinyl alcohol perforated film "Viniplen" intended for the treatment of wounds of donor sites with dermatomal skin grafting. It can also be used for the temporary closure of flat wounds of a different etiology, in cosmetology, etc. The film is non-toxic, shortens the treatment time for wounds, avoids their treatment with tanning disinfectant solutions, does not injure the wound and has good draining properties.

Film with Vaseline "Vazoderm S" made on the basis of specially made cotton fabric and impregnated with a neutral ointment containing anhydrous wax, liquid petroleum jelly, fish oil, Peruvian balsam. It is used to treat fresh and weeping wounds, burns, peeling nails, ulceration, phimous operations, skin transplants in plastic surgery and various skin lesions. Advantages: does not stick to the tap, absorbs secretions, improves granulation and epithelization, prevents secondary infection, has an antiseptic effect.

Biological wound dressing "Biokol-1" is a transparent, elastic, porous film that reliably self-fixes on the wound, helps to stimulate regeneration, which leads to accelerated wound healing. It is absolutely non-traumatic and has an analgesic effect. It is used to treat burns, trophic ulcers, protect donor sites and autografts.

The above films are produced in Russia.

Bandages are tissue applied to a wound or part of the body to protect against external influences and accelerate healing.

Aseptic dressings are made of sterile dressing material (one or two cotton-gauze pads, gauze bandage and retainer) and are designed to protect against microbial contamination and other contamination of wound surfaces.

Synthetic bandages "Elafom" are intended for the treatment of various wounds, including burns. Produced in single packages, sterile. The use of these dressings can halve the number and duration of dressings.

In recent years, new PSs with immobilized enzymes have been developed in Russia, for example, Dalcex-trypsin, Lax-trypsin, Dalcex-Collitin. They are a cellulose or polycaproamide carrier with immobilized proteolytic enzymes, trypsin, or with lysocin, collitin. They are used in surgery for the treatment of purulent-necrotic wounds at the stage of hydration, as well as bedsores, ulcers of various etiologies, and burns.

Modern trends in the development of dressings

Currently, PM and PS are being developed taking into account the following progressive directions:

Expansion of the spectrum of pharmacotherapeutic efficacy of PS (with immobilized proteolytic enzymes, antimicrobial and anesthetic effects);

Improving physical properties (increasing sorption capacity);

Increased biocompatibility (wound resorption);

Prolongation of action (PS are gradually resorbed in the tissues of the body);

PS, self-fixing on the wound (sticky).

So, abroad are produced impregnated bandages, which are impregnated with an infusion containing medicinal substances (zinc oxide, calamine, etc.). Their main purpose is to treat leg ulcers, incl. varicose, chronic eczema.

Sports injuries target sticky bandages, non-displaceable elastic for fixing joints during sprains.

To fix the bandages on the joints and other uncomfortable parts of the body, use surgical adhesive plasters. They are permeable to air and water, and may include drugs.

In recent years, special spray films in aerosol packages have begun to be used as dressings: Akutol, Nobekutan, Aeroplast (Akutin), which are applied in the form of a liquid to the skin with tampons. It is not recommended to use them in the case of fresh and festering wounds, so that wound discharge does not accumulate under the film. Designed to protect the skin surface from harmful substances.

Gypsum

mineral CaSO4, CaSO4 2H2O usually white
it is fired at t = 1300-2000C
must be dry, without lumps, the consistency of wheat flour
when mixed with water does not change color and odor
quality is checked organoleptically
stored in a dry place. When damp, the quality is restored by drying in a drying oven for 6-8 hours.
ways to check the quality of setting:

1 hour of water + 2 hours of gypsum - after 6-7 minutes the gypsum hardens
gypsum is mixed with an equal volume of water, a ball is rolled from the resulting mass, then the ball is dropped on the floor: it must remain intact or split into several pieces

Products:

Sacral support - for holding the pelvic girdle in an elevated position when applying plaster casts, made of cast iron
Plaster knife with a wide abdomen - for leveling the ends of the plaster cast, made of steel
Scissors for cutting plaster casts - equipped with massive handles, made of steel
Saw for cutting hardened plaster casts - made of steel, hot-air sterilized
Apparatus for cutting plaster casts - foot, which is brought under the bandage, 2 saw-knives, 2 handles, electric motor
Plaster bending pliers

S.R. Tuisin

The article touches upon the actual problem of treating long-term non-healing wounds through the use of combined dressings. In the treatment of patients in the main group with a long-term non-healing wound area of up to 30 cm2, a "Dressing agent for the treatment of extensive purulent wounds" was used (RF patent No. 88270). All patients of the main and control groups with a defect area of 31–50 cm2 underwent autodermoplasty with a split perforated skin graft.

Purulent diseases

long-term non-healing wounds

proteins of the acute phase of inflammation

combined dressing material.

Introduction

During the treatment of a number of traumatic injuries and purulent diseases, wound defects are often formed, requiring surgical interventions to restore the integrity of the skin. According to various authors, the proportion of patients with purulent-septic diseases of soft tissues is about 20-30% of all surgical inpatients. Of these, 5-10% of patients with surgical infection need autodermoplasty.

During the long-term existence of the wound, other pathogenetic mechanisms are superimposed on the primary etiological factors: the development of antibiotic-resistant microflora, microbial and drug allergization, changes in immunological resistance, fibrotic changes in the edges and bottom of the wound, leading to disruption of microcirculation in the wound area, and some other factors. This leads to a decrease in reparative processes, increases the time of epithelialization.

It is widely known that when performing autodermotransplantation with a split skin flap, the method of wound management and the used dressing material are of great importance. It is necessary to achieve atraumatic dressings, without losing the possibility of mechanical, physical and medical effects on the wound and skin flap. Such conditions are most feasible if gel dressings are used as dressings.

Target

Improving the results of treatment of patients with long-term non-healing wounds.

Materials and research methods

The work is based on the analysis of the results of surgical treatment of patients with long-term non-healing wounds who were treated in the surgical department of the OB polyclinic at the Ufa station in the period from 2002 to 2008.

The main group consisted of 83 patients, the control group - 79 patients with long-term non-healing wounds that were formed during the treatment of purulent soft tissue diseases.

The following criteria were chosen to enroll patients in the study:

patients with long-term non-healing wounds (no signs of epithelialization for 14 days or more);
the age of patients is 20-60 years.

The analysis of the distribution of patients by age and sex revealed: the groups are identical, no significant differences were found. It was found that the majority of patients in the main and control groups fall on the most working age, i.e. 30-50 years old. In the main group - 65 (78.3%) patients, in the control group - 63 (79.7%) patients, which increases the social significance of the problem.

In the first group, there were 51 men (61.4%), women - 32 (38.6%); in the second group - 49 (60.9%) men and 30 (39.1%) women.

All patients underwent a comprehensive examination, which included clinical, instrumental and laboratory research methods.

In addition, all patients underwent a detailed analysis of the leukoformula and immune status. To determine the immune status, a set of the most informative and available methods was used to assess the functional state of the defenses of patients suffering from purulent-inflammatory diseases. The population of lymphocytes in the peripheral blood was determined according to the generally accepted method for detecting E-ROK and EAC-ROK, and the phagocytic activity of leukocytes was studied.

The clinical course of the wound process was assessed on the basis of the timing of complete cleansing of wounds from pus, necrotic tissues, the appearance of granulation, the onset of marginal epithelialization of wounds, and the subsidence of the phenomena of perifocal inflammation.

The measurement of the area of wounds was carried out according to the method proposed by L.N. Popova (1942). Measurements were performed prior to autodermoplasty. According to various authors, the degree of reduction in the area of the wound surface per day can vary from 2.3% to 10.7%. The course of the wound process is considered normal with a decrease in the area of the wound surface per day by about 4%. After performing autodermoplasty, its results were not taken into account when performing planimetric calculations.

To assess the results of free skin grafting with a split graft, an indicator was used - the degree of engraftment of an autodermotransplant, which was calculated by the formula:

P = K1 / K2 X 100%,

where P is the degree of engraftment (%); K1 - the area of the removed flap (cm2); K2 - the area of the engrafted flap (cm2) on the 8th day after the operation.

To exclude bone pathology, all patients with purulent-inflammatory diseases of soft tissues underwent X-ray research methods.

Results and its discussion

83 patients of the main group and 79 patients of the control group had long-term non-healing wounds that were formed during the treatment of purulent diseases of soft tissues.

Among 83 patients of the main group, 41 had a skin defect area of up to 30 cm2 and 42 patients - 31-50 cm2. In the control group, the distribution was as follows: in 38 patients, the wound area was up to 30 cm2 and in 41 - 31-50 cm2.

In the treatment of patients in the main group with a long-term non-healing wound area of up to 30 cm2, a "Dressing agent for the treatment of extensive purulent wounds" was used (RF patent No. 88270).

The control group patients underwent traditional treatment using the Activetex combined dressing material.

The timing of wound healing in the main group was 16.4 + 1.7 days, while in the control group it was 20.7 + 2.1 days (P<0,05).

Studies have shown that the use of the dressing "Dressing for the treatment of extensive purulent wounds" reduces the time of wound healing due to immunomodulatory, anti-inflammatory, regenerating, reparative properties.

All patients of the main and control groups with a defect area of 31-50 cm2 underwent autodermoplasty with a split perforated skin graft. In the main group, dressings were carried out with the "Dressing agent for the treatment of extensive purulent wounds", in the control group - with an atraumatic dressing "Activetex".

We note the more successful results of skin grafting of patients, in the local treatment of which the "Dressing agent for the treatment of extensive purulent wounds" was used. This circumstance is associated with the high antimicrobial activity of the components contained in the dressing gel, the physical properties of the material, allowing atraumatic dressings without displacing the flap.

In the main group, the degree of engraftment of the autograft was 68.7%, while in the control group it was 54.5%.

In the course of the research, no pyrogenic, antigenic and toxic complications associated with the use of the "Dressing agent for the treatment of extensive purulent wounds" were noted.

A detailed analysis of the leukoformula showed that in patients with long-term non-healing wounds, the total number of leukocytes is 3.8 + 0.2x109 g / l, the content of T-lymphocytes is 54.6 + 5.4%; B-lymphocytes - 12.8 + 3.6%.

The study of the phagocytic activity of leukocytes shows that the picture of incomplete, perverted phagocytosis prevails (table). Phagocytosis is 22.3 + 2.7%, the phagocytic number is 2.1.

Cytograms of wound prints in patients with long-term non-healing wounds

Cellular elements	before surgery	3rd day p / o	5th day p / o
number of leukocytes. in p / sp.
destruction of leukocytes,%
Phagocytosis activity:
completed
unfinished
perverted
extracellular location

conclusions

In patients with long-term non-healing wounds with a defect area of up to 30 cm2, conservative treatment is possible using combined gel-based dressings; with a defect size of 31-50 cm2, it is necessary to carry out autodermoplasty. split perforated skin graft.

Complex treatment of patients with long-term non-healing wounds with the use of a "Dressing for the treatment of extensive purulent wounds" allows to improve the condition of patients at an earlier date, to speed up the healing of wounds.

The use of the "Dressing for the treatment of extensive purulent wounds" during autodermoplasty increases the timing and frequency of flap engraftment and improves treatment results.

Bibliography

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Bibliographic reference

S.R. Tuisin TREATMENT OF LONG-TERM NON-HEALING WOUNDS BY USING COMBINED DRESSING MATERIALS // Modern problems of science and education. - 2010. - No. 1 .;
URL: http://science-education.ru/ru/article/view?id=1621 (date of access: 02/01/2020). We bring to your attention the journals published by the "Academy of Natural Sciences"