DEEP VEIN THROMBOSIS PREVENTION (LITERATURE REVIEW). EXCERPT FROM THE GERMAN GUIDELINES

T. WERNER

Department of General and Abdominal Surgery of Betel Hospital, Bückeburg, GERMANY

Deep vein thrombosis (DVT) commonly affects the leg veins or the deep veins of the pelvis. A DVT can occur without symptoms, but in many cases the affected extremity will be painful, swollen, livid and warm, and the superficial veins may be engorged. The most serious complication of a DVT is a pulmonary embolism (PE). Untreated lower extremity DVT has a 3% PE-related mortality rate.

The annual incidence of symptomatic DVT in the general population is 90-130 per 100,000 inhabitants. Without prophylaxis, the incidence of DVT in hospitalized patients is 10-20% of internal medicine in general surgery at 15-40%, in orthopedics for hip or knee joint replacement at 40-60% (according to ACCP 2004 / 2008)

All patients with surgery, trauma or acute diseases the risk of DVT should be considered. The indications for VTE prophylaxis should be individualized, risk-adapted.

The individual risk of thromboembolism is composed of expositional and dispositional risk factors and is divided into three groups (low, medium, high). Type and extent of thromboprophylaxis should be based on this classification and to the contraindications.

Dispositional risk factors on the relative importance are: (high) prior DVT / PE, thrombophilia, malignancy; (middle) increasing age, DVT in first-degree relatives, heart failure, previous heart attack, obesity, acute infectious or inflammatory disease with immobilization, therapy with or blockade of sex hormones; (low) pregnancy and postpartum, nephrotic syndrome, varicose veins.

Expositional risk factors on the relative importance are: (high) major surgery in abdominal and pelvic regions in neoplastic / inflammatory disorders, multiple trauma, severe injury to the spine, pelvis or lower extremities, major surgery on the spine, pelvis, hip or knee joint, major intervention in body cavities; (middle) longer surgery, immobilization of the lower extremity, arthroscopic surgery of the lower extremity; (low) minor surgical procedure, with minimal soft tissue injury claims.

The expositional risk of DVT in patients with visceral, vascular surgery, gynecological and urological surgery in the abdomen and pelvis is considered to be comparable. For laparoscopic surgery and minimally invasive surgeries with access to the same indications apply for DVT prophylaxis as with open surgery in the abdominal and pelvic area.

Among the measures for DVT prophylaxis include general basic measures such as early mobilization, exercise, instructions to exercises;physical measures such as Medical thrombosis prophylaxis stockings, intermittent pneumatic compression and pharmacological measures. Here are unfractionated heparin (UFH) and low molecular weight heparin(LMWH), fondaparinux and other anticoagulants are available. In consideration of effectiveness, bleeding and HIT II risk LMWH should be used in preference to UFH. Other anticoagulants are effective, but useful only for specific indications or approved. Aspirin should not be used for DVT prophylaxis. The application of a drug for DVT prophylaxis should be performed only at a safe distance in time to a regional anesthesia or catheter removal.

In patients with low (individual) risk of DVT should be basic measures used regularly and can be supplemented by MTPS. In patients with moderate or high risk of DVT is a drug prophylaxis with heparin (UFH or LMWH) be made. Alternatively, fondaparinux can be given. In addition, MTPS be applied.The duration of prophylaxis is usually 5-7 days. With continuing risk, prophylaxis should be continued.In oncological surgery and hip replacement, they should last 4-5 weeks, with knee replacement two weeks. Only in elective hip and knee replacement surgery at the time can also be employed oral dabigatran and rivaroxaban for prevention.

ADVANTAGES OF JOINT USE OF LASER ILLUMINATION AND PROTEOLYTIC ENZYMES IN THE TREATMENT OF SEPTIC WOUNDS

F.E.VERDIYEV

Clinical hospital No. 6 named after A.D.Malikov, Baku, AZERBAIJAN

Despite the prophylactic measures taking of which was possible after the use complex surgical interventions, suppuration of wounds have negative influence on the result of surgical interventions. Suppuration of wounds not only create vital dangers in the organism, but also sharply extends the term of postoperative hospital stay and increases economic expenses of treatment. Therefore, the main purpose of the work is the improvement of the result of treatment of septic wounds with joint use of laser illumination of collagenolytic and proteolytic enzymes.

To achieve the set goal of the investigation, 85 patients were divided into four groups: the first group (control group) – 20 patients with septic-necrotic wounds treated with traditional, antibiotic and various antiseptics; the second group (20 patients) – those with septic wounds after surgical treatment and treated with bandage materials soaked into kollitinum and lisosym enzymes offered by us; the third group (20 patients) – septic patients with suppurated wounds after surgical intervention were exposed to laser illumination; the fourth group (25 patients) -37 patients with suppurative diseases of soft tissues were treated with offered methods.

In accordance with the set purpose of the investigation, the examined groups underwent clinical, histologic, histo-chemical and microbiologic examinations.

It was determined in the result of conducted examinations that joint application of immobilizing kollitinum and physical factors in bandage materials, provided more rapid cleansing of septic wounds and transitions of the wound process to dehydratation stage, activation of the reparative process, early appearance and intensive growth of granulation tissue that significantly reduced preparation term of wounds for secondary sutures, and term of healing of the wounds.

The application of complex treatment method, is safe, highly effective and economically advantageous in the treatment of suppurative diseases of soft tissues. As a result, joint application of immobilizing enzymes and laser illuminations demonstrated that in patients treated by this method the term of cleansing, granulation and epithelization of wounds reduces, the number of post-operative septic wounds decreases, which leads to early placement of secondary sutures and reduces the treatment term of patients.

Date: 2014-12-28; view: 824