The use of bioactive borate glass for the treatment of trophic wounds in children with myelodysplasia

Goal. Evaluate the possibility of using borate glass material in the treatment of trophic wounds in children with myelodysplasia.

Materials and methods. Data on 3 children who underwent surgery for spinal hernias in the neonatal period are presented. All children due to myelodysplasia had impaired trophism of the lower extremities, which led to severe healing of wounds or bedsores. Bioactive borate glass "Mirragen" made in the USA for the treatment of trophic wounds in these children was offered by Medivo Medical Center.

Results. The use of bioactive borate glass in the treatment of trophic wounds in children with myelodysplasia was effective. Deep wounds completely healed without complications within 8 weeks, and superficial wound-bedsores - within 5 weeks. The wounds gradually epithelialized both from the depths and from the periphery at a rate of up to 12–15% of the area per week. No adverse general or local reaction to borate glass was observed in patients.

Conclusions. The temporary biomaterial framework from borate glass provides the necessary form for formation of new fabrics and promotes fast healing of wounds. The use of bioactive borate glass is a cost-effective and effective method of treating trophic wounds in children with myelodysplasia.

Key words: bioactive borate glass; wounds that are difficult to heal; children.

MG Melnichenko¹, IR Dilanyan², LP Matviychuk², AM Klimenko³

¹ Odessa National Medical University,
² Odessa regional children's clinical hospital,
³ Medivo Medical Center, Odessa

The use of bioactive borate glass

Wound healing as a normal biological process

Wound healing as a normal biological process in the human body has four phases: hemostasis, inflammation, proliferation and remodeling. For successful primary wound healing, all four phases must occur in the proper sequence and time frame. According to the literature, in the case of normal healing, the wound area is reduced to 4% per day. But there are many factors that affect this process, causing a violation of the sequence of phases of healing. The authors emphasize the influence on the regeneration process of both endogenous (age parameters and sex hormones, stress, diabetes, obesity, etc.) and exogenous (oxygenation disorders, infection, drugs, alcoholism, smoking, nutrition, etc.) factors [1, 2].

In children, the process of wound healing is influenced by the presence of various denervation changes of the lower extremities, the development of neuropathy in the presence of congenital myelodysplasia. Severe trophic disorders in the form of trophic ulcers of the perineum and lower extremities, which do not heal for a long time, occur in 32.9% of patients [3]. The approach to the treatment of myelodysplasia is complex and depends on the characteristics of a particular patient, and the results - on the degree of neurological disorders.

It is known that ulcers in myelodysplasia heal for a long time. According to research, even when the level of medical care is good, in 3-6 months complete epithelialization of wounds occurs in only 24.2% of patients [3]. Thus, despite the presence of established treatment protocols, the healing of trophic wounds in children is a long, laborious, costly process. Therefore, there is a need to create innovative medical technologies that will complement the basic approaches to the treatment of trophic wounds in children and lead to a significant reduction in the healing time of wounds, reducing the frequency of complications [2, 4]. As you know, in late autumn 2010, under the supervision of the internal committee of the Audit Regional Medical Center of Phelps County, an empirical study of the created fibrous borate glass material produced by Mo-Sci for medical use in patients with venous stasis [5]. The developed borate glass had fibers 300 nm long and up to 5 μm in diameter. The structure of the material mimicked the microstructure of fibrin, which is the basis of the thrombus to support the healing process. It has been shown that in vitro borate glass had a beneficial effect against E. coli, salmonella and staphylococci [6].

Special cotton fiber at the same time slows down bleeding, stimulates the body's natural healing mechanisms, prevents scarring, and therefore is quickly absorbed by surrounding tissues. The temporary biomaterial frame made of borate glass provides the necessary shape or support while the new tissue is growing, and is an important aspect of all tissue engineering [5, 6]. Bioactive glass in terms of its strength, biocompatibility and range of achievable properties is widely used to expand support in tissue engineering [6]. But in recent publications we have not found data on the use of bioactive borate glass in the treatment of wounds in children with myelodysplasia.

Wound healing as a normal biological process

Materials and methods of research

Data on 3 children treated at the Odessa Regional Children's Clinical Hospital are presented. All children (two boys aged 10 and 14 years and one girl aged 6 years) in the neonatal period were operated on for spinal hernias. In all children due to myelodysplasia, the trophism of the lower extremities was impaired, which led to severe healing of wounds or bedsores.

All children underwent a complete general clinical and instrumental examination according to the indications (ultrasound examination, computed tomography of the abdominal cavity). The research was conducted in accordance with the principles of the Declaration of Helsinki according to the protocol approved by the Local Ethics Committee of the institutions mentioned in the article. Informed parental consent was obtained for the research. Bioactive borate glass "Mirragen" made in the USA for the treatment of trophic wounds in these children was offered by Medivo Medical Center free of charge.

Materials and methods of research

Results

The effectiveness of the proposed method of treatment of trophic wounds or ulcers was evaluated by the clinical course of wound healing (pain or discomfort in the wound, healing rate, recovery time), the occurrence of complications (suppuration, colloid scar). According to our observations, no child complained of pain or discomfort from the presence of bioactive borate glass in the wound.

The rate of wound healing and recovery time, in our opinion, depended on its area and depth. Thus, a superficial bedsore healed 2 times faster than deep wounds. Due to the anti-inflammatory properties of boron during the use of bioactive borate glass in children there was no suppuration of wounds. At the end of treatment, patients also did not have colloid scars. As the problem of wounds in difficult-to-heal children is insufficiently covered, we consider it necessary to provide clinical observations.

Results

Patient S., 6 years old

Diagnosis: congenital malformation of the central nervous system, spinal hernia of the lumbar spine, the condition after plastic surgery; lower flaccid paraparesis, bilateral rigid valgus deformity of the feet; trophic deep (to the heel bone) ulcer of the soft tissues of the right heel.

Trophic ulcer in the patient was observed during the year, in addition to drugs, dermoplasty was performed twice, but due to tissue trophic disorders there was no effect. Our hospital offers treatment with bioactive borate glass. After surgical treatment to clear the trophic ulcer, a wound 18 mm in diameter, up to 20 mm deep, was formed, in which bioactive borate glass was loosely placed, and an aseptic bandage was applied on top (Fig. 1a). Bandaging was done once a week for eight weeks. Thanks to borate glass, wound regeneration took place both from the depth and from the periphery. Already in the second week, the restoration of vascularization in the regeneration zone of the trophic ulcer was morphologically confirmed, and in the eighth week, complete wound healing (Fig. 1b).

Fig. 1. Patient S., 6 years old.
a - trophic deep (to the heel bone) ulcer of the soft tissues of the right heel;
b - eight weeks after the start of treatment, complete wound healing.

Patient S., 6 years old

Patient V., 10 years old

Diagnosis: congenital malformation of the central nervous system, spina bifida of the lumbosacral spine, syringomyelia at the level of VTHI-LIII; lower paraparesis, static and gait disorders, pelvic reservoir function; post-traumatic trophic deep (to the heel bone) soft tissue ulcer of the left heel.

The boy injured his left heel, after which he developed a deep wound for 6 months. Necrectomy was performed and treatment with bioactive glass was proposed. At the beginning of treatment, the diameter of the wound was up to 25 mm, the depth of the wound - up to 45 mm. The wound was treated and loosely tamped with bioactive borate glass (Fig. 2a). Examination and dressing were done once a week. During the first 4 weeks, the bandages were abundantly soaked with wound exudate, and the wound healed from the bottom. Morphologically confirmed active germination of connective tissue from the periphery of the wound. At the eighth week, complete wound healing was determined (Fig. 2b).

Fig. 2. Patient V., 10 years old.
a– post-traumatic trophic deep (to the heel bone) wound of the left heel;
b - complete wound healing on the 56th day of treatment.

Patient V., 10 years old

Patient N., 14 years old

Diagnosis: congenital malformation of the central nervous system, spinal hernia of the lumbar spine, the condition after plastic surgery; lower paraparesis, trophic bedsores of the sciatic bone. The boy had bedsores in the sciatic bone several times, the latter was treated for two months.

The use of borate glass is proposed. After cleaning the wound, borate glass was applied to the decubitus wound measuring 25 and 25 mm (Fig. 3a). Within five weeks, the decubitus ulcer completely healed (Fig. 3b). According to the first experience of using bioactive borate glass for the treatment of trophic wounds in children with myelodysplasia, complete healing of deep wounds after 6 and 12 months of previous unsuccessful treatment was observed within 8 weeks without complications, and superficial bedsores - within 5 weeks. The wounds gradually epithelialized both from the depths and from the periphery at a rate of up to 12–15% of the area per week. No adverse general or local reaction to borate glass was observed in patients. The obtained result testifies to the effectiveness of using bioactive borate glass for the treatment of trophic wounds in children with myelodysplasia.

Fig. 3. Patient N., 14 years old.
a - borate glass is applied to the trophic bedsore;
b - the condition of the wound in the fifth week of treatment

Patient N., 14 years old

Discussion

The healing process of trophic wounds in children with myelodysplasia is disrupted due to neuropathy, which requires the use of the latest bioactive materials for their treatment. For this purpose, we used bioactive borate glass in three children with trophic wounds of the lower extremities. After cleaning the wound, it was loosely filled with fiberglass under an aseptic bandage once a week. The wounds were observed until complete healing, which is documented photographically. Analysis of the healing process of trophic wounds showed a tendency to accelerate it. Thus, the area of wounds decreased by 12–15% every week, the wounds were closed both from the bottom (depth 20 mm - in the first observation, 45 mm - in the second) and from the periphery to the center. There was no infection or other complications of wound healing during the entire treatment period.

Morphometric analysis of tissues taken from the periphery of the wounds confirmed the restoration of vascularization in the regeneration zone, active germination of connective tissue and biocompatibility of the applied material. Macro- and microscopic adverse reactions to bioactive borate glass were not determined in our observations. In addition, the treatment process is economical, which we consider necessary to emphasize, as it is very important in pediatric surgery.

The obtained results give grounds to recommend the use of bioactive borate glass for the treatment of trophic wounds in children with myelodysplasia. Our positive initial experience encourages us to continue to study the possibilities of using bioactive fiberglass in the treatment of wounds of second origin.

Discussion

Conclusions

Trophic disorders in children with myelodysplasia require bioactive methods of treatment, which can significantly reduce the healing time of wounds, reduce the incidence of complications.
The temporary biomaterial framework from borate glass provides the necessary form for formation of new fabrics and thus promotes fast healing of wounds.
The use of bioactive borate glass is a cost-effective and effective method of treating trophic wounds in children with myelodysplasia.

Conclusions

Confirmation

Financing. At your own expense.
The authors declare no conflict of interest.
All authors have read and approved the final version of the manuscript.
All authors have agreed to publish this manuscript.
MG Melnychenko - concept and design of research, analysis of the received data, writing of the text; IR Dilanyan - collection and processing of materials; LP Matviychuk - collection and processing of materials; AM Klymenko - collection and processing of materials.

Confirmation

The use of bioactive borate glass for the treatment of trophic wounds in children with myelodysplasia

Wound healing as a normal biological process

Materials and methods of research

Results

Patient S., 6 years old

Patient V., 10 years old

Patient N., 14 years old

Discussion

Conclusions

Confirmation

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