Evaluation of the effectiveness of correction of cicatricial deformation of soft tissues in the lumbar region using laser phoresis of a gel containing heparin and cepalin in patients with myelodysplasia

Introduction. Myelodysplasia is a collective term that combines a large group of spinal cord malformations with typical localization (most often within the L_I-S_V segments). If myelodysplasia manifests as a myelocele, it requires urgent surgical intervention in the first hours after the child’s birth to excise the myelocyte. Treatment and rehabilitation of such children include using technical means of rehabilitation (TMR): orthoses, mobile vehicles, compression garments, etc. Success in the treatment and socialization of the patient depends on an individual approach for selecting TMRs and their maximum fit to the child’s body. In many cases, mature deforming scars of the lumbosacral region in a child challenge achieving the goal of rehabilitation and socialization of a disabled child.

Aim. To evaluate the effectiveness of the local therapy regimen, including laser phoresis of the drug with proteolytic activity, Contractubex gel, and its subsequent application to the scar tissue area without laser phoresis in disabled children after surgical excision of a myelocele. The therapy’s effectiveness criteria include softening and flattening old hypertrophic scars, increasing range of motion, decreasing tissue tension in the lumbosacral region, and improving the scar’s aesthetic condition.

Materials and methods. The main group included 20 children, 8 females and 12 males. The children were 5–17 years old, with a mean age of 11 years. The control group included 20 children (7 females, 13 males) aged 2–16, with a mean age of 11. Contractubex gel, manufactured by Merz Pharma LLC, was used to treat mature postoperative scars of the lumbosacral region in 20 main group patients. Proposed method and treatment regimen: 7 daily procedures of laser phoresis of the gel on the scar area, followed by switching to daily topical gel application without laser phoresis for 3 months. Evaluated indicators included scar width, size, color, pigmentation, vascularization, density, itching in the scar area, pain, feeling of skin tension, limited mobility, defects on the scar (cracks, wounds, ulcers), aesthetic discomfort, and quality of life. Each indicator was evaluated with 0 to 4 points, where 0 is the absence of a sign, and 4 is the most pronounced dissatisfaction with the sign. Statistical analysis was performed using the Page test.

Results. As a result of the therapy using the proposed regimen, in the main group, there was an improvement in the quality of life of children of 24±3 points and the achievement of positive results in several criteria at once, such as a decrease in pigmentation and vascularization of the scar, a decrease in the density of the scar and a decrease in the feeling of tension in the soft tissues surrounding the scar. According to the study findings in the main group, the average score before the start of treatment was 21 points vs. 16 points after the treatment. In the comparison group, the average baseline score was 18 vs. 17 at the end of the study. Improvements in the main group of patients led to increased quality of life and the possibility of more comfortable use of various TMRs that affect the scar area (locomats, exercise machines, corsets, etc.).

Conclusion. Correction of mature postoperative scars in the lumbosacral region in children operated for myelocele with a Contractubex containing onion extract (Cepalin), heparin, and allantoin according to the regimen with sequential use of laser phoresis and application of the drug without laser phoresis to the scar area has shown its effectiveness and is quite promising. The proposed therapy method helps to solve such problems as increasing the range of motion, the possibility of using TMRs, reducing the tension of the surrounding tissues, and improving the esthetics of the scar.