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Management of post operative Fistulectomy wound with Panchatikta ghrita application
Fistula in ano is one of the most common benign anal conditions in daily surgical practise. It is defined as an epithelialised abnormal track connecting two surfaces, usually the rectal mucosa and perianal skin. Conventional surgical options for a low fistula in ano include a Fistulotomy and Fistulectomy. These both lay open the fistulous tract, thus leaving smaller unepithelialised wounds which hasten the wound healing.
The treatment of this condition still poses a surgical problem due to its tendency for recurrence and the risk of causing incontinence. Anal fistula disease has its maximum incidence between the third and fifth decades. The male: female ratio is at least 2:1.
There are many measures to create favourable conditions for wound healing such as use of antiseptic solutions and many topical de-sloughing and debridement agents which promote healing but, there are certain drawbacks of these agents like damage to healthy granulation tissue, local skin irritation etc. Since time immemorial, it has been an ongoing process to search out better remedies in order to overcome the previous drawbacks.
Keeping in view aforesaid problem ancient literature was explored and formulation Panchatikta ghruta application as mentioned in Bhaishaja Ratnavali and Yoga Ratnakara 1 is taken for study.
AIMS AND OBJECTIVES:
To study management of post operative fistulectomy wound with Panchatikta ghrita application.
MATERIAL AND METHODS:
- Source of the data : study is carried out in “IPD of Shalyatantra , Y.M.T. Ayurvedic medical college and hospital , kharghar , navi Mumbai
- Type of study: single case study.
A male patient GS of age 36 years. He was complaining of-
- pain at operated site
- Discharge from the wound since 6-7 days
No H/O – DM / HTN/ KOCH’S / Bronchical Asthama
No H/O – Any drug allergy.
P/M/H – NIL
P/S/H- fistulectomy done on 8th may 2015
O/E – G.C- fair
T- A febrile
Wt - 73 Kg
P- 80/ MIN
B.P.- 120/ 80 mm of hg.
S/E- RS- AEBE Clear
CVS- S1 ,S2- normal
CNS- conscious and oriented properly.
P/A- Soft and non tender.
P/H- Bowel – irregular bowel habit
Bladder –normal habit
Sleep – normal
Appetite - normal.
Addiction: - no any specific addiction
- CBC with ESR
- Cultural sensitivity
Treatment planned as follows:
Application of panchatikta ghrita on post operative fistulectomy wound
A single patient was selected who was diagnosed as fistula in ano. Patient was definitive treatment. Data related to the objectives of the study was collected.
An Informed written consent of the patient included in trial in the language best understood by him was taken. C R F was prepared for this study.
Post operative fistulectomy wound was cleaned by Normal saline. Required amount of Panchatikta ghrita was taken on sterile gauze and applied directly over the wound and dressing was done. Application of Panchatikta ghrita was done till healthy granulation tissue was seen.
Discussion on drug review:
Though a wide variety of chemical substances have been evaluated for their efficacy as wound healing agents, with limited success, little correlation has been observed in their molecular structure and mechanism of action. A natural product, Asiaticoside from Centella asiatica has been found to be effective in wound healing. Similarly, Curcumin from Curcuma longa with antioxidative properties has been found useful in wound healing. Several other herbal products from Aloe Vera, Lithospermum erythrohizon, Alkana tinctoria etc. have not only been used traditionally in wound healing but have also been found effective in clinical trials.
Procedure Discussion on Characteristic features
Size: With the help of ―Prinana and ―Vrana Ropana action of trial drug acted as promoter on rate of contraction.
Pain and Tenderness: By the virtue of ―Shita and ―Shoolhara properties of trial drug the pain and tenderness subsides.
Smell: Panchatikta containing very good fragrance of volatile oil and this is helpful in to bad odour of the infected Vrana.
Discharge: By the virtue of ―Shita and ―Katu property of trial drug, the discharge is ceased.
Swelling: ―Shothahara property of the drug demolishes the ―Shotha (Swelling) of the Vrana.
Colour: Ghrita contain Varnya properties which is helpful to enhance the local appearance of the wound.
Infection: The trial drug has ―Krimihara property and Panchatikta has antiseptic property. This is help to sweep out the infections from the wound.
Unhealthy granulation tissue: ―Lekhana and ―Shodhana stop the unhealthy granulation tissue in wound. Hence, the Panchatikt ghrita has the basic qualities of controlling the cardinal symptoms of the ―Vrana , these proves the efficacy of the drug in ―Vrana Ropana .
From the discussion on the subject " Management of post operative fistulectomy wound with panchatikta ghrita application”following conclusions can be drawn -
1. Panchatikt ghruta has shown Vranashodhaka, Vranalekhana, Putihara, Vedanasthapaka, Vranaropaka, and Jantughna properties in management of post operative fistulectomy wound.
2. Panchatikt ghruta is easily available, easy technique to use in post operative fistulectomy wound, can be used in tribal areas also, use as home remedy and very cost effective.
3. Even after wound healing and post treatment follow up no adverse reaction found in the present study. Also complication like keloid formation and hypertrophic scar formation are not found in any case.