Wound Healing Protocols
Here you can find some materials from the Russian Ozone Therapy in practice.
- the mechanisms of therapeutic action of ozone therapy
- the main clinical symptoms of the most widespread surgically treated pathologies
- the recommended methods of ozone therapy and expected clinical results
- Purulent Wounds
- Trophic Ulcers
- Decubitis ( pressure sores)
- Thermic Traumas (Burns)
The effect of medical ozone on the infected wound surface is achieved through the combined therapy.
The local ozone therapy leads to elimination of regional hypoxia in the purulent focus through stimulation of activity of the respiratory enzymes succinodehydrogenase and cytochrome oxidase. This takes place along with an increase in partial oxygen tension in the wound by 10-16% in comparison with the initial level (Yu.N.Belokurov, V.M.Molodkin, 1995) and maintenance of the increased level of tissue oxygenation in the period after the performed treatment. Normalization of tissue metabolism is associated with elimination of acidosis, improvement of microcirculation and trophism of tissues modified by inflammation, normalization of reparative processes and acceleration of epithelization.
Ozone in gaseous phase and contained in solutions of crystalloids is able to suppress the growth of bacterial flora: staphylococcia, Proteus, colibacillus, Klebsiella, fungi, anaerobic flora. Through ozone it comes to an increase in the sensitivity of microbes to antibiotics that reduces their dose and exposition time. It comes to fast bacterial decontamination of wounds, cleaning of their surface from necrotic masses, appearance of granulations and edge epithelization. Through ozone therapy on the 3rd-4th day it comes to disappearance of pain syndrome.
The parenteral use of ozone produces a detoxication effect on the organism, speeds up correction of the free-radical processes, activates the endogenous defense enzymes, improves the rheology of blood, leads to mobilization of the humoral and cellular immunity.
After the surgical treatment of purulent focus the wound surface is exposed to irrigations with an ozone/oxygen gas mixture by means of plastic frame-chamber (the wound has been previously moistened). Ozone concentration and exposition time depends on the area of affection, causative factor, severity grade of purulent-inflammatory process. As soon as it comes to cleaning of pathological focus from necrotic masses and appearance of granulations, higher ozone concentrations should be gradually decreased for stimulation of regeneration and completion of epithelization. The frequency of treatments and duration of treatment course of local ozone therapy should be determined individually.
For acceleration of cleaning of wound surface from necrosis and pus it is possible before the irrigation with an ozone/oxygen gas mixture to use “mini”-baths with cooled ozonated distilled water.
For local sanitation it is also possible to use ozonated saline solution in the form of flowing irrigations of pathological surfaces.
After the local treatment of inflammation focus it is a time for applications with ozonated solutions or ozonized olive oil. S.N.Gorbunov suggests for the first 2-3 days to cover the wound with sorbent treated with ozonated 10% sodium chloride solution.
It is necessary to perform daily intravenous drop-by-drop infusions of ozonated physiological saline at a volume of 400 ml for 10 days. In case of severe endotoxicosis ozonated saline solution can be introduced twice a day or in combination with major autohaemotherapy with ozone twice a week.
Owing to suppression of the organism’s compensatory-adaptive mechanisms the combined therapy should include the use of antioxidants.
The combination of local and systemic methods of ozone therapy in the treatment of purulent wounds allows shortening treatment duration, repeated operations, lethality.
In the treatment of this pathology the use of ozone is based on its main properties: bactericidal, analgesic effects, improvement of the rheological properties of blood in the microcirculatory zone, activation of the oxygen-dependent extra- and intracellular processes, intensification of activity of immunocompetent cells and regeneration.
The treatment includes several methods of ozone therapy: local – ozone gas irrigations of focal processes by means of plastic chamber, subcutaneous ozone injections around the place of ulceration, applications with ozonized olive oil; systemic – parenteral infusions of ozonated saline solution. The treatment schema for each patient is determined individually depending on the character and ulcer size, its genesis.
After 2-3 procedures of ozone therapy the patients report about remission of pain, decrease in the feeling of heaviness in the damaged limb, burning sensation and itch, regress of local appearances of inflammation. After 6-8 procedures it comes to active cleaning of ulcer, appearance of granulations, gradual process of focal and edge epithelization. It comes to general improvement of the patient’s condition, stabilization of the picture of lipid profile, activation of the antioxidant enzymatic system.
In some cases epithelization of ulcerous surfaces comes after the second course of complex ozone therapy, when the interval between them is 2-3 weeks. If plastic surgery is necessary, the use of ozone for sanation leads to complete transplantability. Recidivation of ulcer is considerably reduced, hospitalization time of this group of patients is decreased.
Decubitis (pressure sores)
The use of ozone in the treatment of decubitis is the most suitable variant both for the patient and doctor among the numerous methods of traditional treatment. It does not cause any trouble to the patient. It leads to fast disappearance of necrosis and unpleasant smell.
Recommended methods of ozone therapy:
- Ozone/oxygen gas irrigation under “suction cup” in low-pressure conditions;
- Major autohaemotherapy with ozone.
In case of strongly contaminated or necrotized tissues associated with suppuration for bactericidal purpose it is necessary to perform ozone irrigations at higher ozone concentrations for 20-40 min depending on the tolerance. In case of tendency towards healing ozone concentration used should be gradually decreased, otherwise there is a risk of repeated opening of wound. Treatment duration and frequency of procedures is determined individually. Along with local ozone therapy it is necessary to perform major autohaemotherapy with ozone for stimulation of oxygen-dependent processes, metabolism, defense systems of the organism, elimination of tissue hypoxia.
Thermic Traumas (Burns)
Ozone is used against the major mechanism of tissue damage – oxidative stress that develops as from the first days of burn shock due to sharp intensification of the oxidative processes and insufficiency of the antioxidant defense system. The administration of therapeutically dosed active oxygen facilitates restoration of dynamical balance between lipid peroxidation and antioxidant enzymes. It comes to a considerable decrease in the level of endotoxemia that results in the better-manifested correction of immunological status, increase in the activity of phagocytosis. Ozone ensures optimization of the respiratory, cardiovascular, secretory systems. It actively participates in the correction of practically all pathological processes encouraging the syndrome of polyorganic insufficiency in burn disease. All the above-mentioned allow considering ozone therapy as a method of endogenous detoxication.
Recommended methods of ozone therapy:
- Intravenous drop-by-drop infusions of ozonated saline solution or major autohaemotherapy with ozone for systemic effects;
The local treatment of burn wounds in the form of ozone gas irrigation by means of plastic chambers facilitates elimination of pathogenic flora and inflammation inside and outside the wound, formation of bright fine-grain granulations, reduction of time required for wound healing, improvement of autotransplantation in deep burns.
Ozone gas irrigation of burn surfaces is performed at higher ozone concentration in case of their contamination, then in case of wound cleaning and beginning of focal or edge epithelization ozone concentration should be decreased. Duration and frequency of local ozone therapy is individual.
For surgical treatment of burn surfaces ozonated saline solution (at high ozone concentrations) is widely used as a bactericidal agent. At the stage of epithelization of skin defects it is possible to use applications with ozonized olive oil.
During the ozone therapy it comes to a considerable increase in pO2, decrease in the blood level of glucose and underoxidated products, fast dynamics of decrease in the markers of endogenous intoxication, improvement of the rheological properties of blood, normalization of the antioxidant defense activity, elimination of dysphagocytosis, normalization in the indices of T-lymphocytes, IgM, IgG, IgA.
The clinical efficiency of ozone in the complex of infusion-transfusion therapy in burn disease allows using it at a full range.