Surgical treatment optimization in patients with superficial and deep dermal burns

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Surgical treatment optimization in patients with superficial and deep dermal burns

Journal Title: Хірургія України - Year 2018, Vol 0, Issue 2

Abstract

The aim — to improve the treatment results in patients with superficial and deep dermal burns by the wound process course optimizing, conservative and surgical treatment improvement with modern wound coating. Materials and methods. 130 patients with dermal burns 5 — 50 % TBSA at the age of 18 — 65 years who were treated at the Burn Center during 2013 — 2017 were under supervision. Depending on the treatment tactics of superficial and deep dermal burns (different origin wound coating, timing and methods of operations, the timing of necrotic scab removal, the method of wound closure) the patients were divided into groups: 70 patients in the main group and 60 patients in the comparison group. To determine the depth of the burn wound, in addition to the clinical method, pH measurements of wounds and noncontact infrared thermometry of wounds were used. Results and discussion. Patients of the main group with superficial dermal burns (n = 35) underwent surgical treatment — ultrathin excision of superficial necrosis with wound closure by polyurethane coatings 1.50 ± 0.06 days after trauma. 30 patients of the comparison group received conservative treatment. The timing of burn wounds complete epithelialization in patients main group was 19.9 ± 6.3 days compared to 22.9 ± 6.4 in the comparison group. The early necrotic tissue excision and wound closure with temporary wound coatings on a polyurethane base (n = 18) or xenograft (n = 17) followed by autograft was performed in patients of the main group with deep dermal burns (n = 35). The choice of coating depended on the wound location, pH and wound temperature. In the comparison group patients with deep burns (n = 30) the early necrotic tissues excision with single‑stage autograft was performed. The number of necrectomy was 3.30 ± 0.06 in patients of the main group against 4.20 ± 0.17 in the comparison group (p £ 0.05), the amount of autograft was 3.1 ± 0.5 and 4.70 ± 0.34 (p < 0.05), the total number of operations was 6.40 ± 0.31 and 8.60 ± 0.53 (p < 0.05), accordingly. The development of scar deformities in the first half of the year was not observed. A year later, good results were noted in 84 % of patients. Conclusions. In the surgical treatment of deep skin burns, the preference should be given to delayed autograft. In the treatment of superficial dermal burns, it is advisable to carry out an ultrathin excision of necrotic tissues with one‑time wound closure with temporary coating. The developed algorithm of surgical treatment provides 100 % autograft adhesion; reduction of treatment terms, amount of dressing; anesthetists; substantially improves the cosmetic and functional results of the injury.

Authors and Affiliations

A. O. Kovalenko, O. M. Kovalenko, G. P. Kozinets

Keywords

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EP ID EP342057
DOI 10.30978/SU2018221
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