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• Introduction
• 1. Bandage classification
• 2 . Dressings and wound dressings
• 3 . Fixing bandages
• 4 . Bandage types
• 5 . Private types of bandages on the body area

Introduction

The existing variety of dressings requires classification for a better understanding of their purpose. Currently, there is no single generally accepted classification of dressings. From our point of view, the following classification of dressings is one of the rational options.

1. Classification of dressings

Bymindappliedmaterial.

Soft:

a) bandages;

b) bandage-free (adhesive, kerchief, sling-like, adhesive plaster, T-shaped, coatings).

Solid (tire, starch, gypsum).

INdependenciesfromgoals.

Wound dressings:

a) sorption;

b) protective;

c) activated by drugs;

d) atraumatic (promoting wound healing and protecting against drying and mechanical irritation).

Fixing - designed to fix the dressing on the wound.

Pressure bandages - creating constant pressure on any part of the body (to stop bleeding).

Occlusive (sealing) dressings - preventing the penetration of air into the pleural cavity from the outside and a violation of the act of breathing.

Compression - designed to improve the venous outflow of blood from the lower extremities.

Immobilizing dressings:

a) transport;

b) therapeutic (ensuring the immobility of the damaged part of the body).

Corrective dressings - correcting the incorrect position of any part of the body.

Soft bandages include bandages applied with a bandage, gauze, elastic, mesh-tubular bandages, cotton fabric. Soft bandages are varied. Most often, dressings are applied to hold dressings (gauze, cotton wool) and medicinal substances in the wound, as well as to immobilize the victim during the transportation to a medical facility. Most often, bandages are used to apply soft bandages. Less commonly, other means (without bandages) - adhesive, kerchief, sling-like, T-shaped, contour dressings; mesh-tubular bandages.

Rigid dressings use a solid material (wood, metal) or a material capable of hardening: gypsum, special plastics and starch, glue, etc.

Most often in desmurgy dressings are used to fix the dressing material in the wound to create optimal conditions for tissue healing.

It is necessary to clearly understand the difference between the dressing material and the methods of its fixation.

2. Dressing material and wound dressings

The dressing material used during operations and for dressings must meet the following requirements: be biologically and chemically intact; have capillarity and good hygroscopicity; be minimally loose; soft, elastic, do not injure soft tissues; easy to sterilize and not lose their qualities; be cheap to produce.

According to their properties, modern dressings are divided into:

sorption;

protective;

drug activated;

atraumatic.

The classical sorbents that have found wide application are cellulose and its derivatives - cotton wool, gauze, lignin.

The most common dressing material used in surgical practice is gauze. Medical bleached hygroscopic gauze can be of two types - pure cotton and with an admixture of viscose. The difference lies in the fact that gauze with an admixture of viscose is wetted 10 times slower than cotton gauze, however, medicinal substances are absorbed worse on it, and repeated washing reduces its sorption capacity. The advantage of hygroscopic gauze is its high moisture capacity. Large and small napkins, tampons, turundas, balls and bandages, cotton-gauze medical bandages, dressing bags are made from it. The annual consumption rate for a surgical bed is 200 m of gauze and 225 bandages.

A very valuable dressing material is cotton wool, which is of two types - simple (non-fat) and hygroscopic. The latter has a high suction capacity. Plain cotton wool is not hygroscopic and is used in surgery as a soft lining, for example, when applying splints, plaster bandages, and also as a material that retains heat (warming compresses, etc.). The disadvantage of cotton wool is its relative high cost.

A cheap dressing material, which also has very high suction properties, is lignin - a specially processed wood of coniferous trees, produced in the form of layers of thin corrugated paper. Due to its low elasticity and strength, as well as its insufficient popularization among medical workers, lignin has not found wide application. In general, any but absolutely clean rag can be successfully used as a dressing material in extreme conditions. However, it is completely unacceptable to use artificial fiber fabrics for these purposes.

The insufficient amount of natural cotton materials, as well as the need to take into account the phases of the wound process, determine the development of non-woven synthetic materials. An example is a medical non-woven canvas-stitched threadless fabric made on the basis of cotton fibers, which has good plasticity, with a sorption capacity of 1400-2400%. Based on the chemical modification of viscose fibers, medical surgical hygroscopic cotton wool "Viscelot-IM" with an absorption capacity of 2,000% has been developed.

Immobilization of cellulose sorbents on such tissues increases the absorption capacity up to 3400%. Low cost and ease of sterilization determine the wide distribution of such materials - cellulose gauze (Russia), "ES" (Germany), "Surgipad" (USA), etc.

The disadvantage of these materials is the adhesion to the wound. This leads to granulation injury, with pain during dressings.

Cellulose-absorbing dressings do not have these shortcomings, they are represented by a non-adhesive inner and outer water-repellent layer that prevents secretion from seeping out. Currently, self-adhesive cellulose wound dressings are produced with a hydrophobic micromesh on the side of the wound, a suction pad made of clean cotton and a soft base made of non-woven material coated with hypoallergenic polyacrylate adhesive. For the treatment of small superficial wounds, non-adhesive gel dressings are available with an integrated cellulose wadding absorbent element. These dressings are highly absorbent and air permeable.

On the basis of cellulose material, combined sorption dressings with a three-dimensional suction capacity have been created. In this case, the discharge from the wound is distributed not only superficially, but throughout the entire volume of the dressing.

The range of dressings includes dressings based on carboxymethylcellulose, viscose, oxidized cellulose. Multilayer dressings made of non-woven material such as "Biatraum" (Russia) have a gauze-like structure and consist of viscose fiber and polyester.

In addition to increasing the number of layers of cellulose material, special sorbent materials are placed in the dressing for this purpose.

According to the degree of affinity for water, all sorbents are divided into water-swellable and hydrophobic.

The sorption capacity of water-swellable sorbents is comparatively higher. This group of sorbents realizes its activity due to the combined action of three main factors - capillarity, high porosity and the effect of functional hydrophilic groups that bind water and wound exudate components. Used for this purpose, "Gelevin" and others are not wound dressings in their pure form and must be used with a gauze bandage.

Hydrophobic sorbents, in comparison with water-swellable ones, have a lower ability to absorb liquid, but actively sorb microorganisms. Among the hydrophobic sorbents, carbon, organosilicon, polyurethane, etc. are distinguished. Polyurethane sponges, which have good air and water vapor permeability, are most widely used. They are elastic and soft, while their sorption capacity is 1800-2000%.

As wound sorbents of the hydrophobic type, various carbon materials are widely used - vaulene, resorb, etc. The use of carbon materials is advisable in the treatment of wounds with low exudation. Carbon sorbents are a convenient basis for the immobilization of various drugs.

Effective sorption-active dressings are hydrocolloid dressings. Dressings of this type consist of swellable colloids encapsulated in a self-locking elastomer. Hydrocolloid dressings are intended for the treatment of slightly and uninfected, as well as moderately and slightly exuding wounds, as well as wounds with areas of "dry" necrosis. Due to the properties of the hydrogel, a plasticizing effect is provided on the wound tissues, softening of necrotic formations during diffusion of the gel under them and facilitating the removal of non-viable tissues.

Protectivebandages. They perform the function of isolation, preventing the penetration of microorganisms into the wound, and also limit moisture loss. The main, and sometimes the only, structural element of such coatings is an elastic polymer film.

Protective dressings are conditionally divided into two groups:

coatings used in finished form;

coatings formed directly on the wound.

Coatings of the first group - transparent films attached to a healthy part of the body with adhesives. They allow you to monitor its condition without removing the film, but are effective only on wounds that are not accompanied by abundant exudate.

Insulating coatings of the second group are formed directly on the surface of the wound. For this purpose, aerosol compositions have been proposed, when applied to a wound for 1-2 minutes, a film coating will be created due to the evaporation of the solvent. Film-forming aerosols include BF-6 glue, furoplast, "Lifuzol" (Russia), "Plastubol" (Hungary), etc. Coatings of this group are used to protect surgical wounds from infection, protect the skin from maceration and treat small skin wounds. Their advantages are simplicity and speed of application, which do not require highly qualified medical personnel. Saving dressings, the ability to monitor the state of the wound without changing the dressing, the film is waterproof, allowing you to wash patients. The use of film-forming coatings is contraindicated in bleeding, contaminated, weeping wounds, extensive skin lesions.

With large defects in the skin, it is very important to limit the evaporation of tissue fluid. Dressings used for these purposes are presented in the form of a polymer film with controlled gas and vapor permeability. For the same purpose, dressings are made of silicone or natural rubber, polyvinyl chloride, polyurethane, polyamides, polyethylene, polystyrene, polypropylene, silicone. In recent years, wound dressing from chitosan - "Chitosan" (Great Britain, Taiwan) has been obtained. This coating consists of a derivative of lobster chitin and is a semi-permeable biological membrane.

bandages,activatedmedicinaldrugs. To increase the therapeutic effect of dressings, they include drugs of various directions of action. As carriers for the immobilization of medicinal substances, non-woven materials made of polyvinyl alcohol fibers activated with sodium dichloroisocyanurate or hydrogen peroxide, cotton dressings, fluorolone compounds, oxidized cellulose and viscose fibers, various sponges and films are used. With the introduction of drugs in dressings, their combinations are often used. To combat infection, wound dressings include antiseptics (dioxidine, chlorhexidine, capatol, miramistin) - "Aseplen-K" and "Aseplen-D", sulfonamides, antibiotics, "Lincocel" (Belarus), nitrofurans - "Coletex", iodine - "Aserlen-I". Silver ions, xeroforms are also used.

As a result of the immobilization of proteolytic enzymes on the material of the polymer coating, it is possible not only to lengthen the duration of the enzyme and reduce its therapeutic concentration, but also to limit the possibility of absorption of the drug into the bloodstream. For this purpose, enzymes are used - trypsin, chymotrypsin, lysozyme, terrilitin, etc. This group of wound dressings includes: "Polypore" - a polyurethane foam composition with immobilized trypsin; "Dalceks-trypsin" - trypsin immobilized on medical gauze; "Paxtripsin" - trypsin immobilized on a nylon knitted fabric; "Teralgin" - a porous sponge containing the enzyme terrilitin; "Ferantsel" (Belarus) - contains chymotrypsin immobilized on monocarboxycellulose.

In some cases, there is a need for local application of coatings with hemostatic properties. For this purpose, it is possible to use wound dressings containing gelatin, thrombin.

Atraumaticbandages. A serious disadvantage of many dressings is their sticking (adhesion) to the wound, as a result of which the dressings become painful, and most importantly, the regenerating tissues are injured. Currently, to eliminate these shortcomings, gauze bandages impregnated with paraffin and lanolin are used. However, such dressings are impermeable to air and do not have sorption properties.

In addition to gauze, polymeric materials are widely used to create non-stick dressings. The principle of their design is that the surface of a cellulose or synthetic material facing the wound is covered with a thin film of a hydrophobic polymer, and in order for the dressing to not lose its sorption activity, the film is usually perforated. Polyethylene, polyvinyl chloride, polyamides, silicone, polypropylene are used as materials for the hydrophobic layer. To increase the rate of absorption of exudate by the sorbent, it is proposed to cover the perforated film with surfactants, as, for example, in the Aseplen dressing.

Another way to make non-adhesive dressings is to coat the surface facing the wound with a thin layer of vacuum-sprayed metal, impregnated with silicone or acrylic resin containing ZnO, silver or aluminum powder.

The simplest and longest-used atraumatic dressings are ointment dressings. The physical and mechanical properties of such dressings can vary due to the type of material used or the composition of the ointment base. Their use is indicated in patients with sensitive skin or drug intolerance.

There is a group of sticky but atraumatic sorbent coatings based on natural and synthetic polymers. Dressings of this type do not need to be removed and remain in the wound until completely absorbed. Alginates belong to this group of wound coverings. In particular, Algipor, which is a mixed sodium-calcium salt of alginic acid, a polysaccharide derived from seaweed.

The use of collagen to obtain absorbable wound dressings is associated with its properties to stimulate fibroblastogenesis, lyse and be replaced by connective tissue. On the basis of soluble collagen, the "Kombutek-2" coating was developed; "Oblekol" - collagen film with sea buckthorn oil; "Gentatsykol" - a combination drug containing gentamicin sulfate. These drugs are used to treat bedsores, donor skin areas and other wounds in the 2nd phase of the wound process. Absorbable dressings can also be made on the basis of synthetic polymers: polyglucolide, polylactide, etc.

3. Fixing bandages

The dressing material on the wound should be applied so that it does not stray and does not squeeze the damaged part of the body, providing, under certain indications, rest for the damaged organ, the most advantageous functional position and free outflow of the wound discharge.

There are a fairly large number of ways to fix the dressing, and each has certain indications.

Adhesivebandages

Adhesive dressings are applied to the area of ​​the postoperative wound and in case of small injuries. Their advantages:

by closing the area of ​​the wound directly, one can observe the state of the surrounding skin;

easy and quick to apply;

do not limit the movements of the patient;

economical.

Allocate the following adhesive bandages.

Adhesive plasters bandages

The simplest form of strengthening bandage is the adhesive bandage. Adhesive plaster is produced in the form of rolls of tape of various widths. It adheres well to dry skin and is used to fix various dressings and to seal small wounds. Adhesive plaster is also used when it is necessary to bring together the edges of a granulating wound and keep them in this position to speed up the healing process. The sticky patch is used to treat fractures by continuous traction, especially in children. Adhesive plaster is of great importance when it is necessary to eliminate the communication of any cavity with the atmosphere, for example, with penetrating wounds of the chest. To apply such a bandage, a piece of adhesive tape is taken that is larger than the wound. The first strip is placed at the lower edge of the wound, bringing its edges closer. The second strip of plaster and each subsequent one in such a way that they seal the previous one 1/3 of the width, like tiles on a roof, hence the name "tiled" dressing. Adhesive dressings come off when wet, irritate the skin, and are laborious and expensive when used in large volumes.

Cleol bandage

Currently, cleol is used for sticker bandages, which does not tighten and irritate the skin less. Its composition: rosin - 40 parts, alcohol 96 ° - 33 parts, ether - 15 parts, sunflower oil - 1 part. The procedure for applying an adhesive bandage: a dressing is applied to the wound, and the skin around the wound is smeared with a cotton swab with a thin layer of glue. After 30-60 seconds, when the glue begins to dry out a little, a gauze napkin of the required shape and size is glued, pressing it tightly against the skin and stretching along the edges. The free edges of the gauze napkin that do not stick to the skin are cut off.

collodion bandage

Collodium is a solution of colloxylin in ether and alcohol. The solution is applied with a brush to the edges of a gauze pad applied over the dressing. When the solvents evaporate, the collodion solidifies, tightly fixing the bandage to the skin. The disadvantages of this dressing are skin irritation and discomfort as a result of skin tightening at the site of lubrication with collodion, in addition, collodion is highly flammable. Currently, collodion dressings are used quite rarely.

kerchiefbandages

A kerchief is a common first aid bandage, since it does not require complex devices, it can be quickly applied using a headscarf, sheet, gauze flap, canvas, etc. A kerchief is a piece of triangular-shaped fabric in which a base is distinguished (long side ), the top (the angle lying against the base) and the ends - the other two corners.

When providing first aid, a scarf made from a headscarf can be used to apply a bandage and fix the dressing on almost any part of the body. However, most often the kerchief bandage is used to suspend the upper limb, especially for injuries of the forearm and hand.

dressing material

To fix the arm (Fig. 1), the latter is bent to a right angle, and the scarf is brought in so that the upper end fits under the collarbone on the side of the affected arm, and the second end hangs down, the top of the scarf comes out from under the elbow. Having wrapped the upper end up in front of the forearm of the diseased hand, it is carried out on the shoulder girdle of the healthy side and behind the neck, where it is connected to the other end of the scarf. The top of the scarf is bent around the elbow and secured in front of the elbow with a pin.

Rice. 1 . Using a scarf to immobilize the shoulder girdle and upper limb

With the help of a scarf, bandages can be applied to the mammary gland (Fig. 2), foot, hand (Fig. 3) and head. When bandaging the head, the scarf is placed on the back of the head and crown, the top is lowered onto the face, the ends are tied on the forehead, then the top is bent in front of the tied ends and secured with a pin.

Rice. 2 . Using a scarf to apply a bandage to the mammary gland

Rice. 3 . The imposition of a scarf bandage on the brush. 1,2,3 - bandaging steps

sling-likebandages

A sling in desmurgy is a piece of gauze in the form of a ribbon 50–60 cm long, both ends of which are notched in the longitudinal direction so that the middle 10–15 cm long is uncut (Fig. 4).

Rice. 4 . sling bandage

This bandage has 4 ends; the middle part is designed to cover the damaged area over the dressing and secure the latter. The sling bandage is most often used on the face in the area of ​​the nose, forehead, neck, chin as a temporary measure for holding tampons and temporary immobilization. Like a kerchief, it does not seal the hermetically damaged area and is fragile.

The technique of applying a sling-like bandage on the nose to the chin is shown in Fig. 5 (a, b), and on the back of the head and crown - (c, d). A prerequisite for applying a sling is to cross its ends before tying.

T-shapedbandages

This bandage is convenient for holding the dressing on the perineum, scrotum and anus. It is easy to manufacture, if necessary, can be quickly applied and removed. It consists of horizontal and vertical (wider) bandage strips, with the horizontal part going around the waist in the form of a belt, and the vertical part - from the waist through the crotch forward and tied to the same belt (Fig. 6).

Rice. 5 . Options for applying sling dressings

The T-shaped bandage can successfully replace the so-called suspensorium used to support the scrotum, for example, after surgery for dropsy of the testicle, with orchitis, orchiepididymitis, etc.

Rice. 6 . T-shaped crotch bandage

Bandagesfromusingelasticmesh-tubularbandages

To hold the sterile material on the wound, tubular knitted bandages and elastic mesh-tubular bandages "Retilast" are widely used, which, having great extensibility, tightly fit any part of the body, do not unravel when incised, and at the same time do not restrict movements in the joints.

They look like a tube woven from cotton and rubber thread and come in different diameters.

Depending on the size, five numbers of tubular bandages are distinguished: 1 - on the finger, 2 - on the forearm or lower leg, 3 - on the shoulder, 4 - on the thigh and head, N 5 can stretch so much that it can be worn on the chest or stomach person.

Having a mesh structure, elastic mesh-tubular bandages provide the possibility of aeration and monitoring of the state of peri-wound tissues.

Bandagebandages

Bandage bandages are the most common, as they meet the requirements for a modern rational bandage (strength, elasticity, porosity, creation of the necessary pressure, etc.). At present, soft gauze, which has good elasticity, is almost exclusively used for bandaging. Gauze bandages do not prevent the evaporation of moisture from the bandage. Bandages made of denser fabrics (flannel, canvas, calico) are not currently used. The use of soft bandages remains to date one of the most common ways to strengthen the dressing, despite the widespread use of adhesive tape, glue, polymerizing plastics, synthetics, etc. This is due to the versatility of bandages, their adaptability to any type of body surface and any pathological processes. If we add to this the possibility of their combination with other methods of fixation, then the scope of their application becomes limitless.

The rolled up part of the bandage is called the head, and its beginning is the free end. Bandages can be single-headed and double-headed (rolled from two ends to the middle), the latter are used in exceptional cases (headband). The back of the bandage, i.e. the surface facing the bandaged part of the body is called the back, and the opposite side is called the abdomen, and when bandaging the abdomen should be turned outward so that the bandage can easily and freely roll out on the surface of the bandaged body area. The bandage is narrow (up to 5 cm), medium (7-10 cm) and wide (12 or more cm). Each part of the body requires its own bandage width.

Basic requirements for a bandage bandage:

cover the affected area of ​​the body;

do not disturb blood and lymph circulation;

hold securely on the body area;

be as neat as possible.

rules overlays soft bandage bandages

Despite the high prevalence of bandage dressings, their imposition requires a certain skill, knowledge and skill. A properly applied bandage does not disturb the patient, it is accurate, firmly and for a long time fixes the dressing material. In order for the bandage to lie correctly, bandages of the appropriate width should be used, depending on the size of the anatomical region being bandaged. So, for the torso, wide bandages are needed, for the head - medium, for the hand and fingers - narrow.

Bandaging consists of the following steps:

imposition of the initial part of the bandage;

the imposition of the actual moves of the bandage;

fixing the bandage.

rules bandaging

When starting bandaging, care should be taken to ensure that the patient is in a comfortable position for him, and the bandaged part of the body is accessible from all sides.

A prerequisite is the application of a bandage with the patient in a horizontal position in order to prevent complications (shock, fainting).

The exception is minor damage.

The bandage is applied in such a position of the limb, which is functionally the most beneficial, especially when applying a bandage for a long time.

It is very important that the application of the bandage, like the bandage itself, does not cause discomfort in the patient, which largely depends on the skill of the bandager. During bandaging, he must face the patient in order to constantly monitor his condition.

Bandaging is very tiring and uncomfortable if the health worker has to bend over or raise his arms up, so it is best to position the bandaged part of the body at the level of the lower chest of the bandager.

Bandaging should begin with the peripheral parts, gradually covering the central areas of the body with bandage tours.

The exception is bandages on the hand, foot and fingers of the hand and foot, when the bandage tours are located from the center to the periphery.

Bandaging begins with the first two fixing rounds of the bandage.

The head of the bandage is held in the right hand, the beginning of the bandage is in the left, the bandage is rolled from left to right with the back on the bandaged surface of the body, without taking your hands off it and without stretching the bandage in the air.

In some cases, bandaging from right to left can be carried out, for example, when bandages are applied to the right area of ​​​​the face and chest.

The bandage should roll smoothly, without wrinkling; its edges should not lag behind the surface and form "pockets".

The bandage should be applied not too tight (unless a pressure bandage is required) so that it does not interfere with blood circulation, but not too loose so that it does not slip from the wound.

The hand of the bandager should follow the course of the bandage, and not vice versa.

When applying a bandage, except for a creeping one, each subsequent round covers the previous one by 1/3 or 1/2 of the width of the bandage.

To fix the bandage at the end of bandaging, the end of the bandage is torn or (better) cut with scissors in the longitudinal direction; both ends are crossed and tied, and neither the cross nor the knot should lie on the wound surface.

Sometimes the end of the bandage is folded over for the last circular move or pinned to previous rounds with a safety pin.

When removing the bandage, the bandage is either cut or unwound.

Start cutting the bandage away from the damaged area or from the side opposite to the wound.

When unwinding, the bandage is collected in a lump, shifting it from one hand to another at a close distance from the wound.

Mistakes at overlay soft bandages

If the bandage is applied tightly, cyanosis, edema occur, the temperature of the distal limb decreases, and throbbing pains appear. When transporting a patient with a tightly applied bandage in winter, frostbite of the distal limb may occur. In the event of the appearance of the described symptoms, the injured limb is given an elevated position. If after 5-10 minutes there is no improvement, the bandage must be loosened or replaced.

With a weak bandage tension, the bandage quickly slips. In this case, it is better to change it, ensuring the complete passive position of the injured limb during bandaging.

The integrity of the bandage is easily broken if the first fixing rounds are not made. To correct the error, the bandage must be bandaged, strengthening it with glue and adhesive tape.

4. Types of bandages

In order to properly apply any bandage, it is necessary to know the anatomical features of a particular part of the body and the so-called physiological positions in the joints. Different parts of the limbs have a different shape (cylindrical - shoulder, conical - forearm, lower leg), which must be taken into account when applying bandages.

The nature of bandaging (more kinks in the bandages) can also be influenced by more pronounced musculature in men and greater roundness in women.

Taking into account these provisions, various types of bandage dressings have been developed.

circular,orcircular,bandage (fascia circularis )

This is the simplest form of a bandage dressing, in which all the tours of the bandage fall on the same place, completely covering each other. They begin with it and finish the bandage with it, less often it is used as an independent one on areas of the body of a cylindrical shape. In this case, the moves of the bandage, going from left to right, cover each other completely in an annular fashion. At the beginning of bandaging, the first move of the bandage can be given an oblique direction by bending the edge, which is then fixed with the second move (Fig. 7). A circular bandage is convenient for bandaging small wounds and is more often applied to the shoulder, wrist joint, lower third of the lower leg, abdomen, neck, forehead.

Rice. 7 . circular bandage

Spiralbandage (fascia spiralis )

It is used if it is necessary to bandage a significant part of the body. It, like any other bandage, begins with circular bandages (2-3 layers), then the bandage is led from the periphery to the center. At the same time, the tours of the bandage go somewhat obliquely from the bottom up and each next tour closes 2/3 of the width of the previous one. As a result, a steep spiral is formed (Fig. 8).

Rice. 8 . spiral bandage

Rice. 9 . creeping bandage

creepingorserpentine,bandage (fascia serpenses )

Such a bandage is used mainly for the rapid and temporary strengthening of the dressing over a considerable length of the limb. A creeping bandage is started with a circular bandage, which is then transferred into a helical bandage, from the periphery to the center and back. So that the turns of the bandage do not touch (Fig. 9). After fixing the dressing with a creeping bandage, further bandaging is continued in the usual way, applying a spiral bandage.

cruciform,oreight-shaped,bandage (fascia cruciata ceu octoidea )

A bandage in which the tours of the bandage are applied in the form of the number 8 (Fig. 10). In this case, the bandage moves are repeated several times, and the cross is usually located above the affected area. This bandage is convenient for bandaging body parts with an irregular surface shape (ankle joint, shoulder, hand, occipital region, perineum, chest).

Rice. 10 . Cross bandage. a - brush; b - chest; c - perineum; g - foot

A variation of the eight-shaped bandage is spike-shaped (fascia spica). Its difference from the cruciform is that the cross does not pass at the same level, but gradually moves up (ascending bandage) or down (descending). The place where the bandage crosses in appearance resembles an ear, hence the name of the bandage (Fig. 11). Usually, a spica bandage is applied to the area of ​​\u200b\u200bthe joints.

A variant of the 8-shaped bandage is also turtlebandage,convergingAnddivergent (fascia testudo inversa or reversa). Such a bandage is applied to the area of ​​​​large joints (elbow, knee). It consists of bandage moves that cross on the flexion side of the joint and diverge in the form of a fan on the extensor side.

Rice. 11 . Spica bandage on the hip joint

A diverging bandage begins with a circular motion through the center (the most protruding part) of the joint. Subsequent bandage moves are above and below the previous ones, crossing on the flexion side of the joint and covering 2/3 of the previous moves until the affected area is completely closed (Fig. 12).

A converging turtle bandage is started with circular bandages above and below the joint and also crossing on the flexor side of the latter.

Further moves bring them closer to each other to the convex part of the joint until the affected area is closed.

Rice. 12 . Turtle bandage. a - divergent; b - convergent

Rice. 13 . Returning bandage on the stump

Return bandage ( fascia recurens )

It is usually applied to rounded surfaces (head, limb stumps). Such a bandage is reduced to the alternation of circular bandage moves with longitudinal ones, going sequentially and returning back, until the stump is completely closed (Fig. 13).

It should be emphasized that a bandage bandage on any part of the body cannot be only circular or only spiral, etc., since such a bandage can easily be displaced, therefore it must necessarily be reinforced with 8-shaped passages in order to fit snugly against the surface of the bandaged part body. When bandaging a limb of unequal thickness, for example, the forearm, it is advisable to use a technique called an inflection. The bend is performed in several rounds and the steeper, the sharper the difference in the diameters of the bandaged part.

Improvisation and a combination of different types of dressings are possible when bandaging large areas of the body. So, when bandaging the entire lower limb, all 7 basic bandage options can be used.

5. Particular types of bandages on the body area

HEADBANDS

To apply a bandage bandage on the head, bandages 5-7 cm wide are used. The most commonly used are: "hat", "Hippocratic hat", "cap", "bridle", bandage on one eye, on both eyes; on the ear, cruciform on the back of the head.

Simplebandage (cap)

This is a return bandage that covers the cranial vault (Fig. 14). Two circular passages lead around the head, capturing the region of the glabella and the region of the occiput (1). Then an inflection is made in front, and the bandage is led obliquely along the lateral surface of the head, slightly higher than the circular one (2). Going to the back of the head, make a second bend and cover the side of the head on the other side (3). After that, the last two oblique moves are fixed with a circular bandage and then again make two oblique returning moves (5 and 6) slightly higher than the previous ones (2 and 3) and fix it again.

This relatively simple dressing requires very good application technique. It is important that the bends of the bandage lie as low as possible and are better fixed in circular motions. Due to its low strength, it is not applicable for imposition in severe patients.

Rice. 14 . Headband "hat"

HatHippocrates

Facing the victim, the bandager takes one head of a double-headed bandage in each hand and, deploying them, applies one or two circular moves around the head. Having brought both heads of the bandage to the back of the head, the left head is brought under the right one and a kink is made, the right head continues its circular course, and the left one, after the kink, goes in the sagittal direction through the crown to the forehead. In the forehead area, both heads meet: the right one goes horizontally, while the left head again returns through the crown to the back of the head, where it again intersects with the horizontal course of the right head, etc. Longitudinal returning passages gradually cover the entire head. Thus, anteroposterior moves are made with one part of the bandage, and circular with the other. The bandage is fixed with circular passages of both heads around the head (Fig. 15).

Cap

A piece of bandage 50-75 cm long is placed in the transverse direction on the crown of the head so that the ends descend vertically down in front of the auricles, where an assistant holds them in a taut position (sometimes the patient himself does this). On top of this bandage, the first horizontal moves are carried out around the head so that their lower edge goes over the eyebrows, over the auricles and over the occiput. Having reached the vertical tie on one side, the bandage is wrapped around it (a loop is made) and then on the forehead area somewhat in an oblique direction, covering half the circular course. Having reached the opposite tie, they again make a loop and again lead in an oblique direction to the occipital region, half covering the underlying passage, etc. So each time, throwing the bandage over a vertical tape, they lead it more and more obliquely until they cover their entire head.

Rice. 15 . Bandage "hat of Hippocrates"

Rice. 16 . Bandage "cap"

The bandage is finished with circular moves of the bandage, tying a knot in front (Fig. 16). The ends of the vertical tape are tied under the chin to securely fix the entire bandage.

Bandagetypefrenulums

It is used for damage to the lower jaw, after reduction of dislocation, etc. (Fig. 17). First, two horizontal circular moves are applied around the head from left to right. Next, the bandage is led over the ear of the left side obliquely upward through the back of the head under the right ear and under the lower jaw in order to grab the jaw from below and exit from the left side in front of the left ear up to the crown.

Then the bandage behind the right ear is again led under the lower jaw, covering the front half of the previous move. Having made three such vertical moves, the bandage is led from behind the right ear forward to the neck, then obliquely up through the back of the head and a circular move is made around the head, strengthening the previous rounds.

Rice. 17 . Bandage "bridle"

Then they again go behind the right ear, then almost horizontally cover the entire lower jaw with the bandage and, having come to the back of the head, repeat this move again. Then they go under the right ear under the lower jaw obliquely, but closer to the front, then along the left cheek up to the crown and behind the right ear. Having repeated the previous move, and then, having rounded the neck in front, they go to the back of the head above the right ear and finish the bandage with a circular horizontal bandage.

Bandageon theoneeye

The bandage begins with circular moves around the head, and for the right eye, the bandage is led from left to right, for the left, on the contrary, from right to left (Fig. 18). Having strengthened the bandage with horizontal moves, lower it from behind down to the back of the head and lead it under the ear from the diseased side obliquely up through the cheek, closing the sore eye. An oblique move is fixed in a circular way, then an oblique move is made again, covering half the previous one. So, alternating oblique and circular moves, they cover the entire area of ​​\u200b\u200bthe eye.

Rice. 18 . One eye patch

Rice. 19 . Bandage for both eyes

Bandageon thebotheyes

After fixing the bandage with circular moves (Fig. 19), it is led from the back of the head under the ear and an oblique move is made from the bottom up, closing the eye on one side. Then they continue to lead the bandage around the occipital region of the head and through the forehead obliquely from top to bottom, closing the eye on the other side, then they carry out the bandage below the ear and across the back of the head, come out from under the ear from the opposite side and make another upward oblique move. So, alternating with each other, the oblique moves of the bandage gradually close both eyes. Fix the bandage with a circular bandage.

Bandageon theregionear (Neapolitanbandage)

It begins with circular tours around the head (Fig. 20). On the affected side, the bandage is lowered lower and lower, covering the ear area and the mastoid process. The last move is located in front along the lower part of the forehead and behind the occiput. Finish the bandage with a circular bandage.

eight-shapedbandageon theback of the head

It begins in circular tours around the head (forehead-back of the head), then over the left ear descends to the back of the head, then goes under the right ear to the front surface of the neck from under the left corner of the lower jaw up through the back of the head over the right ear to the forehead (Fig. 21). Repeating these tours, close the entire back of the head.

Quite often, "sling-like bandages" are used on the chin and nose, as well as kerchief bandages, the technique of applying which can be found in the relevant sections.

Rice. 20 . Ear band "Neapolitan hat"

Rice. 21 . Eight bandage on the back of the head

BANDAGESON THEUPPERLIMB

Most often, the following dressings are applied to the upper limb: spiral - on one finger, spike-shaped - on the first finger, "glove"; returning and cruciform - on the brush; spiral - on the forearm; turtle bandages - on the elbow joint; spiral - on the shoulder; spike-shaped - on the shoulder joint; bandages Deso and Velpo.

Spiralbandage

It is used for trauma to one finger (Fig. 22). First, the bandage is strengthened with two or three circular moves in the wrist area. Then the bandage is led obliquely through the back of the hand (2) to the end of the diseased finger, from where the entire finger is bandaged to the base with spiral passages. Then (8) the bandage is brought back to the wrist, where it is fixed.

Rice. 22 . Spiral bandage for one finger

Rice. 23 . Thumb bandage

Bandage on thebigfingeris being donespike-shaped ( eight-shaped) (Fig. 23). It starts in the same way as above. Next, the bandage is led along the back surface of the thumb to its top (2) and the palmar surface of this finger (3) is covered with a semicircular stroke.

Then the bandage is led along the back of the hand to the wrist and the eight-shaped move is repeated again, each time going down to the base of the finger. Attach the bandage to the wrist.

Rice. 24 . Bandage on all fingers "knight's glove"

Rice. 25 . Bandage on the brush "mitten"

Bandageon theallfingers " knightlyglove"

It is used when you need to bandage several fingers or all fingers individually. It begins as a bandage on one finger (see Fig. 23). Having bandaged one finger spirally, the bandage is led along the back surface through the wrist and the next one is bandaged in this way until all fingers are bandaged (Fig. 24). On the left hand, the bandage begins with the little finger, and on the right hand, with the thumb. Finish the bandage with a circular motion around the wrist.

Bandageon thebrushreturning " mitten"

It is applied when it is necessary to bandage the hand (Fig. 9-25) together with the fingers (with extensive burns and frostbite). The bandage begins with circular moves around the wrist (round 1). Then the bandage is led along the back of the hand (2) onto the fingers and all fingers are covered with vertical strokes from the palmar and back sides (3,4,5). Then in horizontal circular strokes, starting from the ends of the bandage on the wrist.

Turtlebandage

Superimposed on the area of ​​​​the joints in a bent position (Fig. 26). They are divided into divergent and convergent. The convergent dressing begins with peripheral tours above and below the joint (1 and 2), crossing in the cubital fossa. Subsequent moves are similar to the previous ones, gradually converging to the center of the joint (4, 5, 6, 7, 8.9). Finish the bandage with a circular stroke at the level of the middle of the joint. A divergent bandage in the area of ​​the elbow joint begins with a circular move through its middle, then similar moves are made above and below the previous one. Subsequent moves diverge more and more, gradually closing the entire area of ​​the joint. The moves intersect in the subulnar cavity. Fasten the bandage around the forearm.

Rice. 26 . Turtle elbow bandage

Rice. 27 . Spiral bandage on the forearm

Spiralbandage

It can be performed with or without kinks (Fig. 9-27). The second is convenient for bandaging parts of the body that are uniform in thickness (shoulder, lower leg, thigh, etc.). They start the bandage with two or three circular moves, and then the bandage tours go in a spiral, partially covering the previous tours by two thirds. Depending on the direction of bandaging, the bandage can be ascending or descending.

A bandage with kinks is applied to the conical parts of the body. After two or three circular moves, they begin to bandage with kinks. To do this, the bandage is led obliquely upwards, pressing down its lower edge with the thumb and bending the bandage so that its upper end becomes the lower one, then the bandage is led obliquely downwards, circled around the limb and the bend is repeated again. The greater the degree of expansion of the limb, the steeper the bends. All folds are made on one side and along one line. In the future, if necessary, either make a simple spiral bandage or continue to bend the bandage.

Spikebandage

It is a kind of eight-shaped (Fig. 28). It is applied to the area of ​​the shoulder joint as follows. The bandage is led from the side of a healthy armpit along the front surface of the chest and further to the shoulder (stroke 1). Having bypassed the shoulder in front, outside and behind, the bandage is led through the armpit and raised obliquely to the shoulder (stroke 2), the previous round is crossed on the front surface of the chest and shoulder. Next, the bandage goes along the back of the back to a healthy armpit. From here begins the repetition of moves 1 and 2 (3 and 4). At the same time, each new move lies slightly higher than the previous one, forming an ear shape at the intersection.

BandageDeso

Superimposed with fractures of the humerus and collarbone. The patient is seated, the arm is bent at the elbow at a right angle (Fig. 29). The first moment consists in bandaging the shoulder to the body, which is achieved by imposing a series of circular spiral moves from the healthy arm to the patient (1). Next, the second part of the bandage is started with the same bandage: from the axillary region of the healthy side along the front surface of the chest, the bandage is led to the shoulder girdle of the diseased side (2), from here vertically down the back of the shoulder under the elbows, grabbing the elbow with a bandage, obliquely through the forearm into the armpit of the healthy side (3). From here, a bandage is led along the back to the sore shoulder girdle down the front side of the shoulder (4). Having bypassed the elbow in front, the bandage is led obliquely through the back into a healthy armpit, from where the repetition of moves begins (2, 3.4).

Rice. 28 . Spike bandage on the shoulder joint

Rice. 29 . Bandage Deso

Rice. 30 . Velpo bandage

Such moves are repeated several times to obtain a good fixation. Then they hang the hand with a piece of bandage of sufficient width, strengthening it to the back (see Fig. 29).

BandageVelpo

It is used for temporary immobilization for fractures of the clavicle, after reduction of dislocations of the shoulder joint (Fig. 30). The arm from the damaged side is bent at the elbow joint to form an acute angle, and the palm is located in the deltoid region on the healthy side. In this position, the limbs are bandaged. First, the arm is fixed with a circular bandage from the diseased arm to the healthy one (1), which covers the shoulder and forearm of the diseased side, goes back through the healthy axillary fossa. From here, the bandage is lifted obliquely along the back from the damaged deltoid region, go around it from back to front, lower the bandage down the shoulder (2) and, grabbing the elbow from below, direct it to the axillary fossa from the healthy side (3). The bandage moves are repeated several times, with each vertical bandage move placed inside the previous one, and each horizontal one below it.

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Classification of modern filling materials. Materials for dressings and temporary fillings. Requirements for temporary filling materials. The use of medical pads. Materials for permanent fillings, characteristics of their composition.

Dressings and dressings are used to make and apply dressings to protect against secondary infection and other external influences, as well as to stop bleeding, dry wounds during surgical operations and immobilize organs and tissues.

In Russia, in order to increase the efficiency of use and reduce the negative impact on the health of the population of this segment of products, a regulatory and methodological framework has been developed, as well as state registration of goods and quality control during their production.

Dressings are products that are fibers, threads, fabrics, films, non-woven materials and are intended for the manufacture of dressings by industrial enterprises or immediately before use by medical personnel and end users.

A dressing is a medical device made from one or more dressings intended for the prevention of infection and for the treatment of wounds.

Ready-made dressings - prefabricated products made of gauze and cotton wool, non-woven fabric and other materials, ready for use for their intended purpose (bandages, napkins, dressings, dressing bags, adhesive plasters, etc.).

General requirements are imposed on dressings and dressings. They should be:

• 1) sterile and atraumatic;
• 2) strong, plastic, anti-adhesive;
• 3) permeable (for air and pathological substrate) and impermeable to microorganisms;
• 4) soft, but not fragile;
• 5) hygroscopic;
• 6) own good capillarity and wettability;
• 7) have a neutral reaction and be neutral in relation to the organism;
• 8) have a certain percentage of humidity;
• 9) be reliably sterilized by one of the sterilization methods without changing its properties;
• 10) harmless to the body, must not have allergic and toxic components;
• 11) low cost and ease of production;
• 12) must ensure the comfortable existence of patients and be economical and convenient to use;

The main indicators of the quality of dressings are humidity, absorption capacity, capillarity, chemical neutrality, color, smell.

Humidity - loss in mass due to hygroscopic moisture, which is determined by drying to constant weight.

Absorption capacity - the ability to absorb liquid (water, blood, aqueous solutions, tissue fluids). It is estimated by the amount of water in grams absorbed by 1g of relatively dry cotton.

Capillarity - the ability of a material to lift liquid from the lower layers of the material to its upper layers. It is estimated by the height of the rise of liquid over the material in mm for a certain period of time.

Chemical neutrality - neutral reaction of water extract.

Fibrous dressings

Fibrous dressings are most commonly used to create pads for dressings. These include cotton wool and alignin.

Medical cotton wool and methods for determining its quality

Medical cotton is divided into hygroscopic and compressor.

Absorbent cotton

For dressings, medical hygroscopic cotton wool is used, which is made from the best varieties of cotton or from cotton with viscose additives and processed accordingly.

Depending on the purpose, the industry produces three types of medical absorbent cotton.

• 1) Cotton eye cotton of the 1st grade;
• 2) Surgical cotton wool made of pure cotton of at least grade 3 or with viscose fiber (up to 30%).
• 3) Hygienic household cotton wool of the 5th grade.

Medical hygroscopic cotton wool is cotton soft fibers of white color without gloss. To give cotton wool hygroscopic properties, the feedstock is degreased. Cotton is boiled in an alkaline solution, which leads to the removal of fat and wax and pectin substances that prevent wetting of the fiber and the penetration of water into its cavity. In ready-to-use cotton wool, the mass fraction of fatty and waxy substances does not exceed 0.3-0.5%, which ensures its capillarity and the ability to absorb moisture. After degreasing, cotton wool is bleached, combed, formed into loose bundles and wound on a drum. Bunches in the form of fluffy strips are folded into a tight roll and packed in wrapping paper.

Methods for determining the quality of medical cotton wool.

1. Determination of the content of short fibers (less than 5 mm) and cotton dust.

Three portions of 5 g each are taken from the total sample (weighed with an error of not more than 0.01 g). Each sample is divided into separate balls and separated by hands, holding between the thumb and forefinger over black glass 5 times in a row. Short fibers 5 mm long formed on black glass and cotton dust are collected in a glass and weighed with an error of not more than 0.001 g (one milligram)

PS are made of PM and are finished products for intended use. presented on It includes such PS groups as bandages, bags, napkins, plasters, tampons, aerosols (spray foams and spray films), wound coverings.

Bandages are a kind of dressings made from cotton-viscose gauze in the form of rolls of certain sizes; belong to the traditional, widely used PS. Types of bandages are presented on

Non-sterile gauze bandages are produced in sizes 10 m x 16 cm, 10x10, 5x10, 5x5, 5x7, 7x10, 7x14, 7x7 cm both in secondary and in individual packaging.

Sterile gauze bandages are produced in sizes 5x10, 5x7, 7x14 cm in individual packaging.

PS classification depending on the form

PS classification depending on the form

Types of medical bandages

Types of medical bandages

Plaster bandages contain gypsum, which, after getting wet, is applied to the injured parts of the body in order to fix them; used mostly in traumatology. Available in sizes 3x10, 3x15, 3x20 in individual packaging. In recent years, such bandages have been produced with PVA plasticizer to improve consumer properties.

Elastic bandage is made of harsh cotton yarn, which is based on woven rubber threads, which sharply increase the elasticity of the bandage. Elastic bandages are not sterilized, they are used for non-rigid tightening of soft tissues.

Bandage tubular is a seamless tube of hydrophilic material; its elasticity is provided by the knitted type of weaving. Available in several diameters for use on various areas of the upper and lower extremities.

A special type of tubular bandage is mesh bandage - a mesh tube of various diameters, which is rolled up in the form of a roll. A piece of the required length is cut off from it in order to fix the surgical dressing on the wound.

The hydrophilic bandage has the ability to absorb water; available in two versions: sterile and non-sterile (width 4-20 cm).

Starched bandage is made from starched gauze or organza. It is used as a reinforcing material over hydrophilic bandages (it can “dry up” directly on the wound, damage the skin at the fold).

A zinc-containing adhesive bandage is a conventional bandage with a thin layer of paste containing glycerin, gelatin, sodium chloride, zinc oxide, i.e. this type of bandage refers to therapeutic PS. When dry, such a bandage “sits down” and the bandage becomes very tight, so it is used where it is necessary to avoid tissue swelling, for example, in case of skin inflammatory diseases.

In the group of napkins, dressing napkins proper (for example, gauze napkins) and medical napkins (for example, Koletex napkins) are distinguished,

Gauze napkins are two-layer cuts of gauze sized 16x14 cm, 45x29 cm, etc. Sterile wipes are available in packs of 5, 10, 40 pcs., non-sterile - 100 pcs.

Medical wipes are a composite dosage form, which is either a medical biopolymer on a substrate (most often tissue), in which a medicinal substance is immobilized, or a tissue base impregnated with a medicinal substance.

Napkins "Coletex" - composite PS, which is a layer of special textile material as a carrier of a biopolymer with a therapeutic effect, with a drug immobilized in it. They contain hemostatic, anti-inflammatory, wound healing and analgesic substances (furagin, chlorhexidine, propolis, sodium alginate, urea, metronidazole) in various combinations. They are intended for use as a therapeutic and prophylactic agent for the primary closure of injured tissues, sutured wounds, for the closure of infected and granulating wounds, trophic ulcers, burns, bedsores. Packed in primary packaging in the form of a sterile (inside) paper bag and secondary packaging - cardboard boxes. Can also be used in oncology

as a local application radiosensitizing agent for radiation therapy and post-radiation lesions.

Dressing bags are a ready-made dressing for applying to a wound in order to protect it from contamination, infections and blood loss. The composition of individual dressing packages includes a sterile hydrophilic bandage (7 cm x 5 m), a cotton pad (13.5x11 cm), which can be sewn to the beginning of the bandage, and a pin to secure the ends of the bandage. Cotton-gauze pads are impregnated with a solution of sublimate. There are two types of packages: small and large, in which there is one or two pads (one is sewn to the beginning of the bandage, the second is free). Individual dressing bags are made in such a way that sterility is not violated during constant wear. If, nevertheless, the protective shell is broken, then the core of the bag remains sterile.

At present, dressing pads are made that adhere weakly to the wound (they dry little to exuding wounds).

Dressing swabs are a small piece of cotton wool or dressing cloth used to close a wound or ulcer or to stop bleeding (during surgery to remove blood from dissected vessels).

Plasters used as PS, taking into account the purpose of the application, refer to fixing and covering plasters. They may contain a medicinal substance (cover patches), may not contain it (fixing patches).

Fixing plasters are used in surgery and traumatology for fixing dressings; cover patches - in dermatology for the treatment of a number of diseases or mechanical damage to the epidermis.

Usually dressing patches are combined under the conditional name "adhesive plaster". In appearance, they are divided into tape and strips. As a rule, adhesive plasters have a sticky (adhesive) layer on one side; in the case of cover adhesive plasters, a gauze pad impregnated with drugs (for example, a bactericidal plaster) is attached to the sticky side.

Adhesive plasters are produced: Leukoplast, Siofaplast, Tricoplast, Santavik, etc. In addition, perforated paper-based plasters are produced under the trade names Leukopor, Betabant, etc.

Firm "Veropharm" (Russia) produces a series of plasters "Uniplast", including: Fixing adhesive adhesive medical tape, dimensions 500x10 cm, 500x1.25 cm, 500x2.5 cm, 500x0.5 cm; release

etsya in rolls with a protective coating, and a smaller size - on coils; the base of the tape is elastic viscose fabric, non-woven adhesive fabric.

Dressing strips "Uniplast Plus" provide reliable fixation of the dressing, protect the wound from microbes, do not cause allergic reactions and skin irritation. They have a flesh color, do not leave marks on the skin and clothes.

Patches are made in different sizes and configurations, including rectangular or round shapes on a fixing adhesive tape with or without perforation. In packs of 8, 10, 20 pcs. one standard size and in the form of sets of 10, 16, 24, 30 pcs. products of various shapes and sizes.

Variety of dressing strips:

Waterproof;

Hypoallergenic;

Elastic (convenient for use on the joints).

The Band-Aid series of antimicrobial patches is manufactured by Johnson & Johnson. It is made of non-woven material, does not stick to the wound, contains benzalkonium chloride antiseptic, transparent. The adhesive coating fixes the patch on the skin, does not cause irritation. Sizes 7x2 cm, 4x1 cm, 4x4 cm, packs of 24 different sizes.

Types: antiseptic waterproof, antiseptic tissue - suitable for protecting wounds on the folds.

Medicinal sponges are a dosage or non-dosed dosage form, which is a porous mass of various sizes and shapes, containing medicinal and excipients (mainly polymeric materials). Sponges have the form of plates of different sizes (50x50, 100x100, 90x90, 240x140 mm, etc.). Currently, sponges are obtained mainly from the skin or tendons of cattle, seaweed; released in sterile packaging.

The nomenclature of medicinal sponges is presented on

Types of medicinal sponges

The hemostatic sponge is made from human blood plasma with the addition of calcium chloride and aminocaproic acid; is a dry, porous substance of white color with a yellowish tint. It is applied topically, and gradually dissolves in the wound. Contains thrombin, fibrin, aminocaproic acid, hemostatic; issued in vials. The hemostatic sponge can also be made with collagen.

Absorbable gelatin sponge is a hardened sterile foam, soluble in water; undergoes resorption in body tissues. Designed to stop bleeding during surgery. A variety of gelatin sponge is a gelatin-starch sponge, which serves the same purpose.

The collagen sponge is a sterile porous plate obtained from collagen; has resorptive, hemostatic and weak adhesive properties, due to which it is widely used for wound dressings. Collagen sponges are often combined with various natural polymers and medicinal substances (for example, chitosan, pectin, antibiotics, etc.), which can significantly improve their consumer properties.

Algipor is a sponge made from a polymeric substance (alginate), which is extracted from seaweed. A sterile sponge is applied to the wound and absorbs the wound discharge. Over time, this coating will dissolve. The sponge itself contains medicinal substances that actively promote healing. It is used to treat trophic ulcers, bedsores; due to complete resorption, it can be used in operations on internal organs.

Algimaf is a modification of algipore, contains a different set of antiseptic substances, promotes accelerated wound healing.

In recent decades, such a segment of the PS market as wound coatings has been developing very dynamically. This is due, on the one hand, to the demand for new types of PS in medicine, on the other hand, to scientific and technological achievements.

Wound dressings are intended mainly for the treatment of chronic wounds. Their composition and types depend on the type of wound and the stage of the treatment process (the main stages of treatment: cleaning, removal of organic matter, granulation, vascularization, epithelialization). They produce alginate, sponge, hydrogel and hydrocolloid coatings, from which dressings are made, designed to absorb wound exudate and control the condition

wound hydration. Vapor-permeable films and membranes are also used as wound coverings.

Perforated absorbent film covers solve the problem of drying mesh dressings for wounds with light to moderate exudate.

The Austrian company "NYCOMED" produces an absorbent wound dressing "Tachocomb", designed for hemostasis and tissue bonding, especially during surgical interventions on the parenchyma of various organs (liver, spleen, etc.), in gynecology, urology, vascular surgery, traumatology, etc. .d. Tachocomb is a collagen plate coated with a special fibrin glue that contains fibrinogen, thrombin, riboflavin, etc. The Tachocomb plate applied to the wound is absorbed in the human body within 3-6 weeks. The coating is produced in hermetic packaging and applied under strict sterility conditions. Plate dimensions 9.5x4.8x0.5 cm; 1 PC. in a package, in a pack of 5 or 10 pcs.

Wound films are usually sterile perforated sheets of different colors (yellow, dark blue, colorless, etc.) depending on the antiseptics they contain. The range of wound films is presented on

Nomenclature of wound films

Polyvinyl alcohol aseptic film "Aseplen" is intended for the treatment of infected wounds, burns of I-II degrees, for temporary closure of transplanted skin autografts and donor sites. The films are produced in three modifications: with dioxidine (Aseplen-D), with iodine (Aseplen-I), with catapol (Aseplen-K). They are hydrophilic, easily modeled on the wound, due to perforated holes they do not interfere with the outflow of wound discharge, provide a prolonged antimicrobial effect, are easily removed from the wound surface, create a tender scab and favorable conditions for regenerative processes in the wound,

prevent the development of infectious complications. The transparency of the film provides visual control over the condition of the wound.

Perforated polyvinyl alcohol film "Viniplen" is intended for the treatment of wounds at donor sites in dermatomal skin grafting. It can also be used for temporary closing of flat wounds of other etiologies, in cosmetology, etc. The film is non-toxic, reduces the time of wound healing, avoids treatment with tanning disinfectant solutions, does not injure the wound and has good draining properties.

Film with vaseline "Vasoderm-S" is made on the basis of cotton fabric and special production and impregnated with a neutral ointment containing anhydrous wax, liquid vaseline, fish oil, Peruvian balsam. It is used to treat fresh and weeping wounds, burns, detached nails, ulcerations, phimosis operations, skin transplants in plastic surgery and various skin lesions. Advantages: does not stick to the wound, absorbs secretions, improves granulation and epigelization, prevents secondary infection, has an antiseptic effect.

Biological wound dressing "Biokol-1" is a transparent, elastic, porous film that reliably self-fixes on the wound, stimulates regeneration, which leads to accelerated wound healing. It has an absolute atraumaticity, has an analgesic effect. It is used to treat burns, trophic ulcers, protect donor sites and autografts.

The above films are produced in Russia.

Dressings are fabric applied to a wound or part of the body to protect against external influences and speed up healing.

Aseptic dressings are made of sterile dressing material (one or two cotton-gauze pads, gauze bandage and fixative) and are intended to protect against microbial contamination and other contamination of wound surfaces.

Elafom synthetic dressings are intended for the treatment of various wounds, including burns. Are issued in single packings, sterile. The use of these dressings can halve the number and duration of dressings.

Foreign manufacturers produce a variety of dressings as a type of wound dressing that absorbs exudates and has a therapeutic effect due to the content of various medicinal

substances (absorbent deodorizing, primary viscose, povidone-iodine, etc.).

In Russia, in recent years, new PS with immobilized enzymes have been developed, for example, Dalceks-trypsin, Lax-trinsin, Dalceks-Collitin. They are a cellulose or polycaproamide carrier with immobilized proteolytic enzymes, trypsin or with lysocine, collitin. They are used in surgery for the treatment of purulent-necrotic wounds at the stage of hydration, as well as bedsores, ulcers of various etiologies, and burns.

Study of the performance properties of polymeric dressings

O. A. Legonkova1, V. G. Vasiliev2, L.Yu. Asanova1

1FGBU "Institute of Surgery named after A.I. A.V. Vishnevsky" of the Ministry of Health of Russia; Russia, 117997, Moscow, st. Bolshaya Serpukhovskaya, 27; 2FGBU “Institute of Organoelement Compounds named after A.I. A.N. Nesmeyanov" RAS; Russia, 119991, Moscow, st. Vavilova, 28

Contacts: Olga Aleksandrovna Legonkova [email protected]

Currently, there are a large number of modern dressings in the form of sponges and films made on the basis of various polymers. In practical work, it is important for doctors to know the optimal specific values ​​of the key performance characteristics of dressings, which determine comfort and ease of use. As the main operational characteristics, we have chosen: sorption capacity, which determines the amount of liquid absorbed by a unit mass of material; modulus of elasticity, which is an indicator of the elasticity of the material; surface and apparent density of the material; as well as investigated the relationship between these performance characteristics.

We have suggested differentiating materials according to specific swelling values, as manufacturers categorize wound dressings with different amounts of exudate without specifying exact values. We also studied the physical and mechanical properties of multilayer dressings, paying attention to the parameters that determine the elasticity of the material.

Therefore, the purpose of this work as a whole is to conduct comparative tests of the operational properties of dressings of domestic and foreign manufacturers in order to assess the sorption and physico-mechanical properties.

Key words: dressings, deformation-strength characteristics, operational properties, polyurethane, cellulose, sorption capacity

DOI: 10.17650/2408-9613-2015-2-2-32-39

Investigation of polymeric wound dressings" operational properties

O.A. Legon"kova1, V.G. Vasil"ev2, L. Yu. Asanova1

IA.V. Vishnevsky Institute of Surgery, Ministry of Health of Russia; 27 Bolshaya Serpukhovskaya St., Moscow, 117997, Russia

2A.N. Nesmeyanov Institute of Organoelement Compounds, Russian Academy of Sciences; 28 Vavilova St., Moscow, 119991, Russia

Nowadays there are a lot of contemporary wound dressings in theforms like foams and films made on the basis of different polymers. It "s necessary to know optimal particular numeric values ​​of wound dressings" key operational properties, which determine comfort and easy to use.

As the basic operational characteristics we have chosen for investigation such parameters as: swelling behavior, which indicates the amount of liquid, swollen by the unit weight of the material; elastic modulus as a measure of material "s elasticity; surface and apparent density of the material; relations among these characteristics.

We "ve offered to differentiate materials in accordance with particular values ​​of swelling behavior, because manufactures range wound dressings for wounds with different amount of secreted exudate without specifying exact values.

Also physical and mechanical properties of multilayer wound dressings were investigated, paying attention to the elasticity of the material. So, the target of the investigation as a whole was thecomparison of wound dressings" operational properties from different manufactures to investigate swelling behavior, physical and mechanical properties.

Key words: wound dressing, deformation and strength characteristics, operational properties, polyurethane, cellulose, swelling behavior

Introduction

Evaluation of the effectiveness of modern dressings is one of the activities of the department of dressings, sutures and polymeric materials in surgery of the Testing Center of the Federal State Budgetary Institution “Institute of Surgery named after A.I. A.V. Vishnevsky" of the Ministry of Health of Russia. To date, for the management of the wound process, there is a sufficient

a range of dressings, such as hydrocolloid dressings, foams, films, differing in physical structure, chemical composition, methods of preparation and intended for wounds with different amounts of exudate.

The performance characteristics of synthetic and natural dressings are determined by the functional activity of the polymer base,

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Rice. 1. Samples under study

the correct choice of the drug and the method of its immobilization in the polymer matrix. At the same time, the properties of the polymer matrix should not reduce the bioavailability of drugs, sorption and desorption properties, and mechanical characteristics, i.e., the operational properties of the medical device as a whole.

The purpose of this work is to study the performance properties of some dressings in the form of sponges and films available on the Russian market and selected randomly. The products of the following companies were studied: Urgo (Urgoclean, Urgostart), Starmedix (foam dressing, silver foam dressing, oxidized carboxymethylcellulose, oxidized regenerated cellulose, alginate dressing, silver alginate dressing), Cellonex, Bay-medix, Advancis medical (Advazorb, Advazorb Border, Eclypse ), Smith&Nephew (Allevyn Life), Cureamedical (Curea P1, Curea P1 drain, Curea P2), Vancive (Bene-hold), NPP Nanosintez LLC (Hyamatrix), AS-pharma OJSC (Biodespol-1), LLC "SPC Amphion" (Vini-krol-M), OJSC Luzhsky plant "Belkozin" (hemostatic collagen sponge, Meturakol). Products are differentiated by manufacturers according to their purpose for wounds with different amounts of exudate: high-, medium-, low-exuding (Fig. 1).

Materials and methods

In the study, 20 types of samples of dressings indicated above were used. For statistical evaluation of the experimental results, a series of 10 or more tests was performed on each sample.

Since there are currently no target regulatory documents for modern dressings in the form of sponges and films, the selected samples were examined according to the regulatory documents used in the registration procedure for medical devices: GOST 29104.1-91, GOST 9412-93, GOST 3913-72, GOST 409-77, GOST 15873-70, GOST

24616-81, GOST 26605-93, GOST 29088-91, GOST 2908991, GOST 2439-93, GOST 14236-81.

Performance was evaluated by:

♦ swelling coefficient (g/g; at t = 25 °C), which was calculated by the formula:

Q = (Mw - Ms) / Ms, where Mw and Ms are the masses of the wet and dry samples, respectively;

♦ swelling rate constant (min-1), which is the tangent of the slope of the straight line in coordinates: 1^m/ - Q) = K(0,

where Q is the amount of liquid absorbed by 1 g of the swelling substance during the time ^ Qm is the maximum amount of absorbed liquid (limiting swelling);

♦ surface density (rpov), mass in grams per 1 m2 of material (g/m2);

♦ apparent density value (for porous sponges) (rkazh), mass in grams per 1 m3 of material (g/m3);

♦ modulus of elasticity, stress and relative strain in tension (MPa) - the tangent of the slope of the dependence stress/relative strain in tension, characterizes the elasticity of the material (Erast);

♦ modulus of elasticity and stress in compression - the tangent of the slope of the dependence stress/relative strain in tension, characterizes the elasticity of the material (Ecompress).

The deviations of the obtained values ​​in the determination of sorption and physico-mechanical properties do not exceed 10% of the average value. Compression was carried out at 10% at a clamping speed of 30 mm/min. In tensile testing of specimens, the clamping speed was 50 mm/min.

Brief information on the initial characteristics is presented in Table. one.

Table 1. Test objects differentiated by the manufacturer according to their purpose

Starmedix Foam Dressing* Pp = 605.1 ± 46.5 g/m2; RKaj = 1492.6 ± 119.2 g/m3 Polyurethane, sodium polyacrylate

Starmedix Silver Foam Dressing Pp = 293.1 ± 0.2 g/m2; Rkazh = 1068.7 ± 77.6 g/m3 Polyurethane + silver

Cellonex Ppov = 314.6 ± 10.6 g/m2; Pp°w = 700.8 ± 72.3 g/m3 Regenerated cellulose and cotton fiber

Continuation of the table. 1 End of the table. one

Brand name, density Dressing base

Baymedix Ppov = 417.8 ± 14.2 g/m2; RKaj = 1753.4 ± 36.3 g/m3 Polyurethane

Vinicrol-M Rpov = 669.1 ± 77.4 g/m2; Pp°l = 1115.1 ± 129.0 g/m3 Polyvinyl alcohol

Eclypse 1-Ppov = 85.1 ± 4.1 g/m2; 2 - Рsov = 56.8 ± 3.8 g/m2; 3 - Рsov = 206.9 ± 22.5 g/m2; 4 - Рpow = 86.5 ± 11.9 g/m2 Cellulose-based multi-layer coating

Allevyn life 3 - Ppov = 737.3 ± 107.5 g/m2; Papp = 3686.4 ± 537.4 g/m3; 4 - Rpov = 484.1 ± 14.9 g/m2; Ppow = 1613.6 ± 49.4 g/m3 Breathable film / Protective layer / Super absorbent layer / Porous sponge / Silicone layer

Curea P1/Curea P1 drain Pp = 481.2 ± 26.6 g/m2 Epoxy resin, cellulose

Collagen hemostatic sponge Belkozin Рcase = 1264 ± 65 g/m3 Collagen

Meturacol Rkazh = 1137.1 ± 180.7 g/m3 Collagen

Urgostart Рsov = 645.3 ± 41.4 g/m2; Pcase = 1411.4 ± 7.8 g/m3 Polyurethane with silicone contact layer

Advazorb Ppov = 624.9 ± 36.7 g/m2; P^w = 1315.1 ± 60.5 g/m3 Polyurethane

Advazorb Border Pp = 799.3 ± 39.5 g/m2; Pcase = 3996.7 ± 197.3 g/m3 Polyurethane with silicone contact layer

Starmedix Alginate Dressing Pp = 152.4 ± 6.3 g/m2 Calcium alginate

Starmedix Silver Alginate Dressing Rp = 150.25 ± 10.9 g/m2 Calcium alginate + silver

Curea P2 Psov = 473 ± 50.9 g/m2 Epoxy resin, cellulose

Urgoclean Pp = 373.0 ± 15.2 g/m2 Ammonium polyacrylate with acrylic core

Starmedix Oxidized Carboxymethyl Cellulose Pp = 102.2 ± 15.5 g/m2 Oxidized Carboxymethyl Cellulose

Starmedix Oxidized Regenerated Cellulose Pp = 232.6 ± 25.5 g/m2 Oxidized Regenerated Cellulose

Benehold (for weakly and moderately exuding wounds) Рpov = 172.8 ± 5.1 g/m2 Polyurethane with acrylic contact layer

Brand name, density Dressing base

Biodespol-1 (for the treatment of II-111A degree burns) 1 - Рsov = 62.5 ± 2.7 g/m22 2 - Рsov = 124.5 ± 3.4 g/m2 Copolymer of lactide with glycolide

Nuasha ^1x (for the restoration of skin defects) Ps = 62.4 ± 1.9 g/m2 Hyaluronic acid

*Apparent density values ​​are given for porous samples only.

Results and discussion

The results of the study of the sorption properties of the samples are given in table. 2 and in fig. 2-5.

Table 2. Values ​​of the degree and rate constants of swelling of the studied samples of medical devices

Grade Equilibrium values ​​of swelling degree, g/g Swelling rate constant, min-1

Dressings for highly exuding wounds

Starmedix Foam Dressing 13.7 ± 0.3 0.083

Starmedix Silver Foam Dressing 15.1 ± 0.5 0.073

Cellonex 16.1 ± 1.2 0.052

Baymedix 17.4 ± 0.6 0.068

Vinicrol-M 16.9 ± 0.6 0.065

Allevyn Life 16.1 ± 0.8 0.081

Curea P1/Curea P1 drain 41.8 ± 2.6 0.1

Eclypse 53.7 ± 4.1 0.047

Hemostatic collagen sponge Belkozin 52.3 ± 1.4 0.087

Meturacol 8.2 ± 0.2 0.085

Dressings for moderately exuding wounds

Urgostart 11.2 ± 0.4 0.067

Advazorb 14.5 ± 0.6 0.08

Advazorb Border 4.4 ± 0.4 0.063

Curea P2 38.8 ± 2.6 0.076

Starmedix Alginate Dressing 10.7 ± 0.6 0.17

Starmedix Silver Alginate Dressing 13.2 ± 1.4 0.11

The end of the table. 2

Grade Equilibrium values ​​of swelling degree, g/g Swelling rate constant, min-1

Urgoclean 8.5 ± 0.2 0.054

Dressings for low-exuding wounds

Starmedix Oxidized Regenerated Cellulose 5.6 ± 0.7 0.051

Starmedix Oxidized Carboxymethyl Cellulose 11.0 ± 0.6 0.13

Benehold 6.2 ± 0.6 0.028

Hyamatrix 7.2 ± 1.2 0.051

Biodespol-1 3.9 ± 0.3 0.062

Starmedix Foam Dressing Starmedix Silver Foam Dressing

Cellonex Baymedix Vinicrol-M Allevyn Life

5 6 Time, h

■ Curea P1 Eclypse

Rice. 2. Curves of swelling of dressings for highly exuding wounds

Swelling rates for most dressings for highly exuding wounds range from 13.7 ± 0.3 to 17.4 ± 0.6 g/g or above 40 g/g (note that these samples are based on natural polymers) . Even if a swelling-limiting layer, such as epoxy resin or silicone, is present, the values ​​for the degree of swelling are high.

In dressings for moderately exuding wounds, the values ​​of the degrees of swelling are in the range

4 5 6 7 Time, h

Urgostart Advazorb ■ Advazorb Border Starmedix Alginate Dressing

Starmedix Silver Alginate Dressing Urgoclean

012345678 Time, h

Rice. 3. Swelling curves of dressings for moderately exuding wounds

□ 1 2 3 4 5 b? E

Rice. 4. Curves of swelling of dressings for low-exuding wounds

Biodespol-1

2 3 Time, h

Rice. 5. Film swelling curves

vale from 8.5 ± 0.2 to 14.5 ± 0.6 g/g. In the case of the Advazorb Border sample (Q = 4.4 ± 0.4 g/g), the silicone contact layer reduces the absorption capacity, which puts the sample in the group of sponges for low-exuding wounds and films.

Samples of Fe1urFe, Cugea P1, and Cugea P2 stand out (equilibrium values ​​of the degrees of swelling: 53.7 ± 4.1; 41.8 ± 2.6 and 38.8 ± 2.6 g/g, respectively) made of cellulose.

In the group of dressings for low-exuding wounds, the values ​​of the degree of swelling are in the range from 5.6 ± 0.7 to 11.0 ± 0.6 g/g.

In the group of films, the values ​​of the degree of swelling range from 3.9 ± 0.3 to 7.2 ± 1.2 g/g.

Thus, the ranges of swelling degrees of sponge dressings for high and medium exuding wounds overlap. It can be assumed that the values ​​of the degree of swelling of dressings for highly exuding wounds should start from the value of 14 g/g, for medium exuding - to be in the range from 8 to 14 g/g, for low exuding - below 8 g/g.

Therefore, the division recommended by the manufacturer is very conditional. For example, a sample of the brand UCLOCLEAN is recommended by the manufacturer for highly exuding wounds, while its degree of swelling is 8.5 ± 0.2 g/g.

From the values ​​of the swelling degree kinetics obtained experimentally, the swelling rate constants were calculated. For dressings in the form of sponges for highly exuding wounds, the values ​​of the constants are in the range from 0.047 to 0.1 min 0.028 to 0.062 min-1. However, it is interesting to note that sponges based on polyurethane from different manufacturers have approximately the same swelling rates, in the range from 0.06 to 0.08 min-1.

Rice. Fig. 6. Distribution histogram of the equilibrium values ​​of the degrees of sponge swelling with increasing apparent density

Despite the fact that the swelling rates of the sponges vary significantly, in general, all samples reach equilibrium swelling in 0.5-1.5 h. The films behave somewhat differently: equilibrium swelling is observed after 4 h. In this work, we did not study the processes of drug migration from various polymer matrices under conditions of a completed sorption process, when the diffusion rate of the latter is significantly hindered.

It should be noted that no relationship between the apparent density and the equilibrium values ​​of the degrees of swelling was found (Fig. 6).

The next stage of the work was the study of the physical and mechanical properties of dressings in the dry and swollen state of sponges and films under various deformation conditions (tension and compression) in order to investigate changes in the properties of materials. The data are given in table. 3-5.

Table 3. Changes in the physical and mechanical properties of sponges during tensile testing

Starmedix Foam Dressing

Starmedix Silver Foam Dressing

0.1 ± 0.01 0.29 ± 0.02

0.26 ± 0.04 0.35 ± 0.034 1.0 ± 0.1 0.8 ± 0.05

Dry samples

swollen samples

78.7 ± 10.4 393.9 ± 19.1

433.8 ± 75.0 37.7 ± 7.5 47.7 ± 6.8 32.5 ± 3.5

Yarast MPa

0.1 ± 0.01 0.34 ± 0.04

0.15 ± 0.08 2.3 ± 0.3 6.1 ± 0.9 5.3 ± 0.5

0.024 ± 0.003 2.3 ± 0.2

0.14 ± 0.03 154.0 ± 1.2

The sample is destroyed 0.12 ± 0.026 238.9 ± 42.7

0.095 ± 0.012 0.057 ± 0.0057

120.7 ± 12.9 Forms a gel Forms a gel Forms a gel

0.02 ± 0.007 0.08 ± 0.01

0.096 ± 0.021 0.04 ± 0.002 0.06 ± 0.005

0Dast, MPa

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Table 4. Physical and chemical properties of sponges under compression

Grade "compressed* Mpa Ezhat MPa

Cellonex 0.03 ± 0.002 0.13 ± 0.04

Starmedix Foam Dressing 0.003 ± 0.0002 0.02 ± 0.004

Baymedix 0.005 ± 0.0004 0.05 ± 0.006

Urgostart 0.002 ± 0.0008 0.013 ± 0.0001

Starmedix Silver Foam Dressing 0.005 ± 0.001 0.038 ± 0.006

Vinicrol-M 0.1 ± 0.07 0.8 ± 0.009

Advazorb 0.002 ± 0.0002 0.01 ± 0.002

As a criterion for the atraumaticity of dressings, the modulus of elasticity (E, MPa) was used as a measure of the elasticity of the material, which is a key parameter that determines its comfort for the patient during operation.

From a series of experiments on changing the physical and mechanical properties, it can be seen that the swollen sponges lose their strength properties, and the studied films practically do not change their performance in the wet state. The best mechanical properties in this study are polyurethane films with an acrylic contact layer Bene-hold.

The compressive elastic moduli compared with the tensile elastic moduli for samples of polyurethane sponges without a top film coating (Baymedix, Starmedix Silver Foam Dressing) decrease by 2.2 times. For samples with a film coating, the difference was: Starmedix Foam Dressing - 10 times, Urgostart - 26 times, Advazorb - 15 times. This increase is precisely explained by the effect of the film coating on the strength of the samples.

Despite the fact that the elastic modulus of the sponges decreases with increasing degree of swelling (Fig. 7), which is associated with the plasticizing effect of sorbi-

Rice. Fig. 7. Dependence of the tensile modulus of samples in the swollen state on the degree of swelling (on the example of polyurethane sponges)

Rice. Fig. 8. Dependence of the ratio of elastic moduli in the dry and swollen state of the samples on the magnitude of the degree of swelling (on the example of polyurethane sponges)

liquids, the ratio of the elastic moduli in the dry and swollen state remains practically unchanged (Fig. 8).

In the case of monolayer materials, the lower the modulus of elasticity, the softer and more elastic is

Table 5. Changes in the physicochemical properties of films under tension

Grade Dry samples Swollen samples

Vcr> MPa £, % MPa VcT MPa £, % EpacT MPa

Hyamartix 10.1 ± 2.3 3.3 ± 1.6 335.0 ± 106.2 0.9 ± 0.2 6.3 ± 3.1 1.9 ± 0.8

Biodespol-1 (1) 62.8 ± 6.4 4.5 ± 0.5 2666.7 ± 400 22.8 ± 9.5 6.4 ± 2.3 400.6 ± 53.7

Biodespol-1 (2) 27.0 ± 3.7 4.1 ± 0.3 855.6 ± 361.0 Sample slides

Benehold 11.0 ± 1.5 1056.7 ± 55.0 3.4 ± 0.1 5.6 ± 2.1 932.9 ± 266.2 3.3 ± 0.6

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0,4 0,35 0,3 0,25 0,2 0,15 0,1 0,05 0

293,1 417,8 605,1 624,9 645,3

medix Silver Foam essing X mk<и Е medix Foam essing ■Q О N a го (Л o

Rpow, g/m2

Rice. Fig. 9. Histogram of the distribution of tensile moduli depending on the surface density on the example of polyurethane sponges (the last three samples are coated in the form of a film)

0,06 0,05 0,04 0,03 0,02 0,01 0

Rice. Fig. 10. Histogram of the distribution of moduli of elasticity in compression depending on the surface density on the example of polyurethane sponges (the last three samples are coated in the form of a film)

the material itself. In the case of multilayer materials (in our version, for sponges), during tensile tests, the modulus of elasticity is determined by the most elastic layer of the multilayer structure of sponges (additional silicone and / or polyurethane film layer), during compression tests, by the porous component of the multilayer material, which was confirmed as a result of the tests (Fig. 9, 10).

Conclusion

The work studied the performance properties (water absorption (swelling) and mechanical properties)

stva) dressings made of individual and multilayer materials produced by several manufacturers and intended for wounds with varying degrees of exudation. It should be noted that the division by the manufacturer of dressings according to the use for wounds with different amounts of exudate is very conditional. As a result of the study, it was calculated that the degree of swelling of dressings for highly exuding wounds should start from 14 g/g, for medium exuding wounds it should be in the range from 8 to 14 g/g, for low exuding wounds it should be less than 8 g/g.

The degree and rate constant of swelling weakly depend on the purpose of the dressings, but are determined by the type of material.

The degree of swelling does not depend on the surface and apparent density, in contrast to the mechanical characteristics.

The most resistant to breaking loads are samples of sponges and films made of polyurethane (in the swollen and dry state), as well as multi-layer dressings (with a silicone layer and/or film-like top coating). The mechanical properties of coatings depend on the surface and apparent densities of porous coatings.

The elastic modulus and deformation-strength characteristics of multilayer materials depend on the load application mode (tension or compression). The mechanical properties of combined (multilayer) materials are determined by the polymer coating in tension; in compression, the properties of the porous sponge will be decisive.

The value of the modulus of elasticity serves as an additional criterion for technical tests for the registration of dressings, which determines the performance of materials under various types of load application.

Due to the fact that there are currently no target standards for modern dressings in the form of sponges and films, the need for their development becomes obvious and relevant. In the meantime, unfortunately, one has to rely on the experience of clinical practice or contact accredited laboratories to study the performance properties of dressings purchased at a specific medical institution.

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1. GOST 29104.1-91. Technical fabrics. Methods for determining linear dimensions, linear and surface densities. .

2. GOST 9412-93. Medical gauze. General specifications. .

3. GOST 3913-72. Textile materials. Fabrics and handicrafts. Methods for determining discontinuous characteristics in tension. .

4. GOST 409-77. Cellular plastics

and rubber sponges. Method for determining the apparent density. .

5. GOST 15873-70. Plastics are cellular elastic. Tensile test method

LITERATURE

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8. GOST 29088-91. Materials polymeric cellular elastic. Determination of conditional strength and relative elongation at break. .

9. GOST 29089-91. Materials polymeric cellular elastic. The definition of the

precise compression deformation. .

10. GOST 2439-93. Materials polymeric cellular elastic. Determination of indentation hardness. .

11. GOST 14236-81. Films are polymeric. Tensile test method. .

12. Tsyurupa N.N. Workshop on colloid chemistry. M., 1963. S. 139-40. )