Low-Intensity Laser and Impulse Induction Magnetotherapy in the Treatment of Purulent Wounds

The dissertation is dedicated to the development and scientific substantiation of a comprehensive methodology for the treatment of purulent wounds of soft tissues, based on potentiating traditional therapy with low-intensity laser therapy and impulse induction magnetotherapy. The research includes an evaluation of the effectiveness of various treatment approaches, ranging from traditional methods to combined schemes involving physical therapy interventions. A comparative study of treatment outcomes using various combinations of therapeutic methods was conducted, which made it possible to establish an acceleration of the wound healing process phases and a reduction in treatment duration when applying a combined effect of two types of physical therapy interventions.

Relevance of the Research

The problems of wound treatment, including purulent wounds, which have occupied the minds of researchers for many thousands of years of human civilization, unfortunately, continue to remain one of the global problems of modern medicine. The complexities of the problem are conditioned by many causes, including often the features of origin, formation, and character of course of a purulent wound (A.P. Kolesov et al. 1989, M.I. Kuzin and B.M. Kostyuchenok 1990, L.V. Pisarenko 1991, A.V. Geints 1993, A.M. Svetukhin et al. 1998, 1999, G.I. Nazarenko et al. 2002, Shulutko A.M. et al. 2002). The situation of a purulent wound's existence is largely determined also by the features of the relationships between the macro-world (the patient) and the micro-world (the microorganism) causing the infectious process (A.M. Svetukhin 2003, I.A. Eryukhin 2003, N.T. Gulmuradova 2004, V.D. Fedorov et al. 2005, H.H. Stone 1972, T. Kary et al. 1990, D.H. Ahrenholz 1991, M. Dosch 1991, M. Wilson, J. Dobson et al. 1992, M. Wilson, J. Pratten 1994, R.L. Nichols et al. 2001, D.E. Fray 2001, etc.).

According to current data, the total number of known species of microorganisms approaches 3000 (more than 450 species are isolated from various loci of the human body), and yet potentially any of them may be found in a wound (S.V. Sidorenko 2003).

Since the introduction into medical practice of the principles of asepsis and antisepsis, the use of antibiotics, and other measures, substantial advances have undoubtedly been achieved in the treatment of purulent wounds. However, life inexorably and with persistence demonstrates the achievement of only a temporary victory over purulent infection. That part of the microbial world which is the cause of the development of purulent infection actively counteracts the numerous measures developed by scientists of various medical, biological, and related specialties (S.V. Sidorenko 2003, L.A. Blatun 2005, G.L. Hill 1983). For this reason, clinicians are forced to use and constantly expand the extensive arsenal of means and methods for solving this vital problem.

Drug therapy and physiotherapy, treatment in a controlled abacterial environment, hyperbaric oxygenation (HBO), surgical methods of treatment, and other methods currently in use are evidence of the unresolved nature of many questions in the treatment of purulent wounds (B.P. Kudryavtsev 1993, A.A. Timofeev et al. 1990, A.M. Svetukhin 1993, 2003, E.V. Lebedysov 2000, A.V. Sibilev 2000, G.I. Klebanov et al. 2001, P.I. Tolstykh et al. 1995, 2001, 2004, S.A. Shlyapnikov 2003, S.V. Sidorenko 2003, V.A. Derbenev et al. 2004, D.A. Blatun 2005, G.T. Rodenheaver et al. 1975, S. Falow 1988, I. Brook et al. 1990, L.M. Mundy et al. 2000, A.C. Fluit et al. 2001, D.E. Fray 2001, etc.).

Unfortunately, neither the newest highly active antiseptic agents, nor synthesized antibiotics of the latest generations, nor nitrogen oxide, nor ozone therapy, nor the use of biologically active wound coverings or oxidants (M.P. Tolstykh et al. 2004), nor the energy of quantum generators, making a certain contribution to solving the problem, have been able to put a final end to the problem (G.I. Klebanov et al. 2001, P.I. Tolstykh et al. 1995, 2001, O.Yu. Abakumova et al. 2001, A.B. Shekhtser et al. 2001, etc.).

It should be noted that, according to modern researchers, despite the existing unconditional progress in the treatment of purulent wounds, even today the thought expressed in the last century (1939) by I.G. Rufanov remains valid: 'In no department of surgery do we have such a variety of proposed means and methods as in the department of treatment of wounds, non-healing ulcers, and fistulas' (quoted from A.M. Svetukhin et al. 2005).

According to existing data, in the general structure of surgical morbidity, purulent-inflammatory processes occupy one of the leading places. Among all surgical patients they are observed in 35-45% of patients (S.A. Shlyapnikov 2003, L.A. Blatun 2005). Some authors consider that, in the general structure of nosocomial purulent-septic infections, purulent wound infections constitute 12.5%-38% (A.A. Belozer, O.A. Smirnov et al. 2003, N.P. Domnikova, T.V. Komisарova et al., 2003). To this day, the problem of re-infection of wound surfaces by hospital strains from the hands of medical personnel, bed linen, suture, and dressing materials remains extremely urgent in groups of patients in intensive care units, as well as in patients with limited mobility (those who have suffered a stroke, paralysis of various genesis, etc.). Under conditions of strict control over hospital-acquired infection, purulent complications in the area of the surgical incision are registered in 33-38% of observations, and in 2% of cases patients develop decubitus ulcers. In these cases, the duration of hospital stay substantially increases by 15-18 days (E.A. Oganyasyan, S.I. Pavlov et al., 2003, A.A. Belozer, O.A. Smirnov et al., 2003).

According to the opinion of G.T. Aydinov, M.M. Shvager et al. (2003), in the structure of hospital-acquired infections in surgical wards, the frequency of post-injection infections reaches 20%, and in outpatient-clinic institutions - 76.5%. Infected skin coverings at the site of vascular catheter insertion are the most frequent source of colonization and infection during the period of catheter presence in the vessel up to 10 days. In the United States, approximately 400,000 catheter-associated infections are registered annually (H. Lode, 1998). S.A. Shlyapnikov (2003) considers that soft tissue infections are the leading pathology in the structure of primary surgical patient referrals in the outpatient-clinic network. According to his data, in the inpatient network, postoperative nosocomial soft tissue infections, also occupying a leading position, constitute 40% of all hospital infections.

The cited data indicate that the relevance of the acute problem of treating purulent wounds persists even today, in connection with which, it was planned to carry out the present dissertation research.

Objective of the Work

To improve the results of outpatient and inpatient treatment of patients with purulent wounds of soft tissues by conducting, alongside basic traditional therapy, local impulse induction magnetotherapy and/or low-intensity laser therapy.

In connection with the stated objective, the following main tasks were formulated.

Research Tasks

1. To evaluate the results of treatment of patients with a purulent wound of soft tissues by traditional methods.

2. To evaluate the results of treatment of patients with a purulent wound of soft tissues by a complex method supplementing basic traditional therapy with sessions of low-intensity laser therapy (LILT).

3. To evaluate the possibilities and results of treatment of patients with a purulent wound of soft tissues by a complex method supplementing basic traditional therapy with sessions of impulse induction magnetotherapy.

4. To evaluate the possibilities and results of treatment of patients with a purulent wound of soft tissues by a complex, potentiated method supplementing basic traditional therapy with sessions of impulse induction magnetotherapy and low-intensity laser therapy (LILT).

5. To conduct a comparative analysis of treatment of patients with purulent wounds by traditional methods and by potentiated complex methods based on the additional complex administration of sessions of impulse induction magnetotherapy, low-intensity laser therapy, and their combined local effect on the wound.

Scientific Novelty

For the first time in Russia, a methodology for complex and combined treatment of patients with purulent wounds of soft tissues has been developed, based on potentiating traditional therapy by local effect on the wound with impulse induction magnetotherapy and sessions of low-intensity laser therapy.

For the first time, a comparative study of traditional complex schemes of managing patients with purulent wounds of soft tissues and their supplementation with sessions of local (locally applied) effect on the purulent wound by impulse induction magnetotherapy (IIMT) and low-intensity laser irradiation (LIL) has been conducted.

It has been established that traditional complex (basic) treatment of purulent wounds, potentiated by the administration of sessions of two types of physical therapy interventions, contributes to a substantial acceleration of the course of wound healing phases, improvement of healing processes, and a reduction of treatment duration for patients by an average of 5 days.

Practical Significance

The complex methodology for treating a purulent wound developed in the course of the present research contributes to: shortening the duration of cleansing the wound surface from purulent-necrotic masses; stimulating the processes of proliferation and epithelization in the wound, which ultimately determines substantially better final results of treatment of a purulent wound.

Propositions for Defence

1. Existing numerous traditional methods of treating purulent wounds of soft tissues are not in all situations capable of ensuring proper treatment outcomes.

2. Potentiation of traditional basic therapy of purulent wounds of soft tissues by sessions of impulse induction magnetotherapy and low-intensity laser irradiation substantially optimizes clinical results and reduces treatment duration.

Validation of the Research

The main propositions of the dissertation are reflected in reports and presented in the materials of: the II All-Russian Scientific Conference with International Participation 'Microcirculation in Clinical Practice' April 19-20, 2006, Moscow; the Scientific-Practical Conference with International Participation dedicated to the 20th Anniversary of the State Scientific Center of Laser Medicine of Roszdrav 5-6 October 2006, Moscow.

Implementation of the Research Results

The developed combined, potentiated methodology for treating a purulent wound is actively used in the practical activities of the surgical infections department of the State Scientific Center of Laser Medicine of Roszdrav in the treatment of purulent wounds in patients hospitalized at City Clinical Hospital No. 51 in Moscow, in outpatient conditions of the polyclinic of the State Scientific Center of Laser Medicine of Roszdrav and City Polyclinic No. 58 in Moscow.

Publications

Three scientific works have been published on the topic of the dissertation.

Structure and Volume of the Dissertation

The dissertation is presented on 136 pages of typed text. It consists of an introduction, a literature review, three chapters, a conclusion, conclusions, practical recommendations, and is illustrated with 24 figures, 13 tables, and contains a bibliography containing references to 123 domestic and 29 foreign researchers' works.