Outpatient treatment of bedsores

Despite the introduction of new methods of treatment and medicines including https://pillintrip.com/ru/treatment_option_cystitis_in_turkey into clinical practice, the problem of outpatient treatment of bedsores, wounds and trophic ulcers continues to be extremely relevant. This is due to a large number of both medical and paramedical problems.

Medical problems include advanced age, prolonged immobility (ACV), purulent complications, a complex of trophic disorders caused by general and local factors, immunodeficiency states, shortcomings in outpatient care (late diagnosis due to insufficient attention and the impossibility of using new complex and expensive methods diagnostics), insufficient attention to the problem of asepsis and antiseptics, the use of old – “traditional” means (furacillin, Vishnevsky ointment). Often, therapy for concomitant cardiopulmonary pathology is absent or inadequate to the severity of the process. Anemia in this category of patients is not diagnosed, or the severity and the need for correction are incorrectly assessed.

Paramedical problems: unsatisfactory living conditions, lack of funds, absence of close relatives, prolonged self-treatment and excessive enthusiasm for folk remedies, time factor and maladaptive type of response, refusal to hospitalize or its impossibility.

After a retrospective analysis of the treatment of 165 patients aged 45 to 92 years, we came to the following conclusions:

Long-term unsuccessful treatment of most of these patients before contacting us was due to the absence or excessive surgical treatment, long-term outpatient use of old antibacterial agents (penicillin, gentamicin) without taking into account the sensitivity of the microflora, unreasonably frequent use of Vishnevsky ointment without taking into account its pharmacological properties, and inadequate treatment of concomitant cardiovascular disease. lung pathology, anemia and secondary lymphedema.
We consider it necessary to include antibacterial therapy in the complex of therapeutic measures, taking into account the sensitivity of the microflora or reserve antibiotics, venotonics, and angioprotectors.
Surgical treatment should be carried out in a minimum volume sufficient for drainage of wounds.
We consider it not always justified to pack wounds even with the use of polyethylene oxide-based ointments, since there is a need for frequent change of tampons (1-2 times a day) by a doctor, which is not always possible on an outpatient basis. In a number of patients, alginate-calcium tampons and gel dressings can be successfully applied (Germany).
As physiotherapy, we consider it justified to use iontophoresis, laser therapy and ultraviolet irradiation (according to the stages of the course of the wound process), taking into account contraindications to these methods of treatment.
Ultrasound is indispensable as a diagnostic and treatment procedure. Puncture of purulent foci under ultrasound control (removal of pus, sowing, administration of an antibiotic into the lesion) is a reliable and low-traumatic intervention.
Differences in terms of treatment in the second phase of the wound process with the use of ointments, oils, aerosols were not revealed by us. Therefore, we consider a strictly individual approach to their choice justified.
Treatment of this type of pathology requires a lot of strength and patience from the doctor and the patient.

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