Coloidal scar of ICD. Tastes of thermal and chemical opikiv, ice cream, wounds

Infiltration of the operation is one of the most frequent parts of the process of slowing down the operation of the operation. If you have had an appendicitis, you have seen a grizzly, or you just got an injection.

It is important for this to dutifully pursue one's own camp for operational involvement. Vilikuvati is also easy to complete as soon as you can diagnose it. If you just tighten it up, it will grow into an abscess, and I will even block it with a breach of a gnarial and infected blood.

So tse take?

The term itself is a zlittya of two Latin words: in - "in" and filtratus - "process". Doctors call cym the word pathological process, if all the tissues are in the middle of the tissue, or if any organ is buying up pieces of clitin (including the number of bloods), the shelter itself, the lymph. The name of the viglyada is yak shilne approved, but just chubby.

The two main forms of such a manifestation are ignited (at the same time, speeding up the writing of the operation) and pukhlinna. In the middle of the other, it is not the innocent roof of the lymph, but the chubby cells, and even more often - the crayfish. Some doctors call an infiltrate a dilyanka on the basis of a drug, and injecting an anesthetic, an antibiotic or an antibiotic during treatment. I will call this type "surgical".

The ignition process can be continued before the operation. It is especially common to diagnose the appendicular infiltration, which develops practically in parallel with the inflammation of the appendix. Winning to see more often, not to speed up the operation of appendicitis. Another "popular" option is fluff in the mouth of children, the reason is fibrous pulp.

dear

Igniting infiltration is the main type of such pathology, which is often the result of an operative involvement. Razrіznyayut decilka types of such fiery, in the presence of such clines in the middle of the puddles are the most.

1. Gnіyny (all the middle polymorphic leukocytes were selected).
2. Hemorrhagic (erythrocytes).
3. Krugloklitinna, or lymphoid (lymphoid cells).
4. Gistocyte-Plasmoklitinni (all the middle elements of plasmas and hisistocytes).

Fascinated by any character, you can develop in decilkoh straight lines - or it will grow in an hour (in 1-2 months), or it will transform into an unpalatable scar, or it will develop into an abscess.

With a special type of ignition vvazhayut the infiltrate of the operative seam. It is especially easy to get involved in it - it can be "viscous" і through a few days of the operation, і through 2 rocks. Another option is, for example, for a cesarean rosette, і risik, which burns an overgrowth into an abscess, to finish off a high one.

cause

When there is a new, haemorrhagic and insurmountable decision on the basis of surgical engagement of non-insurances of some kind. It is easy to grow up in small children, in older children, for a banal appendicitis and during the operation with the uterus(Paracervical and іnshі poohlini).

Fakhivtsi name the 3 main reasons for such a phenomenon - injuries, odontogenic infections (in an empty company) and іinshi infections. Yaksho vi spent a lot of time to the lykar through those that caught fire during the operation seam, for a number of reasons:

• Infectious diseases were consumed in the wound;
• if the drainage operation was carried out incorrectly (call on the patients because of the carriage);
• from the blame of the hirurga buv the ball of the pediatric fatty tissue, and there was a hematoma;
• seam material volodya high tissue reactivity.

As the scar will ignite only through the few months or the rocks in the course of surgical manipulations, the same material is to blame. This pathology is called ligature (ligature is a ligature thread).

Provokuvati pathology can also be a weakness to allergies in a patient, weak immunity, chronic infections, inconvenience and illness.

symptoms

Pislyaoperatsіyne accelerated development not all at once - call on the 4-6th day of the year X (surgical involvement). Inodі and ізніше - through a second or two. The main signs of a cob fired in early - tse:

• subfebrile temperature (to move everything on a few pads, it’s uncomfortable to be sick);
• when there is a pressure on the igniter, the light appears;
• as it squeezes even more strongly, there is a dull fossa, as it moves steadily to straighten;
• shkіra in urazhenіy zonі swollen and chervonіє.

Yaksho pukhlina vinikla pislya operatsii z vidalennya groin grill, You can add some symptoms. About the pathological purchased clitin in the black empty one say:

• any pain in the queue area;
• bowel problems (constipation);
• hyperaemia (strong rush of blood until ailments).

In case of hyperaemia, they get rid of boils and boil furuncles, part of the heart, the patient torment headaches.

What kind of postin'єktsіynykh іnfіltrat?

Infiltration for an injection is one of the most frequent acceleration of the injection, the order of hematomas. Viglyada vіn yak a small nasal lump on that mіsci, where the curls inserted the head with the licks. Being smart to such a mini-quickening is very individual: someone has an impairment on the school going to get a skin injection, but for all the life of the day, they have never stuck with such a problem.

To provoke a reaction of the body to a banal prick, there can be offensive reasons:

• the nurse ran a nasty antiseptic treatment;
• the head of the syringe is short or stupid;
• improperly vibrated puncture;
• ін'єкції to roam continuously in one and the same place;
• Likki enter zanadto quickly.

Such a sore can be vilikuvati zychaynoy physiotherapy, iodine sieve or compresses with dilution of Dimexidum. Help і folk methods: compress s cabbage leaf, Aloe, burdock. For greater efficiency, before the compress, you can mask the lump with honey.

diagnostics

To diagnose such an operational pathology is difficult not to become. The drug, when staging a diagnosis, spirals, first for everything, on the symptoms: temperature (like and how to trim), the nature and intensity of pain and in.

Most often, pukhlina does not start out with palpation - it’s a good idea of ​​the unclear and unclear edges, as we see it hurting when it’s promising. Allegedly, surgical manipulations were carried out on black empty spaces, then the reduction can be very much in the middle. І with a fingertip, the doctor just doesn’t know.

In general, more informative methods of diagnostics - ultrasound and computer tomography - come in for help.

Another obov'yazkov diagnostic procedure is the biopsy. The analysis of fabrics can help the intelligence of the nature, igniting, knowing, how the cells were bought up in the middle, stand up, which in the middle of them are evil. Tse allow z'yasuvati the cause of the problem and correctly put the scheme of treatment.

lykuvannya

The main meta in the treatment of postoperative infiltration is to ignore and prevent the development of an abscess. For the whole it is necessary to identify the blood flow in a sick person, to get rid of the problem and to eliminate the pain syndrome. Vikoristovuyt, first for everything, conservative therapy:

1. Treatment with antibiotics (including infection with bacterias).
2. Symptomatic therapy.
3. Local hypothermia (a piece of lowering the temperature of the fire).
4. Physiotherapy.
5. Postіlny mode.

Effective procedures include UV-detection of wounds, laser therapy, mud and mud. One counter-indication for physiotherapy is a price point. In general, the progression and the other procedures can only accelerate the expansion of infections and the possibility of abscesses.

When the first signs of an abscess appear with a spatula that is minimally invasive, drainage of the affected dilyanka (with ultrasound control). In the most common vipads, the gn_ynik is opened in a very special way, vikoristovuchi laparoscopy or laparotomy.

The treatment of the surgical suture with accelerated ones can be traditionally carried out with the help of conservative methods: antibiotics, novokainov blockade, physiotherapy. Iakshcho pukhlina so і didn’t get wet, the seam was cropped, cleaned and sewn up again.

Infiltration during the operation can be approved by the patient, be it in vik, and I will become healthy. By herself, pukhlina beckon no shkodi, but you can serve cob stage abscess - important fierce fire... It is not safe if one pathology develops through a spike of rock when it is sent to the operation, if a scar flares up. It is necessary for the nobility to have all the signs of such an affliction, and at the very least age, to be killed to a lykar. It is also possible to unicuti new accelerated and supplementary surgical procedures.

Article for the site "Health recipes" prepared by Nadiya Zhukova.

* Pushing on the "Send" button, I will wait until

Source: zdorovieiuspex.ru

Included: I will stand, beforehand for the guardianship, hospitalization of the mother's obstetric aid, as well as for the caesarean rosette to the cob

Viklyucheni: pererachivanye will become difficult with canopy (O65.5)

• sub-base
• dvorog_y matts_

Medical assistance is provided to mothers for:

• polyp tila uterus
• uterine fibroid

Excluded: medical aid for mothers with swelling of the cervix (O34.4)

Medical help for mothers with cicatricial scar

Viklyucheni: canopy through the passage of the anterior cesarean rosette NOS (O75.7)

Sewing the shyki with a circular suture because of the unclear about cervical deficiencies or no

Shirodkar suture because of the obscure cervical deficiency or no

Medical assistance is provided to mothers for:

• polypy of the cervix
• overflow of surgery on the uterus
• stricture and stenosis of the cervix
• chubby uterus

nadannya medical aid materi for:

• interconnected vaginal uterus
• vipadanny of the vaginal uterus
• retroversion of the vaginal uterus

Medical assistance is provided to mothers for:

• overwhelming operations for the first time
• a great girl's poultry
• partitions
• stenosis pichvi (dribble) (natural)
• stricture pіkhvi
• pukhlini pikhvi

Viklyuchena: medical aid for mothers with varicose veins veins pіkhvi pіd hour of vaginosti (O22.1)

Medical assistance is provided to mothers for:

• fibrosis of the crotch
• overhanging operations on the crotch and vulva
• rigid crotch
• chubby vulvi

Excluded: medical aid for mothers with varicose veins of the perineum and vulva for an hour of vaginosity (O22.1)

Medical assistance is provided to mothers for:

• cystocele
• pelvic floor plasticity (history)
• in a hanging belly
• rectocele
• rigidity of the pelvic floor

In Russia International classification of ailments 10th look ( ICD-10) Adopted as a single normative document for the incidence of illness, the reasons for the beast of the population in medical mortgage of all households, causes of death.

ICD-10 Introduced into the practice of protecting health in the entire territory of the Russian Federation in 1999 by the order of the Ministry of Health of Ukraine dated 27.05.97. No. 170

A new look (ICD-11) is planned by WHO in 2022 rotsi.

Dzherelo: mkb-10.com

Pislyaoperative scar of the uterus,

Viznennya and zagalny vіdomosti [ed]

A scar (cicatrix) is a profound statement, which is deposited with hyalinized, rich collagen fibers from the resulting tissue, which is a result of reparative tissue regeneration in case of deteriorated integrity.

A scar on the mat is the uterus zone, in which anterior operative procedures were performed (cesariv rostin, myomectomy, reconstructive plastic surgery)

According to the data of the recent authors, the scar on the matt of cesarean rostin є in 12-16% of the vaginal, and the third dermal abdominal canopy in the former є repeat. Over the last 30 years (repaired since 1980), the expansion of caesarean rosin in the Russian Federation has grown 3 times and becomes 22-23%. The number of vaginitis with a scar on the mat is increasing due to myomectomy. It is also performed by laparoscopic or laparotomic access with the presence of an interstitial component, as well as a scar. The incidence of unproblematic scars for myomectomy is 21.3%.

Frozen scar on the mat.

Stan has a scar on the mat.

a) Localization of the scar on the matrix of the cesarean rosin:

- in the lower uterine segment;

- chastkovo in the lower segment, chastkovo in tilі (for іstmіko-corporal distribution on the mattі);

b) A scar on the matt of myomectomy before and after an hour of vaginosity:

- without rosette emptying of the uterus;

- with empty uterus rozkrittam;

- a scar on the matrix of the visible subserous-interstitial university;

- a scar on the mattsі for the appearance of a cervical miomi.

c) Scar on the matt of perforation of the uterus [with intrauterine involvement (with abortion, hysteroscopy)].

d) Scarring on the matt of ectopic vaginosity, loosening in the interstitial form of the uterine tube, in the uterus for visible vaginosis.

e) Scar on the matrix for reconstructive plastic surgery (surgery by Strassman, visualization of the rudimentary uterine horn, plasty of the isthmus to drive an unsuccessful scar on the matrix for caesarean rosin).

A scar on the mat is formed as a result of a cesarean roste, when myomectomy, perforation of the uterus, tubectomy. Rubtsyuvannya is a biological mechanism of preservation of fabrics The heating of the uterus can be seen as restitution (more regeneration) or substitution (disagreement). In case of repeated regeneration of wound healing, it is taken for a shell of smooth blood cells (myocytes), with a substitution - for a shell of bundles of coarse fibrous tissue, not loosely hyalinized tissue.

Pislyaoperative scar of the uterus, which provides medical assistance to mother: Diagnostics [ed]

By informative methods of diagnostics, I will have a scar on the mother in an unavoidable woman є hysterography, and more beautifully, hysteroscopy, ultrasound dosage(SPL).

hysterography vibrate on the 7-8th day of the menstrual cycle, or not earlier than 6 months later during the operation in direct and general projections. Method of allowing vivchiti snakes internal surface pislyaoperative scar on the mat. The incapacity of the operative cicatrix is: change in the position of the uterus in the small pelvis (significant forward position of the uterus, serration and vitality of the contours of the inner surface of the uterus in the area of ​​the anterior scar, "bad").

hysteroscopy to move on the 4th-5th day of the menstrual cycle, if the endometrial functional ball starts to trade, and through the thin basal ball you can see the tissue. On the incapacity of the scar, urge to induce local retraction, for example, in the area of ​​the scar. The faint color of the tissue of the scar, the visibility of the scars, indicate a change in the full tissue component, and the retraction - about the thinning of myometrium as a result of an incomplete regeneration. Invisualizable uterine scar and scar with recuperation of the meat tissue and testify about the anatomical and morphological characteristics.

Ultrasound dosage... Prior to echoscopic signs of incapacity, a scar on the mat should be placed: an irregular contour along the posterior wall sectional mikhura, Vitonennya myometriya, uvrevnosti contours of the scar, is the number of density inclusion (with the resulting tissue). With double ultrasound, pathological changes in the area of ​​the scar on the mat appear significantly earlier, less with hysteroscopy (56% and 85% are evident). With the advent of the Doppler and 3D-reconstruction method, the informational value of the ultrasound scan for assessing the cicatrix on the matt has significantly shifted, as it became possible to assess the hemodynamics of the scar (development of the scarring). Otrimanі the results of preadoptive methods of diagnostics of a scar on the mother's posture of vaginosti to be entered into the outpatient card and to be taken in case of a new diet about the possibility of planning an onset of vaginosti.

With the presence of an unproblematic scar on the matrix at the stage of planning vaginoscopy with the method of prophylaxis and the onset of vaginoscopy, a reconstructive operation is shown - plasty of the isthmus of the uterus, which is carried out in a gynecological hospital with high surgical laparoscopic surgery.

Retractable windscreens for mimic curtains.

Relay cardiotocographic i ultrasonic testing in the process of moving curtains.

Adequate protection in the process of mimic canopy.

Visibility of an uncomplicated scar on the mat in case of repeated cesarean rositis.

Pislyaoperative scar of the uterus

Treatment of vagina with a scar on the matt of cesarean rostin

Retaliation of the anamnesis, which includes the status of health in the last caesarean rosette on the delivery of a vipisk from the obstetric hospital.

View about the advancement of the scar on the matt, performing the posture and the hour of vaginosity.

Parity: chi buli mimovіlnі curtains until operative engagement; the number of services between the operative and the emergency room, no stench is over (abortion, weekend, visit).

The emergence of living children, deaths and deaths of children in front of the canopy.

b) Physical coverage

Palpation of a scar on the anterior cranial bone and on the mat; vimir of the growth of the pelvis and the transfer of the mass of the fetus; Assessment of the age of family nobles and readiness to the body until the age of 38-39 years of gestation.

c) Instrumental methods of follow-up

Ultrasound examination of the fetus from the stasis of Doppler measurements of the umbilical cord, aorta, middle cerebral artery of the fetus and the placenta, repaired from the end of the II trimester of vaginosity.

Cardiac monitoring of the fetus.

Ultrasound of the scar on the skin tissue 7-10 days after 37 vaginal conditions.

The tactics of maintaining a pregnancy with a possible scar on the mat should not be transformed into an external scar.

Obov'yazkovo be carried out, as soon as possible SPL. The main meta tsyogo doslіdzhennya - the value of the place of attachment of the fruit egg in the mother. There are also those who have been rocked in the area of ​​the isthmus on the anterior stance of the uterus (in the area of ​​the cicatrix there is a caesarean rostin in the lower uterine segment) from the medical point of view of the thoroughly reversing of vaginosity, which is how to get rid of the vacuums; so as the proteolytic power of the chorion in the world of progressing vaginosity can lead to inconsistency to find a possible scar on the mat, to the presentation and growth of the placenta into the scar and to the rupture of the uterus. Food about the preservation of vaginosti is in the competence of the woman herself. In case of an unrelenting interruption of the vaginosity and the presence of a scar on the mother of Chergov, a complex treatment is carried out in the 37-38th gestation period in hospitals, so that the birth of the vagina (obstetric hospitals of the 3rd level) is transferred.

Growth of vaginal with a scar on the matt of cesarean rostin

The food about the method of development is guilty of the obov'yazkovo uzgodzheniya with the vagina woman. The head of the obstetrician will report on all the changes and risers, like repeated cesarean rosters, as well as mimic curtains. The residual solution is taken by the woman herself at the viglyad of the written information for one of the methods of development. When there are absolute indications until the planned cesarean rosette, the perevag will go down the canopy through the natural birth of the way, moreover, the spontaneous ear.

The passage of the canopy through the natural birth of the nobility is permissible for a number of minds that have been adopted:

- one cesar rostin in anamnesis with transverse growth on the mat in the lower segment;

- the number of extragenital illnesses and obstetric services, which were shown before the first operation;

- the appearance of a possible scar on the mat (according to the results of clinical and instrumental doslіdzhen);

- localization of the placenta, posture of the scar on the mat;

- the smut of the fetus;

- the rate of growth of the pelvis of the mother and head to the fetus;

- the appearance of minds for the extraordinary development of a cesarean roste: high-quality medical personnel; The possibility of a cesarean roste in an extreme order does not rise, not after 15 minutes of hearing a decision about the operation.

Shown before repeated abdominal flattening with the presence of a scar on the matt of a cesarean rosette:

- a scar on the matts_ of a corporal caesarean rosette;

- an unproblematic scar on the matrix for key and echoscopic signs;

- scar on the matrix for plastics of the isthmus;

- redistribution of the placenta in the scar;

- two or more scars on the matt for cesarean rots in the lower uterine segment;

In case of repeated cesarean rositis, an obovyazkovoy washout є a viscous unproblematic scar on the matt, but often decreases the risk of acceleration at the onset of vaginosity.

Leaning in women with a scar on the mat

When using the method of birth in women with a scar on the mother, it is primarily important to follow the character of the method (laparotomic or laparoscopic) viconano operation. Rizik of the uterus growth on the scar of the myomectomy in the process of mimic canopy starts with the growth of the puff in the mimeter.

Shown before cesarean rosette for myomectomy posture of vaginosity:

- a scar on the matrix of the visualization of the interstitial or subserous-interstitial universities, the growth on the back of the uterus;

- a scar on the matts_p_slya visible chick myomi;

- a scar on the matts_pislya visible intraligamentary miomi;

- cicatrices on the mattsi of the visualization of decilkoh interstitial-subserous universities of great development;

- obstetric history of obstetrics;

- the pelvic area of ​​the fetus;

- FPN (placental deficiency);

- vіk primіstok older than 30 years;

- scar of myomectomy, viroblocked by laparoscopic access.

In case of vaginal canopies with a scar on the matt, the vaginosis posture and during the day are indicated before the cesarean roste, shorten the mimovilny curtains.

A scar on the matt of myomectomy, vyroblenoy before the hour of vaginosity, is indicated before the cesarean roste.

Reconstructive growth of vaginal cicatrices on the mat plastic surgery, Perforation of the uterus and ectopic vaginosis

Shown before cesarean roste:

- scar on the matt of the metroplasty (surgery by Strassman, seeing the rudimentary horn of the uterus from the opening of the empty uterus, plasty of the isthmus with the drive of the unsuitable scar on the mat of the caesarean rosin);

- a scar of perforation of the uterus, rosette in the area of ​​the isthmus along the posterior stance;

- a scar of a visible shy vaginosity, vaginosti in the rudimentary rose of the uterus, a cult from a distance before the tube.

When the canopies are passed through natural births with a scar on the mat, it is necessary to carry out a manual control of the emptying of the empty uterus.

Prevention of incapacity of the scar on the mat

The creation of optimal minds for the formation of a possible scar on the matt during operations on the mat: suturing the rose on the mat with oremovy-ointment sutures, or with a permanent suture (rather than reverse), on the synthetic rose-cut stitches.

Prophylaxis, prompt diagnostics and adequate therapy for patients undergoing surgery.

On'є

Dzherelo: wikimed.pro

Canopy with a scar on the matti code according to ICD 10

Scar (cicatrix) is a strong statement, which is stored with hyalinized, rich in collagen fibers from the resulting tissue, which is the result of tissue regeneration in case of deteriorated sanity.

A scar on the mat is the area of ​​the uterus, in the yaky boule there were performed operative procedures [cesarean roztin (CS)], myomectomy, reconstructive plastic surgery).

Slide to mean that you understand “a scar on the matt of a cesarean rosette”, take it in our land, not far away, as it often does not appear during repeated operations. Foreign authorization zvivayut the terms "in front of the cesarean roztin" and "transferred myomectomy".

ICD-10 CODE
O34.2 Pislyoperative scar of the uterus, which provides medical assistance to the mother.
O75.7 Canopy through the front of the caesarean rosette.
О71.0 Growing the uterus to the ear of the canopy.
О71.1 Growth of the uterus before the hour of flattening.
O71.7 Obstetric hematoma in the pelvis.
O71.8 Obstetric injuries clarified.
O71.9 Obstetric trauma, unspecified.

According to the data of the previous authors, the scar on the cesarean roste mat is in 4-8% of vaginal patients, and close to 35% of abdominal canals in the population are repeated. The expansion of the cesarean rosin in Russia for the last ten years has grown 3 times and to become 16%, and according to the data of foreign authors, close to 20% of all the conditions in the developed countries will end with the operation of the caesarean rosin.

Statistical indicators of the number of vaginals with a scar on the matt of myomectomy and reconstructive plastic surgeries are not simple, but in Danish hour, at the ligament with the development of the uterus miomy in a larger early vіtsі, The swift growth of plump in women of reproductive vіku і її great sizes As soon as I change my mind and vitality, myomectomy was included in the complex of pre-educational training. When women have a vaginosis with my uterus, obstetricians also often use myomectomy, at least 10-15 times. By this rank, the number of vaginal scar tissue on the mother's plate is gradually increasing.

Seeing a lagging and unsuitable scar on the mat. There is also a classification in the presence of the cause of the scar on the mat.
· A scar on the matts_ of a cesarean rosette.
- In the lower uterine segment.
- Coronal scar on the mat.
- Isthmic-corporal scar on the mat.
· A scar on the matt of conservative myomectomy before and after an hour of vaginosis.
- Without rosette empty uterus.
- 3 rozkrittam empty uterus.
- A scar on the matrix of the visualization of the subserous-interstitial university.
- A scar on the mattsi is visible intraligamentary miomi.
· A scar on the mattsi of the perforation of the uterus [with intrauterine involvement (abortion, hysteroscopy)].
Scarring on the tissue of the ectopic vaginosis, in the interstitial appearance of the uterine tube, in the disc of the rudimentary horn of the uterus with the main empty uterus, in the uterus of the vaginosis
· Scar on the mattse of reconstructive plastic surgery (Strassmann's operation, visualization of the rudimentary uterine horn).

A scar on the mat is formed by cesarean roste, conservative myomectomy, perforation of the uterus, tubectomy and in.

Rubtsyuvannya is a biological mechanism of preservation of fabrics The heating of the uterine stem can be carried out by means of restitution (povnotsinna regeneration), as well as substitutions (inconsistent regeneration). In case of repeated regeneration of wound healing, the growths of smooth oyster cells (myocytes) are observed, in case of substitution - bunches of coarse fibrous tissue, loosely hyalinized tissue.

CLINIC PICTURE TO THE RISE OF THE UTERINE ON THE SCARS

Growth of the uterus with dystrophic changes, myometrium or the presence of scar tissue, and pass without swelling classic paintings(Wrongly named "asymptomatic"). Unimportant to the erasure and bends, the nature of the illness, the symptoms may be a matter of interest and is necessary for the nobility.

With the presence of an operative cicatrix on the mattress, it may appear as early as an hour of vaginosity, as well as a half hour.

Behind the critical interruption, there are also stages, and in the case of a mechanical one, it is dangerous, and it’s possible to break the uterus.

Symptoms of uterine growth by scar on the hour of vaginosis

Symptoms of a threatening uterine growth in the scar for an hour of vaginosity is accumulated by reflex subtle changes of the uterus in the area of ​​scar tissue:
· Nudota;
· Blues;
More:
- in an epigastric disease with a lower localization in the lower abdomen, sometimes more on the right (there are symptoms of appendicitis),
- in the transverse area (іtuyut nirkova kolka);

Ailment, sometimes local, in the area of ​​an operative scar during palpation, de be felt
perishing.

Symptoms of the appearance of the uterus in the scar for the hour of vaginosity begin to show hematoma in the uterus for a rakhunok show a nausea of ​​the uterus and sudin. Before the symptoms of a threatening rose, sit down:
· Hypertonicity of the uterus;
· Signs of the state of health of the fetus;
· Mighty blood visions from statuesque nobles.

Symptoms of the growth of the uterus before the hour of vaginosity: before the clinical picture of the threatening
rospochaty razriv_v attachment symptoms of pain and hemorrhagic shock:
· Pogirshutsya zalalny camp і self-respect;
There is a weakness, zamorochennya, as a sprinkle may be buty reflex genesis, and in the fake
obumovatsya blood loss;
· Obvious symptoms of all the middle cranial bleeding and hemorrhagic shock - tachycardia, hypotonia, blight of scruff.

With the completed rosary, which once trap not long ago on the scar tissue, cleaned by the great number of sudins, bleeding into the empty kernels, we may be weary or insignificant. In such cases, on the first plan, there are symptoms associated with the hypoxia of the fetus.

Rise the uterus by the scar in the canopy

The appearance of the uterus by the scar in the canopy can be seen when there is evidence of operative scars on the matts, or dystrophic changes in them, in a lot.

Ragging growth of the uterus before the hour of flattening is characterized by onset symptoms:
· Nudota;
· Blues;
· Pain in the epigastria;
· Rise of the options for the deterioration of the fast feeling of the uterus - discoordination or the weakness of the generic activity, especially when the waters are deep;
· The pain of overloading, as it is not due to its strength;
· Uncompromising behavior of the breed, which is to live with a weak kindred spirit;
· Covering of the fetal penetration in case of reopening of the uterine cervix.

When you try to cut the uterus along the scar in the first period of flattening in conjunction with the appearance of hematoma in the uterus, there are:
· Post_yne, scho not a weakening sprain of the uterus (hypertonicity);
· Sickness during palpation in the area of ​​the lower segment, or in the area of ​​a scarred scar during its manifestation;
· Signs of fetal hypoxia;
· Blood of vision from statues of nobles.
In a large breed, the clock progression appears to show symptoms after a break until the moment
what happened is counted as khilina-mi.

Clinic for the growth of the uterus along the scar is similar to the rate of delay for the hour of vaginosity - in the main sign of hemorrhagic shock and antenatal fetal bend.

In case of preliminaries, it is characteristic that the head ruchomia is viscous, it is previously squeezed or stands at the entrance to the pelvis.

If the uterus is cut along the scar in the II period of the canopy, then the symptoms of the uterus are unclear:
· Weak, ale sickly attempts, step-by-step weakened right up to pinching;
· Pain in the lower abdomen, crises;
· Blood vision from pіkhvi;
· Gostra hypoxia of a fetus with a young bend.

Once the uterus is cut along the scar, it will be done with the rest of the pain. At the same time, it is easy to diagnose the opening of the bucket. Ditina will pop up spontaneously, alive, without asphyxia. The placenta grows independently, pops up later, and only grows symptoms in a small way, due to hemorrhagic shock, so that there is “no reason” hypo-tenzo, some pain in the disease. Clarify the diagnosis is possible only with manual tightening of the uterus or with laparoscopy.

Incomplete growth of the uterus can occur in any period of canopy.

Diagnostics of accelerated vaginosity in women with a scar on the mat was based on the medical history, physical condition and laboratory data.

A retreating anamnesis is guilty of including the removal of abnormalities in the last cesarean rosette (indicated), at the time of KS, about the appearance of mimic conditions before the operative reception and about the number of results of surgery and the appearance of living children, of the dead birth and the bending of children in front of the canopy, about the overflow of vaginosity.

On palpation, a scar was palpated on the anterior cranial stem and on the mat, the size of the pelvis was changed and the size of the fetus was transferred. At 38-39 guests of the gestation, an assessment of the readiness of the body of the vagina to be carried out.

· Zagalny blood analysis.
· Zagalny analysis of the sech.
Biochemistry analysis of blood (the value of the concentration of zahal protein, albumin, sechovine, creatine, surplus nitrogen, glucose, electrolytes, direct and indirect bilirubin, activity of alanaminotransferazinotransfera, aspartate amine aspartate
· Coagulogram, hemostasiogram.
· Hormonal status of FPK (concentration of placental lactogen, progesterone, estriol, cortisol) and assessment of a-fetoprotein.

· Ultrasound of the fetus with dopplerometry of the umbilical cord, fetal aorta, middle cerebral artery of the fetus and the placenta is shown from the end of the II trimester of vaginosity.
· Cardio-monitored guarding of the fetus.
Ultrasound of the scar on the skin mat 7-10 dB.

DIAGNOSTICS I WILL BECOME a scar on the matrix

All women with a scar on the mattress of a cesarean operation were guilty of being taken to the dispensary on the basis of a vipisk from the hospital. The main method of dispensary caution is to serve early diagnosisі development of rapid surgery (genetic fistula, tubo-ovarian education) and prevention of vaginosity during the first time of the operation. For an hour of lactation with the use of hormonal contraception, linestrenol (gestagen) does not show a negative effect on the newborn. When lactation ends, estrogenestagenic contraceptives are prescribed.

In a complex of calls from preparation before the onset of vaginosity, an important role in the assessment of the scar on the mat is important. Using informative methods to identify the cicatrix on the mat in an unavailable manner, hysterography, hysteroscopy and ultrasound diagnosis (USL) are used.

· Hysterography vibrates on the 7th or 8th day of the menstrual cycle (or not earlier than 6 months after the operation) in direct and general projection. For help given method it is possible to vivify the change of the inner surface of the operative scar on the mat. There are advancing signs of impermissibility of the operative scar: the change in the position of the uterus in the small pelvis (the value of the uterus beforehand), the jaggedness and thinning of the contours of the internal surface of the uterus in the area of ​​the anterior scar.

· Hysteroscopy to slow down on the 4th or 5th day of the menstrual cycle, if the endometrial functional ball starts to trade, and through the thin basal ball, tissue is visible. If the scar is incapacitated, invariably be drawn into the scar area. The faint color of the tissue of the scar, the visibility of the scars, indicate a change in the full tissue component, and the retraction - about the thinning of myometrium as a result of an incomplete regeneration. Forecast for the development of vaginosity and canopy through the natural births of the super-verbose. Invisible uterine scar, and the scar with the rearing of the meat tissue and serve as a sign of its anatomical and morphological characteristics. In cich women, vaginosity can be achieved in 1-2 times of operation.

· Prior to ultrasonic signs of incapability of the scar on the mat, to carry out an uneven contour along the posterior wall of a similar slit, the vitality of myometry, the reduction of the contours of the scar, is the number of hyperactive tissue inclusions (in total). In case of double ultrasound examination, pathological changes in the area of ​​the scar on the mat appear significantly higher, lower than in hysteroscopy (in 56 and 85% of cases, it is obvious). However, the founders of Doppler and trivial reconstructions, for the addition of which it is possible to assess hemodynamics in the scar (development of the vertebral hemorrhage), the informativeness of the ultrasonic assessment of the scar on the mat is signi fi cantly improved.

Otrimanie the results of preadopted methods of diagnostics will lead to a scar on the mother's posture of vaginosity to enter in the outpatient card and when changing nutrition about the possibility of planning onset vaginosti.

It is necessary to perform a differential diagnosis due to the secondary threat of a vaginal disturbance and the appearance of an unsuccessful scar on the matrix (Table 52-6). It is also necessary to carry out a differential diagnosis hosprim appendicitisі nirkova how much... Clarification of the diagnosis should be carried out in the minds of the stationary at the headquarters key symptoms, Danikh UZD, efektu vid therapy. If there is an unsuitable scar on the mother, the vagina is guilty of being transferred to the hospital until the birth. In general, every day to carry out a clinical assessment of the vagina, the fetus and the scar on the mat. Ultrasonic scanning is repeated. With an increase in clinical abnormal ultrasound symptoms of incapability of the scar on the matt, it is shown that it is promptly developed after life is shown from the side of the mother, directly from the term of vaginosity.

Table 52-6. Differential diagnosis contaminate the vaginal and incapacitated scar on the cesarean tissue in the lower uterine segment

Shown before the consultation of INSHIKH FAKHIVTSIV

Consultation of an anesthesiologist is indicated if there is a need for anesthesia for anesthesia of an operative development, for the sake of pain in the bed.

· Viability 32 tizniv. The head is overdone by the fetus. Stania has a scar on the matt of a cesarean rosin in 2002. Vodyanka vaginnykh. Stage I anemia.

· Viability 38 tizniv. The head is overdone by the fetus. Scar on the cesarean tissue in 2006 r Placental deficiency. ZRP stage I. The testimony of gestosis of the middle stage of severity is 8 points on the basis of arterial hypertension.

· Viability 37 tizniv. Scar on the matt of myomectomy and small cesarean rosin in 2000 r.

· Viability 36 tizniv. The pelvic floor of the fetus. A scar on the mattsi of a corporal caesarean rosin in 1999 r Anemia.

Improved gestation for the appearance of a scar on the mat

Excessive vaginosity in the presence of a scar on the matrix for a cesarean rosin maє row key features... In cich patients, it is often the case that the growth of the placenta is too low, that of the placenta, the wrong position of the fetus, and with the localization of the placenta in the area of ​​the scar on the mat, PN develops slowly.

One of the most frequent acceleration of the gestation process in women with a scar on the mat is the threat of vaginal disturbance. Symptoms of contamination in the first trimester of vaginosis do not seem to indicate an ethological connection with the appearance of a scar on the mat. Sberihag therapy is recognized for a period of time before the established diagnosis (lack of progesterone synthesis, hyperandrogenism, APS, etc.). You can use it in outpatient minds, however, when you are out-patient, a hospitalization is needed to clarify the diagnosis and correction of the therapy. In case of diagnosed cervical - cervical deficiencies, surgical correction of the pathology in this contingent of ailments is not imaged, there is some evidence of a scar on the matrix in the second place due to the risk of a deterioration of the vagina. Treatment of accelerated treatment includes spasmolytic therapy, with magnesium sulfate, post-treatment, and treatment of vaginal depression. Likuvannya of those accelerated vaginosti in women with an operated uterus, in principle, do not appear from the womb.

VEDENYA VAGITNIKH with a scar on the mat

In case of vaginosity (in the first trimester), carry out a medical check-up, and, if necessary, consultations of summery faculties. Obov'yazkovo priznachayut ultrasonic, the main meta yakogo in the form of attachment of the fruit egg in the mother. Also, there are those who have grown in the area of ​​the isthmus on the anterior stance of the uterus (in the area of ​​the cicatricial cavity in the lower uterine segment), to completely redo the vaginosity, as if the vacuum-aspirator is circulated from the vicistories. This tactic is tied to the fact that the proteolytic power of the chorus in the world of progressing vaginosity can lead to inconsistency to bring a possible scar on the mattress and thrive, and as a result of this vagineness, it will be repeated again. However, there is no absolute contraindication to the prolongation of the vaginosity in all cases, and the nutrition about the retardation of the vaginosity is the woman herself. The onset of screening of the condition, including ultrasound and the advancement of the hormonal status of the fetoplacental complex (FPK), should be carried out at the term of 20-22 diagnostics of the development of the fetus, the diagnosis of the development of the fetal in the area of ​​the scar. For the treatment of PN, the hospitalization in the hospital is shown. In case of an unrelenting excess of vaginosity and a possible scar on the mother of Chergov, it is complex to provide health care at the term of 37-38 hospitalization in hospitals, so that it is allowed to carry out the development of the vagina.

In the canopy, spasmolitic, sedative and antihypoxic drugs, lycarsis, sootin the uterine blood flow are obov'yazkovo stasis.

Rozrodzhennya VAGITNIKH Z scar on the mat

Growth of vaginal with a scar on the matt of cesarean rostin

In most obstetricians, the main postulate in case of vaginal canopies with a scar on the matt of a cesarean rosin is: one caesarean rostin is a caesar rostin. However, both in our country and beyond the cordon, it has been reported that 50-80% of the women with the oiled womb are not only able to, but grow the canopy through the natural births. Rizik with repeated caesariv rostin, especially for mothers, vishche, low risik with mimovil canopy.

Mimovilny canopy in vaginas with a scar on the matrix for cesarean rosin

Carrying out the canopy through natural births with the presence of a scar on the matt of a cesarean rosette is permissible for a number of minds.

· One cesar rostin in anamnesis with transverse growth on the mat in the lower segment.
· The number of extragenital illnesses and obstetric services, which served as demonstrations before the first operation.
· Ability of the scar on the mat (based on the results of clinical and instrumental dosages).
· Localization of the placenta, posture of the scar on the mat.
· Headache over the fetus.
· The difference in the size of the pelvis of the mother and head to the fetus.
· Evidence of minds for an extraordinary development of a caesarean roste (high-quality medical personnel, the possibility of a caesarean rosette in an extraordinary order, not in an extraordinary manner, not in 15 minutes after taking a decision).

The food about the method of development is guilty of the obov'yazkovo uzgodzheniya s vagіtnoyu. The obstetrician slid a report to explain all passages and risiks, such as repeated caesarean roste, as well as curtains through natural births. Residual decision is guilty of taking the woman herself at the sight of written information for one of the methods of development. At absolute times, the indication to the planned cesarean rosette perevagu will go down through the natural birth of the way, moreover, with a spontaneous ear.

The canopies with the presence of a scar on the matt, as a rule, follow the standard mechanism, characteristic of primitives or multiparous. Naybіlsh part uskladnennyami pologіv at zhіnok of scars on mattsі buvayut nesvoєchasne vilittya navkoloplіdnih water anomalії pologovoї dіyalnostі (SSMSC slіd rozglyadati yak zagrozu rozrivu uterus) klіnіchne nevіdpovіdnіst rozmіrіv pelvis materі i golіvki fetus (obumovlene bіlsh part, nіzh in populyatsії, roztashuvannyam golіvki fetus posterior viglyadі), showing a sign of a menacing uterus. In the process of the canopy, the necessary continuous cardio-monitoring control of the fetus's camp, s clinical assessment the nature of the flatness and the scar on the mat. The canopies should be carried out when the operating system is open, with the connected infusion system. In addition to the evaluation of the scar on the matt, in the process of small flats, it is possible to determine the ultrasonic inspection, for the additional assessment of the scar on the mat in the first period of the lower half of the scale, the lower half of the scale can be specified. (ultrasound reconstruction of the uterine osteoarthritis) vaginal dosages, It is very important in the plan of prophylaxis infectious diseases at the breed with a high efficiency of operational development.

Znebolyuvannya canopy in females with a scar on the mat should be carried out according to the accepted rules, including the stasis of epidural analgesia. The method of anesthesiological assistance from an hour to bed is due to the nature of extragenetic or obstetric pathology.

A scar on the matt of a cesarean rosette does not vvazhayut contraindications until the end of the hour for an hour in the midst of obstetric and anesthetics, such as labor arousal or birth stimulation. With a trivial II period of flattening, or if the hypoxia of the fetus is born, it is necessary to speed up the growth of the crotch. If you are in a state of hypoxia of a fetus and a head, you are at the university's part of the empty small basin, the canopy can be completed by the application of obstetric forceps or a vacuum extractor.

Obov'yazkovuyu vvazhayut manually obzhenenya of the uterus immediately after the canopy at the time of the day by ultrasound control.

Symptoms of uterine growth may appear after a significant hour after the flattening, then the ultrasound scan is repeated in 2 years after the flattening with the help of diagnostics of the swelling retrovesical hematomas, which show a lot of undiagnosed growth.

Shown up to cesarean rosin with the presence of a scar on the matt of cesarean rosin:

· Scar on the matts_ of a corporal cesarean rostinu.
· Become a scar on the matrix for clinical and ultrasonic signs.
· Placenta previa.
· Two or more scars on the matts for cesarean rosters.
· Categorically the view of women from the canopy through the natural births of the way.

Leaning in women with a scar on the mat

When using the method of birth in women with a scar on the matt, myom-ectomy is initially significant, the nature of the operation is considered. The incidence of unproblematic scars for myomectomy is 21.3%. The growth of the uterus on the scar of the myomectomy in the process of mimic canopy is deposited in the form of the growth of the puffin in the myometrium (interstitial, subserous-interstitial, sub-serous-interstitial, operative locus of the anterior submucosa) Shown before the operational release will be absolute and definite. Absolutely shown before the cesarean rosette, the myomectomy posture of vaginosity is guided below.

· Scar on the mattsі of the visualization of the interstitial abo subserous-interstitial university, rostasovany on the posterior stіntsі of the uterus.
· A scar on the matts_p_slya visible intraligamentary miomi.
· Scars on the mattse of the visualization of decilkokh interstitial subterranean universities of the great regions.

In case of vaginal canopy with a scar on the matt, after myomectomy, the posture of vaginosity and during the day is absolute, it is better to lead the canopy through natural childbirth. With the presence of a long obstetric history, postponed vaginosity, pelvic over-bedding of the fetus, PN, in the first place over 30 years, it is shown before the cesarean rosette for myomectomy to expand.

A scar on the matt of a myomectomy, virobble for an hour of vaginosity, is indicated for a cesarean roste.

Maintenance of flattening in women with a scar on the mat for reconstructive plastic surgeries
· Pislya metroplastic perevagu sliddavati cesarean rostinu with the method of prevention of maternal traumatism with mimic canopy.
· Pislya visible rudimentary horns of the uterus without rosette and the main empty cans through natural births.

Maintenance of curls in females with a scar on the mat for perforation of the uterus

The canopy of the perforation of the uterus before the hour of the internal wombs is foldable and forward-looking. Great significance is the ma roztashuvannya of the perforated opening in relation to the delivery to the uterus. It is predictively unpleasant to inflate a scar in the isthmus and on the posterior stance of the uterus. With such flattening of the uterus, hypotonic bleeding, pathology of the placenta, especially in females with an accelerated interruption of the operation itself and during the operative period.

The obstetric prognosis is more friendly in quiet areas, if the scar grows along the anterior stance of the uterus, and the operation of the bullet is surrounded only by the stitching of the perforated opening without the additional rosette of the uterus. During the daytime, the conditions of the emptying of the uterus can be slowed down through the natural births and the early control manual closure of the emptying of the uterus.

Leaning in women with a scar on the matt

Vibir to the method of growth, after the transferred ectopic vaginosity, to lay down for the sake of the transferred operation and the woman's health. Operational involvement with the drive of the uterine tube, vaginosity in the rudimentary rose of the uterus (as it is possible with the main empty one), the interstitial evidence of the uterine tube, the cult of the delivery of the tube is shown to serve early

FORECASTING І PROFILACTICS FACING GESTATION

In those with a scar on the mat, they use a group of risk factors for the development of onset obstetric and perinatal acceleration: mimic abortion, scarring of the uterus, early curvatures, PN, hypoxia and intrauterine fetal death, For the prevention of circulatory disorders, it is necessary to attend the dispensary for the vagina, to quickly reveal the acceleration and treatment in obstetric hospitals. Prevention accelerated is based on the widespread propaganda of pregravidarny preparation of women with a scar on the matt, which includes the onset of entry.

· Information about the rizik, dressing with the appearance of a scar on the mat.
- Rizik for the mother: cutting the uterus in the scar, bleeding, maternal lethality, gn_jno-septic acceleration; non-guilt of vaginosti.
- Rizik for fetus and newborn: prematurity, birth traumatism, neonatal acceleration of the risky step bend.
· Diagnostics and treatment of supportive gynecological and extragenital ailments before vaginosis.
· Assurance at the infection, which is transmitted by the state route (ІПССШ) and sanitation in the diagnostics of infections.

LIKUVANNYA USKLADNEN AT THE FLOORS І післаполого periodі

Naybіlsh gryzne accelerated before the hour of flattening - cutting the uterus along the scar. With the introduction of canopies through natural births, women with a scar on the mattress of hyperdiagnostics of the development of the uterus, no underestimation of such a serious acceleration. In the edge of the foldable vvazhayut assessment of the first symptoms, as soon as the uterus is cut along the scar. Diagnosis of uterine growth should be carried out using urahuvannya klinіchno picture: bіl in epіgastralіy dіlyantsі, nudota, bluing, tachycardia, local soreness, blood vision from statues of nobles, shock and іn. Signs of the depletion of the fetus, the weakening of the fast feeling of the uterus can be symptoms of repair, and not too early. Neo-estimated value for the hour of lowering the additional diagnostic methods (ultrasound, tokocardiography).

Razrіznyayut rezryvny і not rezryvny uterus (rasharuvannya, razpovannya scar), if the worm becomes intact. Tactics for the development of the uterus of the polyaga in an extra-cesarean rosette. An obligation to promptly lay down due to the widening of injuries: when the uterus is cut in the area of ​​the scar, the scar is sutured to the fetus, and the uterus is sutured, and when the uterus is cut, it is slowed down by the illumination of the intraluminal hematoma With the onset of vaginosity, it is shown operatively.

Shown to caesarean growth for an hour when it is flattened, with a negative dynamism of the fetus, key signs threatening growth of the uterus, the minds for the perfect mimic completion of the canopy.

PROFILACTICS I RISE THE UTERUS ON SCARS

Prevention of the development of the uterus along the cicatrix of the clearing during the offensive visits.
The creation of optimal minds for the formation of a possible scar on the matt with the first cesarean rosette (in the case of Derfler matt) and the first operations on the matrix: the stitching of the rosette on the matt, with the use of synthetic rosette stitches with monkey stitches і ін.).
· Prediction, prophylaxis, prompt diagnostics and adequate therapy for operational acceleration.
· On'є
· Screening of coverage for hours of vaginosti.
· Retractable windbags for the introduction of canopies through natural births.
· Loop cardiotokographic and ultrasonic control in the process of mimic pologiv.
· Adequate sensation in the process of mimic curtains.
· Svochasna diagnostics of a threatening і / abo rosaceous growth of the uterus.

Keloid cicatrix (ICD 10) - tse Shramov's education, how to form on a dilentzied shkirny cover. After all, it is necessary to get rid of it; A keloid scar can also be used to indicate a shvidka zagonnya zruynovanyh shkіrnyh fabrics.

Keloid scar according to the ICD code 10 is classified as a physiological phenomenon. This is the result of the renewal of fabrics, deformed by the piece method. Most often, they heal with scars and become uncomfortable, more often they become more vivid in their character and vigilance.

Keloid is a schilny narist, which is a call you can nagaduvati pukhlinu, as a result of the offensive features:

• The scar is located behind the borders of the pocketed dilyanka. Grow horizontally.
• Keloid - tse cicatricial scar, which is characterized by welcome the pains, Sverblyachkoyu. Yaskraviy butt - seeks to tighten the shkiri.
• As soon as one becomes practically invisible, then the colossal one does not change color, size. Tse vidbuvaєtsya through those who grow blood-bearing judges in the middle.

Causes and symptoms of education

Before the formation of sore scars, create minor defects in the skin. Among the main reasons are:

• Self-management of the wound. It’s wrong to deform the land and ailments. Qiu pardon can be allowed і lykar.
• Keloid is a legacy of infectious infection. Disinfection and stagnation of all kinds of injuries is the basis for the mind of a safe wound treatment.
• Yak pidtverzhu code according to ICD 10, it is accepted when a heavy pull is applied to the shkiri for an hour of sewing. tse dog zovnishniy viglyad a sprinkling of and in the old age is a factor of ruinous action.
• Medical care is the result of hormonal imbalance. Among the reasons for this number are immunodeficiency.

International Classification of Sickness in the Rise of Spadkov Slenderness. There is a great number of scars in relatives, you can talk about the high imaging rate of keloid scars.

may you expedite

International classifier not fiksuk keloidi yak not safe, Warehouses і create a threat to severe acceleration. Tse will not become the cause of the maybutny puffiness, malicious adoption, yake become a rizik for life.

There are two reasons for the visualization and change of scars:

• Aesthetic. Viglyada is negligently on vidkritiy dilyantsi shkiri. The scar can not be masked for a tan, and when blood-bearing vines grow, it can be seen on the skin.
• Practical. Cicatrix, roztasovani on zgini slopes, shackle the ruffs. When wearing a tight tight clothing, there is discomfort and excessive weariness.

prophylaxis appear

I will appear before the keloid for the help of such diy:

• Bandages. Special bandages, which create a strong grip, localize in a widening range. However, it is not a skin wound that admits such solutions.
• The balance is out of balance. Beginning at once before the lykar can help disinfect the wound and rozrobiti individual program for renewal. Zastosuvannya otstu and іnshih aggressive zasobіv veda to vicious effects.
• Safety. Vidavlyuvati gn_ynik or masazhuvati scar through the withers is not possible. Tse talk about the ignition process, so it turns to fachivtsya.
• Cold calm. Lazne, saunas i high temperature contraindications for patients from Keloid.

In a large deformation of scars - the price of inheritance of injury. When you otrimanny sadna abo mechanic pozhkodzhennya shkіri smut - immediately turn up to the lykar, not navantazhuvati deformed fabrics and do not engage in self-care.

RCHRH (Republican Center for Development of Health Protection of the Ministry of Health of the Republic of Kazakhstan)
Version: Clinical protocols of the Ministry of Health of the Republic of Kazakhstan - 2014

Ailment of pediatric and pediatric cells, associated with viprominuvans, unspecified (L59.9), Keloid scar (L91.0), Decreased surgical and therapeutic involvement of unspecified (T88.9), Vidkrita wound head of unspecified localization (S01.9), Incritical wound іn small і unspecified part of abdomen (S31.8), Incritical injury іnіspecified and unspecified part of shoulder girdle (S41.8), Incritical wound (s) іnospecified and unrecognized part of abdomen an open wound with an unspecified part of the breast (S21.9), an open wound of an unspecified part of the front (S51.9), an open wound of an unspecified part of the breast (S11.9), an incision of the hairy part of the head (S08.0) (T92.8), Sees of the last refined head injuries (T90.8), Sees of the second refined injuries of the lower brain (T93.8), Sees of the last refined injuries of the minor and tulips (T91.8), not classified in other headings (T98.3), Traces of thermal and chemical descriptions and ice cream (T95), Scars and fibrosis of shkiri (L90.5), Phlegmon tuluba (L03.3), Chronic diseases (L98.4), Virazka of the lower picture, not classified in the first r overalls (L97)

Combustiology

General information

Short description

recommended
Expert Council of the Republican State Enterprise on the REM "Republican Center for Development of Protect Health"
Ministry of Health Protection and Social Development of the Republic of Kazakhstan
vid "12" breast 2014 rock protocol No. 9

Tastes of thermal testimonials from ice cream and wines- the whole complex of symptoms, anatomical and morphological changes in the exercises of the tila and navkolishnіkh fabrics, they encircle the quality of life and the functional deterioration.
The main traces of overwhelming growth are stanin cicatrix, which is a trivial hour not to get sick, wounds, contractures and trophies.

scar- the whole tissue structure, which is in the microscopic state of the body with traumatic factors for the improvement of the homeostasis of the organism.

cicatricial deformities- a camp with intermixed cicatrices, cicatricial masses, which can be localized on the head, tulips, shia, kintsivkah without intercourse ruffs, which can lead to natural and physical imperfections and intercourse.

contracture- the chain of interconnection of the rolls of the loam, the wickedness of the navkolishn_kh fabrics, as a result of the inflow of new physical factors, when it’s not possible to get more decalcified or deconstructed in one butt

wound- a lot of fabrication of tissues and organs, which supervise the deterioration of the integrity of the school and the weakness of the fabric.

Trivialo non-destructive wound- a wound, not to be afraid of stretching out the period, which is normal for wounds of a similar type or localization. In practice, for a trivial hour, early (chronic), a wound was taken over, more than 4 times without signs of active burnout (vignatas to become great early defects with signs of active reparation).

Trophic ulcer- a defect in curved tissues with little tendency to burnout, from weakness to relapse, as a result of deteriorated reactivity in many cases, or internal inflows, as for its own adaptive intensity during the period of time With a trophic virazkoy, the wound does not get stuck in more than 6 years.

I. Introductory part

Name of the protocol: Tastes of thermal and chemical opikiv, ice cream, wounds.
Protocol code:

Code (s) ICD-10:
T90.8 Sequins of other specified head injuries
T91.8 Tastes of the other specified injuries of the spine and tulub
T92.8
T93.8 Tastes of the last specified injuries of the lower child
Т 95 Tastes of thermal and chemical opikiv and ice cream
T95.0 Tastes of thermal and chemical opic and frozen head and head
T95.1 Tastes of thermal and chemical opic and iced tulub
T95.2 Tastes of thermal and chemical opic and ice-cream of the upper wine
T95.3 Tastes of thermal and chemical opic and ice-cream of lower flavors
T95.4 Traces of thermal and chemical descriptions, classified only, as long as the area of ​​the damaged file
T95.8 Secrets of the latest updated term and chemical definitions and ice cream
T95.9 Traces of unspecified thermal and chemical specifications and ice cream
L03.3 Phlegmon tuluba
L91.0 Keloid scar
L59.9 The sickle of the schoolchildren and the nursery clit is tied to the viprominium
L57.9 Zmіna shkіri, viklikana chronic infusion of non-ionizing vypromіnuvannya, not specified
L59.9 Ailment of a shkiri and a pedigree klitkovini, mated with viprominuvans, not specified
L90.5 Scars and fibrosis
L97 Circumference of the lower picture, not classified in the other headings
L98.4 Chronic skirting, not classified in these headings
S 01.9 Oncrit the head wound is not specified
S 08.0 Bearing the hairy part of the head
S 11.9 Onset
S 21.9 Oncritic wound of the breast not specified
S 31.8 Incritical wound or not specified part of the abdomen
S 41.8 Incritical wound іn іn’t specified part of the shoulder girdle і shoulder
S 51.9 Oncrit the wound is not specified before the start
S 71.8 Incritical wound іn large і not specified part of the pelvic girdle
T88.9 The arrangement of surgical and therapeutic involvement has not been updated.
T98.3 Tastes of accelerated surgical and therapeutic involvement, not classified in these headings.

Fast, as vikoristovyu in the protocol:
ALT - Alaninaminotransferase
AST - Aspartate aminotransferase
VIL - virus to human immunodeficiency
IPA - enzyme immunoassay
Refinery - non-steroidal prototypes
UAC - zagalny analiz blood
OAM - the out-of-the-box analysis of the sech
UZD - ultrasound doslіgennya
UHF therapy - ultra high frequency therapy
EKG - electrocardiogram
EXHOX - transthoracic cardioscope

Date of release to the protocol: 2014.

to the protocol: Combustiologists, traumatologists-orthopedists, surgeons.

Classification

CLINIC CLASSIFICATION

scar to classify for the offensive criteria:
For walks:

Pislya opikov;

Post-traumatic.

For the nature of growth:

atrophic;

Normotrophic;

hypertrophic;

Keloidnі.

wound dividing in a fallow way, glibinia and a lot of wounds.
tipi wounds:

mechanical;

traumatic;

thermal;

Chemistry.

There are three main types of wounds:

operations;

vipadkovі;

In the fires.

Vipadkovi and in the fires of wounds in the depletion of the object and the mechanism of the ear can be divided into:

pricks;

rizan;

rubans;

hammered;

rosters;

torn;

bitten;

in the fire;

otruni;

combined;

Penetrating and does not penetrate into empty organisms. [7]

contractures clasified in fallowness in the form of fabrics, as well as wickedness. Contractures are clasifed behind the step of enclosing rukhiv in an ear-hooded slope.
The most frequent diagnoses are scars and contractures (dermatogenic). Behind the turn of the turn, the contracture is indicated on the steps:

Stage I (light contracture) - interfering growth, degradation, introduction from 1 to 30 degrees;

Stage II (outside the contracture) - intermingling from 31 degrees to 60 degrees;

Stage III (growth or contracture is important) - enclosing the collapse of transport means more than 60 degrees.

Classification of trophic virazoks by ethology:

post-traumatic;

ischemic;

neurotrophic;

lymphatic;

sudinna;

infectious diseases;

Puhlinna.

For the glybin trophies, they develop:

I step - superficial bend (erosion) in the dermis;

II step - the path, which is the reach of the pediatric cell;

III step - a spiral, penetrating to the fascia of any subfascial structures (mucosa, tendon, ligament, knuckle), into the empty bag of the bag or the slope.

Classification of trophic paths by area:

Small, up to 5 cm2;

Middle - from 5 to 20 cm2;

Great (giant) - 50 cm2.

diagnostics

II. METHODS, APPROACHES AND PROCEDURES OF DIAGNOSTICS AND LIKUVANNIA

Switching the main and additional diagnostic entries

The main (obov'yazkovy) diagnostics of the condition, which is carried out on an outpatient basis:

Dodatkovi diagnostics of the situation, which is carried out on an outpatient basis:

Coagulogram (viznachennya hour of throat, triviality of bleeding).

The minimal change of the situation, which must be carried out when directed to the planned hospitalization:

Coagulogram of blood (viznachennya hour of the throat, triviality of bleeding);

The value of a group of blood

Rh factor value;

Bacterial seeding from wounds (after shown).

Radiography behind the show (urazhenoi dilyanka);

The main (obov'yazkov_) diagnostics of the situation, which is carried out at a stationary: For testimonials, for a control analysis:

Additional diagnostics of the situation, which are carried out at the stationary hospital:

Biochemical blood analysis (glucose bilirubin zagalny, alaninaminotransferase, aspartate aminotransferase, sechovina, creatinine, bilok zagalny);

Bacterial sowing from wounds after shown;

Diagnostics come in, which will be carried out at the stage of shvidkoy inconvenient help: Not carried out.

diagnostic criteria

skargi: On the manifestation of post-traumatic scars of an opiate character with functional damage, pain syndrome or to bring aesthetic non-handiness. On the appearance of wounds good time, Їх soreness;

anamnesis: Evidence in the anamnesis of traumas, frostbite or opikiv, as well as fellow sickness pathological changes in the tissues were wicked.

Physical details:
In the presence of wounds describe their walking (post-traumatic, traumatic), the duration of the wound, the nature of the edges (tears, torns, rosters, callous), their length and size, tissue, the bottom of the wound, the ruggedness of the edges

In the presence of granulation describe:

character;

Evidence and character of vision.

When registering contractures try your way:

Pislya opikov;

Post-traumatic.

Localization, steps and nature of changes in small curvatures (description of scars in case of appearance, size, thickness, character of growth - normotrophic - without weariness over certain tissues, hypertrophic - characteristic of skin growths) [eight]

When describing scars try їх:

localization;

walking;

wideness;

Character, ruggedness;

Evidence of an ignition reaction;

Dilyanok Virazok.

Laboratory Doslidzhennya:
UAC(When zagoyuyutsya, trophic bends, especially giant ones): in addition to the decrease in hemoglobin, adduction of SHOE, eosinophilia,
coagulogram: Zbіlshennya іvnya fibrinogen up to 6 g / l.
Biochemical analysis of blood: Hypoproteinemia.

Shown for consultations of university faculties:

Consultation of a neurosurgeon or a neuropathologist in case of the presence of a neurological deficiency, a major abnormal disability due to progress.

Consultation of a surgeon in the presence of an acute acute pathology.

Consultation of angiohirurg in case of concomitant problems with sudin.

Consultation of a urologist in the presence of a supportive urological pathology.

Consultation of a therapist in case of manifestation of supportive somatic pathology.

Consultation of an endocrinologist in case of the presence of supportive endocrinological illnesses.

Consultation of an oncologist with the help of oncological illnesses.

Consultation of a phthisiatrician on the basis of the prevention of tuberculous etiology.

Differential diagnosis

Differential diagnosis of contractures

Table 1 Differential diagnosis of contractures

Table 2 Differential diagnosis of wounds and pathological changes in tissues

Likuvannya beyond the cordon

Take a lykuvannya in Korea, Izrail, Nimechchin, USA

Otrimati the consultation on medturism

lykuvannya

Cіlі lіkuvannya:

Zbilshennya obsyagu rukhiv in poshkojenih slopes;

Usunennya aesthetic defect;

Updating the integrity of the school curves.

tactics of addiction

non-drug treatment
Diet - 15 styles
Gagalny mode, in during the operational period- postіlny.

Drug treatment

Table 1. Likarsky zasobi, how to stagnate with the addiction of the inheritance of opikiv, ice cream, and wounds developmental ethology (For the blame of the anesthetic suprovod)

Pisle of cicatrices and contractures

Medicines for wounds, trophic wounds, for great wounds and wound defects

Drug treatment, which can be repaired on an outpatient basis:
With pisleopic scars and contractures... Onion extract, wild heparin, sodium heparin, alantoin, gel

With trophic paths
Antibiotics: Strictly according to the indications, before the control of bacterial inoculation from the wound.

disagreganti

Pentoxifilin - rozchin for ін'єкцій 2% - 5 ml, tablets of 100 mg.

Drug treatment, which is repaired on a stationary basis:

Cicatricial contractures and deformities
antibiotics:

Cefuroxime

Cefazolin, powder for preparation of rosin 1000 mg

Amoxicilin / clavulanate

Ampicilin / sulbactam, powder for the preparation of rosters for ін'єкцій 1.5 g - 3 g

Ciprofloxacin, infusion solution 200 mg / 100 ml

Ofloxacin, infusion solution 200 mg / 100 ml

Gentamicin, rozchin for ін'кцій 80 mg / 2 ml

Amikacin, powder for preparing a rosette for ін'єкцій 0.5 g

Pereolikh predatkovyh lykarskiy zasobіv(Less than 100% satisfaction rate).
Non-steroidal anti-burners:

Ketoprofen - rozchin for ін'єкцій in ampoules of 100 mg.

Diclofenac-roschin for intramuscular injection, intravenous injection 25mg / ml

Ketorolac-roschin for intravenous, intramuscular administration 30mg / ml

Metamizole sodium 50% - 2.0 / m

low molecular weight heparin

Nadroparin calcium form vipusku in syringes 0.3 ml, 0.4 ml, 0.6

Enoksaparin-rozchin for ін'єкцій in syringes 0.2 ml, 0.4 ml, 0.6 ml

solution for infusion therapy

Sodium chloride - isotonic solution to sodium chloride 400 ml.

Dextrose - glucose 5% roschin 400ml.

disagreganti

Pentoxifyline - solution for ін'єкцій 2% - 5 ml.

Acetylsalicylic acid tablets 100mg

Medication for treatment, which is to be repaired at the stage of unprecedented assistance: not carried out, hospitalization is planned.

Інші vidi lіkuvannya:

Compress therapy;

Balneological lіkuvannya (sirkovodnevі aplіkatsії, rodonіvі);

mechanotherapy;

ozone therapy;

magnetotherapy;

Applying immobilization devices (splints, soft bandages, gypsum splints, circular bandages, brace, orthosis) in the early term of the operation.

Інші vidi lіkuvannya, scho hope for outpatient іvnі:

magnetotherapy;

Compress therapy;

Balneological treatment;

Mechanotherapy.

I see you hoping for a stationary level:

Hyperbaric oxygenation.

Інshі vidіlіkuvannya, scho rely on the stage of a great non-practical additional help: not to be carried out, the hospitalization is planned.

Hirurgicne involvement:
When there is a positive dynamics of the main prompt engagement for how to add them to them, transplantation of cultivated allogenic or out of logical cells of shkiri as well as biodegradable dressings itself is possible [2]

Hirurgic involvement, like being repaired in outpatient minds: not carried out.

Hirurgical involvement, which is to be repaired in stationary minds

With pislyaopic, post-traumatic scars and contractures:

Plastics with muscular fabrics; with the presence of line scars, contractures with formed "sail-like cicatricial strands", with the presence of intermeshing skin defects.

Plastic valve on the nipple; With the presence of scars, tissue defects in the area of ​​great slopes, with bare tendons, cyst structures on the prosthesis, with defects in the tissues of the hands and on the supporting surfaces of the feet, with the addition of reconstruction of defects in the area of ​​the head, shia, tulub, pelvis.

Valve plastic with valves on the leg anastomoses; With the presence of scars, tissue defects in the area of ​​great slopes, with bare cyst structures on the arms, with defects in the tissues of the hands and on the supporting surfaces of the feet, with the reconstruction of defects in the head, tulub, and pelvic areas.

Valve plasty for axial blood circulation; In the presence of defects in the tissue, in the open slopes, cyst structures, defects in the supporting surfaces (hands, feet).

Combined plastic shkirna; With the presence of scars or tissue defects in the area of ​​great slopes, with bare tendons, cyst structures on the prosthesis, with defects in the tissues of the hands and on the supporting surfaces of the feet, with the addition of reconstruction of defects in the area of ​​the head, shoulder, tulub, pelvis.

Plastic surgery with natural valves (for additional fixation of endoexpanders); With the presence of great cicatricial lesions of shkirny curvatures.

The stagnation of apartments of the name of the fixture; With the presence of fractures of the cysts, arthrogenic contractures, correction of the cyst or the formation of cyst structures.

Transplantation or displacement of muscle and tendon; In the presence of defects in a broach, or a tendon.

Endoprosthetics for other slopes. With the ruining of the loam components and without the success of the other methods of treatment.

Yakі do not go out of wiggles and scars:

Vila autodermoplasty; when there are some great defects in school.

Surgical treatment of granulating wounds: in the presence of pathological changes in tissue

Allotransplantation of shkiri; with the manifestation of great defects in small curves, great curves of various origins.

Xenotransplantation in case of the presence of intercourse or great defects of the school, with the help of preoperative training.

Transplantation of cultivated cells of shkiri in the presence of great defects in shkirny curves, great strains of various origins.

Combination of transplantation and stagnation of factors in growth in the presence of great defects in small curves, great curves of various origins.

Plastic surgery with tissue: in case of the presence of interfering defects in shkirny curves.

Valve plasty on the veins: In the presence of scars or tissue defects in the area of ​​great slopes, with bare tendons, cyst structures on the prosthesis, with defects in the tissues of the hands and on the supporting surfaces of the feet, along with reconstruction of the head, defects in the area ...

Prophylactic come in:

Sanitation of surplus wounds and scars;

Reduction of scar area;

The duration of ignition processes in early;

For wounds and trophic bends:

Burning a wound defect;

Updating the integrity of the skirting cover

preparations ( diyuchі speeches)

A group of drugs in the absence of ATC, which can become stagnant during drug use

hospitalization

Shown for hospitalization from the designated type of hospitalization.

Extraction of hospitalization: Nemaє.

planned hospitalization: We have suffered ailments and suffered from ice-cream, thermal conditions of winter walking with trivial wounds or trophic cuts, cicatrices, contractures.

information

Dzherela and Literature

1. Protocols to send the Expert for the sake of the RCHR MHSD RK, 2014
   1. 1.Yudenich V.V., Grishkevich V.M. 2.S. Kh. Kichemasov, Yu. R. Skvortsov Shkirna of plastic surgery with valves for axial blood loss in cases of detection and frostbite. St. Petersburg 2012r. 3.G. Chaby, P. Senet, M. Veneau, P. Martel, J.C. Guillaume, C. Meaume, i. Dressings for the treatment of gostrich and chronic wounds. A systematic look. Archiv Dermatology, 143 (2007), pp. 1297-1304 4.D.A. Hudson, A. Renshaw. An algorithm for the release of burn contractures of the extremities / Burns, 32. (2006), pp. 663-668 5.N.M. Ertaş, H. Borman, M. Deniz, M. Haberal. Double opposing rectangular advancement elongates tension line as much as Z-plasty: an experimental study in the rat inguinal. Burns, 34 (2008), pp. 114-118 6 T. Lin, S. Lee, C. Lai, S. Lin. Treatment of axillary burn scar contractures using opposite running Y-V plasty. Burns, 31 (2005), pp. 894-900 7 Suk Joon Oh, Yoojeong Kim. Combined AlloDerm® and thin skin grafting for the treatment of postburn dyspigmented scar contracture of the upper extremity. Journal of Plastic, Reconstructive & Aesthetic Surgery. Volume 64, Issue 2, February 2011, Pages 229-233. 8 Michel H.E. Hermans. Preservation methods of allografts and their (lack of) influence on clinical results in partial thickness burns // Burns, Volume 37. - 2011, P. - 873-881. 9 J. Leon-Villapalos, M. Eldardiri, P. Dziewulski. The use of human deceased donor skin allograft in burn care // Cell Tissue Bank, 11 (1). - 2010 P. - 99-104. 10 Michel H.E. Hermans, M.D. Porcine xenografts vs. (Cryopreserved) allografts in the management of partial thickness burns: Is there a clinical difference? Burns Volume 40, Issue 3, May 2014 to rock, pp. 408-415. 11 Aleksov A.A., Tyurnikov Yu.I. Stagnation of the biological dressing "xenoderma" in the treatment of opic wounds. // Combustiology. - 2007. - No. 32 - 33. - http://www.burn.ru/ 12 Ryu Yoshida, Patrick Vavken, Martha M. Murray. Decellularization of bovine anterior cruciate ligament tissues minimizes immunogenic reactions to alpha-gal epitopes by human peripheral blood mononuclear cells. // The Knee, Volume 19, Issue 5, October 2012 pp. 672-675. 13 Celine Auxenfansb, 1, Veronique Menetb, 1, Zulma Catherinea, Hristo Shipkov. Cultured autologous keratinocytes in the treatment of large and deep burns: A retrospective study over 15 years. Burns, Available online 2 July 2014 14 J.R. Hanft, M.S. Surprenant. Healing of chronic foot ulcers in diabetic patients treated with a human fibroblast derived dermis. J Foot Ankle Surg, 41 (2002), p. 291.15 Steven T Boyce, Principles and practices for treatment of cutaneous wounds with cultured skin substitutes. The American Journal of Surgery. Volume 183, Issue 4, April 2002 Pages 445-456. 16 Mitryashov K.V., Terekhov S.M., Remizova L.G., Usov V.V., Obideynikova T.N. Evaluations of the effectiveness of the preservation of the epidermal factor in the growth of shkiri in the treatment of opic wounds in the minds of the “vologic middle”. Electronic journal - Combustiology. 2011, no. 45.

information

III. Organizational aspects of the PROTOCOL

List of list of documents in the protocol based on the qualifications of the qualifications:
1. Abugaliev Kabilbek Rizabekovich - AT "National Science Center of Oncology and Transplantology", head specialist revision of reconstructive plastic surgery and combustiology, candidate of medical sciences, head post-graduate specialist in combustiology of the Ministry of Health and Social Development of the Republic of Kazakhstan
2. Mokrenko Vasil Mykolajovich - PrEP on REM " Regional Center traumatology and orthopedics іmenі Professori H.Zh. Makazhanov "Department of health protection of the Karaganda region
3. Khudaybergenova Mahira Seydualievna - AT "National Science Center of Oncology and Transplantology"

Ordering for the presence of a conflict of interest: dumb.

reviewer:
Sultanaliev Tokan Anarbekovich - Radnik - Head Surgeon of AT "National Science Center of Oncology and Transplantology", Doctor of Medical Sciences, Professor

Letting the minds look at the protocol: Revision of the protocol in 3 ways і / abo, when new methods of diagnostics / treatment appear with a higher level of proof.

Attached files

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The formation of cicatricial tissue is a physiological reference to the formation of small curves and mucous membranes. However, the change in the metabolism of the postclinic matrix (imbalance between its ruinous and synthesis) can lead to overworld cicatrization and establishment of keloid and hypertrophic scars.

Healing of wounds and, also, the establishment of scar tissue includes three stages: ignition (in the first 48-72 years of production of tissue), proliferation (up to 6 types) and remodeling or aging (for more than 1 time). Triva, or the ignition phase is twisted superficially, it can be treated with a weld scar. It is obvious from the results of the present day, in people with genetic cravings, first group of blood, IV-V-VI phototype of cicatricial diagnosis of cicatrices in the possibility of developing according to other factors: hyperimmune globulin, etc. ).

The key role in the formulated keloid scars is the treatment of abnormal fibroblasts and the transforming growth factor - β1. In addition, in the tissues of keloid scars, there is an increase in the number of curative clitins, which are associated with the development of such promoters in fibrosis, such as induction of hypoxia factor-1α, vascular endothelial growth factor.

In the development of hypertrophic scars, the main role is in the destruction of the metabolism of the postcritical matrix to the newly synthesized secondary tissue: hyperproduction and destruction of the processes of remodeling of the microcrystalline matrix due to the disease In addition, the systemic hemostasis is damaged during the overspray neovascularization and the extra hour of re-epithelialization.

Official indicators of sickness and widening of keloid and hypertrophic scars on the day. As a result of the present day, the establishment of scars is spontaneous in 1.5-4.5% of individuals in the overseas population. Keloid scars appear in the rural world in choloviks and women, often in individuals young vik... If there is a decline in vitality to the development of keloid scars: genetic pre-development is shown to be autosomal dominant in favor of incomplete penetrance.

Classification of shkiri scars:

The natively accepted classification is not ісnu.

Clinical picture (symptoms) of scars:

razr_znyayut such key forms scars:

• normotrophic scar;
• atrophic scar;
• hypertrophic scars:
• line hypertrophic cicatrix;
• the hypertrophic cicatrix is ​​widely widened;
• small keloid scars;
• great keloid scars.

It also sees stable (mature) and unstable (immature) cicatrices.

Keloid cicatrices є neatly enlightened schilny vuzli or plaques, from the erysipelas to the lilac color, with a smooth surface and irregular unclear cordons. On the form of hypertrophic scars, the stench is often superficial with pain and hyperesthesia. Covering the scar is a thin epidermis, it is not easy to curl up in curves, often hyperpigmentation is caused.

Keloid scars are set not earlier than after 3 months of writing fabric, but then it can grow in size for an unassigned trivial hour. In the world of growth, the type of pseudo-swelling and deformation of the pseudo-swelling of the stink go beyond the primary wounds, spontaneously DO NOT regress and may tend to relapse into excision.

Osvita keloidnyh scars, including spontaneously, spontaneously occur in the singular anatomical areas (lobes of the vuh, chest, shoulders, upper back, back surface of the shoulder, cheeks, colina).

Hypertrophic cicatrices є vuzli of dome-like form of young growths (from others to even great ones), with a smooth or humpbacked surface. Fresh cicatrices may be a red-headed barnacle, nadal vona is old horny, whitish. On the edges of the scar, hyperpigmentation is possible. Osvita scars seen by stretching the first month of printing fabrics, increasing in size - extending the next 6 months; often with a stretch of 1 fate, the scar will regress. Hypertrophic cicatrices surrounded by cordons of the primary wound, as a rule, retain their shape. In the field of urazhennya you will be localized on the protruding surfaces of the slopes, or in areas that are subdued to the mechanical ones.

Diagnostics of scars of shkiri:

Diagnosis of illness is established at the presentation of clinical picture, the results of dermatoscopic and histological diagnosis (if necessary).
When carrying out combined therapy, it is recommended to consult a therapist, plastic surgeon, traumatologist, radiologist.

Differential diagnosis

Likuvannya of scars of shkiri:

tsіlі lіkuvannya

• stabilization of the pathological process;
• accessibility and preparation of remission;
• Advancing the life of the ailments:
• kupiruvannya sub'active symptoms;
• correction of functional deficiencies;
• dosyagnennya bazhany cosmetic result.

Respect for therapy

Hypertrophic and keloid scars є good wounded children. The need for therapy to begin with a variety of sub-active symptoms (for example, pain / pain), functional deficiencies (for example, contracture / mechanical development through the mouth), as well as natural indicators

Due to the available methods of cicatricial therapy in the presence of monotherapy in Denmark, it is not possible for all types of scars to reduce scar reduction but to improve the functional status and / or cosmetic situation. Practically, all clinical situations require additional different methods of treatment.

drug therapy

Intrafocal injection of glucocorticosteroids

• triamcinolone acetonide 1 mg per 1 cm 2 intralesionally (30 calibers per 0.5 inch). There is a large number of indivdual and in the form of an incidence of therapeutic indications and possible side effects. Intrafocal administration of triamcinolone acetone in the event of surgical visual scarring, recurrence.
• betamethasone dipropionate (2 mg) + betametosone disodium phosphate (5 mg): 0.2 ml per 1 cm 2 of the intralesional system. Oseredook іvnomіrno obkolyut, vikoristovuyu tuberculin syringe and a head of 25 calibres.

Non-drug therapy

criohirurgia

criohirurgia rare nitrogen to produce up to a new or partial reduction of 60-75% of keloid scars of a pislya, shonaimenshe, three sessions (B). the main side effects kriokhirurgii є hypopigmentation, confirmation of puffiness and hopelessness.

The addition of hydrochloric acid and intravenous glucocorticosteroids, has a low synergistic effect for the development of a larger dose of the drug as a result of the reduction in the volume of low-operative tissue scarring.

Scar cleaning can be performed by the method of open cut-off or by the contact method from the tip of the cryoprobe. The triviality of the exposure - not less than 30 seconds; the frequency of consumption is 1 time in 3-4 days, the number of procedures is individual, but not less than 3.

• Carbon dioxide laser.

Scar treatment with CO 2 laser can be carried out in total abo fractional modes. For total ablation of keloid scars with a CO2 laser in monotherapy, relapse is promoted in 90% of cases, and this type of treatment cannot be recommended by vigil monotherapy. Victory of fractional modes of laser injection allows to reduce the number of relapses.

• Pulsed barvnik laser.

The pulsating barbary laser (PDL) generates 585 nm hemoglobin absorption in blood vessels. In addition, direct vessel injection of PDL reduces the induction of transforming factor-β1 (TGF-β1) and the hyperexpression of matrix metaloproteinases (MMP) in the tissues of the keloid.

In a large number of PDL vapors, the positive inflow to the scar tissue in the vigor growth, the decrease in the intensity of the urine and the stagnation.

Surgical correction of cicatricial changes superficially occurs with a relapse in 50-100% of cases, behind a vignette of keloid lobes in the shells, Iakі relapse signicantly earlier. This situation is tied to the peculiarities of the operative technique, the vibration method of closing the operative defect, and different variants of plastics with tissue tissue.

Promeneva therapy

To become stagnant in the quality of monotherapy, or to add to the surgical visibility. Surgical correction lasting 24 years after exchange therapy is the most effective approach for treating keloid scars, as well as significantly reducing the number of relapses. It is recommended to consume albeit high doses of exchange therapy during a short hour of exposure.

Before side reactions.Ionizing vyprominuvannya vіyku vіyku erythema, peeling school, teleangiectasia, hypopigmentation and risk of carcinogenesis.

Vimogi to the results

According to the method of therapy, positive clinical dynamics (reduction in scar volume by 30-50%, reduction in the incidence of sub-active symptoms) can be reached after 3-6 procedures or after 3-6 months of treatment.

If there are good results after 3-6 procedures / 3-6 months, it is necessary to modify the therapy (combination with the other methods / change the method / increase the dose).

Prevention of the establishment of scars in shkiri:

Individuals who have a history of hypertrophic abnormal scars, or those who need surgery in the area of ​​increased risk of development, are recommended to:

• For wounds with a high rizik the development of scars, it is necessary to choose products based on silikon. Silikonovy gel or the plate should be applied in order to develop and process the wound for 1 month. For silikon gel, it is recommended that the minimum is 12-year-old vikorystannya or, as much as possible, without interruption 24-year-old vikorystannya with hygienic processing two per day. We can reduce the size of a silikon gel, with a large area of ​​battle, with a victorious on them in the area of ​​exposure, for individuals who live in a hot and vologous climate.
• For patients from the middle step, the development of scars can be carried out using silikon gel or plates (importantly), hypoallergenic microporous lines.
• Patients with low risk of developing scars should be recommended to follow standard hygiene procedures. As a patient, there is a problem in the connection with the possibility of forming a scar, it is possible to use a silikon gel.

A pre-arranged prophylactic visit є the inclusion of sleepy exchanges and the establishment of sleepy creams with the maximum efficiency to recover from sleep (SPF> 50) until the ripening of the scar.

As a rule, the tactics of maintaining patients with scars can be looked at after 4-8 days of treatment with the purpose of determining the need for additional scars.

YAKSCHO YOU HAVE VINIKLI SUPPLIED for this ailment, THEN CALL WITH LIKARIV dermatovenerologists Adaev Kh.M .:

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