RU2618914C1 - Method of complex treatment of border-line skin burns - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to surgery and combustiology. Autotransplant cutting out, excision of necrotic tissues and autoplasty are performed. In the period of 2-7 days after obtaining border-line burn in functional zones and zones, with tendency to scarring, necrectomy is carried out to medium or lower layers of skin. In other areas of buns fibrous-necrotic scurf is removed within surface skin layers to the level of bleeding layer. Autoplasty is carried out in functional and having tendency to scarring zones. Wound covering is applied on other parts of burn for 5-7 days.

EFFECT: method of complex treatment of border-line skin burns, which makes it possible to prevent scar development and achieve positive cosmetic result in postoperative period.

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Description

The present invention relates to medicine, namely to surgery, and can be used in the surgical treatment of border burns after necrectomy and dermabrasion.

The basic principle of the treatment of deep burns is the surgical restoration of the integrity of the skin in areas of deep damage. The presence of a deep burn is an indication for surgical treatment, regardless of the timing of the burn injury, the area of the lesion, other clinical and organizational factors. With "borderline" burns, surgical treatment is used to create optimal conditions for their epithelization. Surgical necrectomy also includes dermabrasion, in which only the necrotic epidermis and the surface layer of the dermis are removed. Surgical necrectomy of a burn wound, as a way of active surgical preparation of deep burn wounds for plastic closure, refers to the early surgical treatment of deep burns. In this case, plastic closure of wound defects is carried out immediately, or in the near future after early surgical preparation of a burn wound, but in a shorter time than when preparing a granulating wound for skin plastic. Early surgical treatment of burn injuries is a priority, reduces mortality of severely burned, significantly reduces treatment time, allows to achieve optimal functional and aesthetic results of treatment and improves the quality of life of burn victims (Surgical treatment of burn victims. - Clinical recommendations. - M .: 2015. - S. 4-7. Www.combustiolog.ru). As a result of independent healing of superficial burns of the IIIA degree, quite often coarse scars form (Azolov V.V., Dmitriev G.I. - Surgical treatment of the consequences of burns. N. Novgorod. - 1995. - P. 5).

An analogue of the invention is a method of early removal of a scab with simultaneous skin autoplasty (Vikhreev BS, Burmistrov VM Burns: A guide. - Medicine, 1986. - 231 S.). On the 4-7th day after the injury, while stabilizing the general condition of the patient and clarifying the boundaries of the deep burn (IIIB century), the scab is tangentially pulled out. For tangential necrectomy, it is most convenient to use an electrodermatitis, which allows you to cut off dead tissue up to 2 mm thick. Excision can be done 2-3 times. The bottom of the resulting wound is even. After necrectomy is completed, hemostasis is performed. From healthy areas of the skin with an electrodermatome, skin autologous flaps are collected. Plastic surgery is performed with full confidence in the viability of the wound. Non-perforated grafts are used on functionally active areas (hands, feet, joints), and autotransplants with perforation are used on the remaining sites.

The main disadvantages of this method are:

1. Expectant tactics to clarify the depth of burns between IIIA and IIIB Art.

2. Surgical treatment of only burns IIIB Art.

3. Self-epithelization of “border burns” IIIA-IIIB Art. with a risk of developing scar tissue in the postoperative period.

4. Preference for plastic mesh (perforated) graft, which reduces the functional and cosmetic results.

As the closest analogue, the method of plastic surgery of border burns IIIA-IIIB Art. after early necrectomy, described by V.A. Aminev et al. (A modern approach to the treatment of deep burns in children // Actual problems of thermal injury: Abstracts. Int. Conf. - St. Petersburg, 2002. - S. 318-319). The method provides for preventing the development of scar tissue at the site of possible self-healing of border burns, on the 3-4th day after the injury, the tangential removal by the dermatome of a scab of border burns IIIA-IIIB Art. to the bleeding layer. After hemostasis, autoplasty is performed on the resulting wound surface with a graft with 1: 1 perforation, which, in its properties, approaches continuous, has better drainage ability.

The disadvantages of this method are:

1. The lack of a smooth border between the graft and non-operated areas, which entails a more severe scarring.

2. Layering of the graft on healthy skin and the presence of a scar zone of transition in the postoperative period.

3. Preference for the use of perforated grafts and, as a result, the presence in the postoperative period of a mesh pattern in the area of skin plastic.

Tasks:

- to improve early autoplasty in combination with dermabrasion in the field of "border burn wounds" IIIA-IIIB st .;

- to achieve in the postoperative period of the non-scar zone of the transition between autoplasty and healthy skin;

- to improve the functional and cosmetic results in the postoperative period due to the use of a whole full-layer free skin autograft in the area of functional areas (back areas of the hands and feet, areas of joints) and areas prone to scarring (inner surfaces of the hips, shoulders, forearms).

The essence of the invention is that in the first 2-7 days after receiving a border burn in functional areas and areas prone to scarring, necrectomy is performed to the middle or lower layers of the skin, and in the remaining areas of the burns, fibro-necrotic plaque is removed within the surface layers of the skin to the level of the bleeding layer, autoplasty is performed in functional and prone to scarring zones, and a wound cover is applied to the remaining sections of the burn for 5-7 days.

Technical result: necrectomy of a border burn in functional areas and areas prone to scarring to the middle or lower layers of the skin, and in the remaining areas of burns, removal of fibro-necrotic plaque within the surface layers of the skin to the level of the bleeding layer, performing autoplasty in functional and prone to scarring zones, and on the remaining burn sites, applying 5-7 days of wound coverage in the postoperative period prevents the development of scars and achieve a positive cosmetic th result.

The implementation of the method of plastic border burns of the skin after early necrectomy is as follows.

On 2-7 days after receiving an injury after stabilization of the general condition of the patient, they are taken to the operating room. The operation begins after standard processing of the surgical field. Then, an electrodermatome takes out skin autografts with an area equal to the expected necrectomy with subsequent autoplasty in the area of functional zones and areas prone to scarring. Dressings with antiseptics are applied to donor wounds. Then, non-viable tissues of border burn wounds IIIA-IIIB st. Are removed with an electrodermatome in functional and scarring areas. with a deepening to the middle and lower viable layers of the skin. Make hemostasis, pressing the wound with dressings with a solution of adrenaline for 3-5 minutes. Then, using a dermabrasive brush and an electrodermatoma, fibro-necrotic plaque is removed within the surface layers of the skin to the level of the bleeding layer. Then autoplasty is performed with split skin autografts without perforation in the functional and prone to scarring areas, and wound coverings are applied to the remaining burn sites for 5-7 days until complete epithelization.

This method in clinical conditions was tested on 15 patients with border burns involving functional areas and areas prone to scarring.

Example 1. Patient G., 3 g., Was admitted to the burn department. GBU3-NII KKB No. 1 named after prof. ST Ochapovsky November 15, 2010 with a diagnosis of Thermal burn (flame) of the face, right upper limb 11% II-IIIA-IIIB Art. The main stages of treatment and plastic surgery of border burn wounds are presented in Appendix 1 in Fig. 1-8. On admission, on the 3rd day after the injury, there was a forming necrosis in the region of the right elbow joint along the medial surface and on the forearm (Fig. 1). 4 days after the injury, under intravenous anesthesia, after standard treatment of the surgical field with the DE-60 electrodermatome, one skin autograft was taken along the front-side surface of the right thigh 0.2 mm thick. After applying the tourniquet to the b / 3 of the right shoulder, the forming burn scab along the medial surface of the right elbow joint was excised by the electrodermatome to the lower viable skin layers in order to deepen the wound surface in the region of the functional zone (elbow joint) and the area prone to scarring (medial surface of the forearm). Hemostasis. A wound with smooth edges formed (Fig. 2). Then, an necrosis was excised along the anterior surface of the forearm with an electrodermatome, and a fibrin-necrotic plaque was removed within the surface layers of the dermis on the remaining burn surfaces of the right upper limb to the bleeding layer with a brush for dermabrasion (Fig. 3, 4). Next, plastic surgery was performed with an integral free skin wound autograft on the medial surface of the right elbow joint and forearm (Fig. 5). Aquasel Ag synthetic silver-containing wound dressing was applied to the rest of the wounds, and the Branolin mesh cover was applied to autoplasty to prevent adhesion to the dressing (Fig. 6). Operation time 30 min. Dressings with a solution of antiseptics. On the first dressing on day 4 after surgery, the adaptation of autoplasty is good, staged epithelization under wound coverings (Fig. 7). Before discharge, 10 days after surgery, complete epithelization of border burns (Fig. 8). Due to this plastic surgery, an integral skin autograft in the area of the functional zone with the creation of a non-scar zone of transition between the operated and non-operated areas of the scar tissue is not formed within 5 years of observation.

Example 2. Patient A., 25 years old, was admitted to the burn department. GBU3-NII KKB No. 1 named after prof. ST Ochapovsky 08/25/2012 with a diagnosis of Thermal burn (flame) of the upper extremities 2% IIIA-IIIB Art. Upon receipt, there was an emerging border burn scab IIIA-IIIB Art. the back surface of the right hand, including the phalanges of the fingers. 3 days after the injury, under intravenous anesthesia, the DE-60 electrodermatome, one skin autograft was taken along the front-side surface of the right shoulder 0.3 mm thick. After applying the tourniquet to the b / 3 of the right shoulder on the right hand, the necrotome excised the forming burn scab along the back surface of the right hand to the lower viable skin layers. Hemostasis. Then, with a brush for dermabrasion, the fibrinous-necrotic plaque was removed within the surface layers of the dermis along the back surfaces of the phalanges of the fingers to the bleeding layer. Next, plastic surgery was performed with an integral free skin autograft on the dorsum of the right hand, and Aquasel Ag wound dressing was applied to the remaining areas. Autograft engraftment and epithelization on day 10 of surgery. Within 3 years of observation: scar tissue does not form.

Claims (1)

A method for the complex treatment of border skin burns, including autograft grafting, excision of necrotic tissue and performing autoplasty, characterized in that in the period 2-7 days after receiving a border burn in the functional areas and areas prone to scarring, necrectomy is performed to the middle or lower layers of the skin and in the remaining areas of the burns, fibro-necrotic plaque is removed within the surface layers of the skin to the level of the bleeding layer, autoplasty is performed in functional and scarring areas, and on the remaining sections of the burn impose a wound cover for 5-7 days.

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