RU2701625C1 - Method for surgical treatment of total deep burns of body - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to surgery and can be used for surgical treatment of total deep burns of trunk. After necrectomy, wound edges are closed to the size of XL VivanoMed for Vivano vacuum system. Film dressing Hydrofilm is glued on the remaining sections of the scab. Constant pressure of 110–120 mmHg is created in vacuum system for 3 days. Performing necrectomy of remaining deep body burns with primary or delayed autodermoplasty using cell cultures of frozen dermal allo-fibroblasts of 5th passage in physiological NaCl 0.9 % in final concentration 2.0 million cells in 1 ml at rate of 30 thousand cells per 1 cm² of wound surface by irrigation.

EFFECT: method enables preventing haematomas formation under skin grafts and reducing the length of treatment.

1 cl, 12 dwg

Description

The present invention relates to medicine, namely to plastic surgery, combustiology, and can be used in patients with total deep body burns.

The problem of burns to date remains one of the most relevant and complex in modern medicine. This is due to the significant spread of burns among the population, and therefore, it can be called the modern traumatic epidemic of densely populated cities and industrialized countries of the world (A.V. Vorobyov, S.P. Peretyagin, S.A. Bukhalov et al., 2008). Burn disease is characterized by the severity of the course, the difficulty of treatment, and frequent adverse outcomes (D.V. Federyakin, D.G. Galakhova, S.V. Ramzin et al. 2010). Deep body burns occupy a special place among all localizations, because the most extensive and dangerous. In case of body burns, often patients receive lesion areas of 10-30%, and often reach depths of IV degree (according to the classification of A.A. Vishnevsky, proposed in 1961), which causes high levels of toxemia, septic complications and mortality in patients .

An analogue of the alleged invention adopted the method of necrectomy described by S.P. Pakhomov and N.A. Ponomareva (Skin and plastic replacement of extensive burn wounds: Photoatlas. - Nizhny Novgorod: Federal State Institution NIITL Rosmedtehnologii, 2008. - 32 p.). For 2-5 days after the injury, when the patient's general condition is stabilized and the boundaries of the deep burn are clarified, the scab is tangentially removed. For tangential necrectomy, a dermatome is used, which cut off dead tissue up to 2 mm thick. After necrectomy is completed, hemostasis is performed. Autografts are taken from healthy skin areas. 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 autografts with perforation are used on the remaining sites.

The disadvantages of the method include:

1. Uneven pressure when applying bandages with a simple medical bandage and gauze.

2. The creation of uncontrolled pressure on the body.

3. Forced uncomfortable position for the patient.

4. The formation of an extensive wound defect after necrectomy.

5. The long duration of treatment.

As the closest analogue, we have adopted the method of treating burn wounds described in the Guidelines for the treatment of wounds by controlled negative pressure (Vol. 2, supplemented. Edited by S.V. Goryunov. - M .: April, 2016. - S. 237-239). The patient underwent staged surgical treatment. A vacuum system was used to cleanse the wounds from fibrin. Used Kerlix antimicrobial gauze. The area of the wounds on the left lower limb under the vacuum system amounted to 10% of the body surface. The vacuum system was changed twice and used for 8 days. After this, skin autoplasty was performed.

The disadvantages of the method include:

1. Conducting a staged surgical treatment.

2. Fixation of the vacuum dressing only on healthy skin, which limits its use.

3. A small area for applying a vacuum dressing.

4. The use of a vacuum dressing only for preparing a wound for skin plastic, without application to autodermografts.

5. Long-term inpatient treatment.

Tasks:

- improve early necrectomy with primary autodermoplasty;

- improve the methodology for applying a vacuum dressing to the body;

- to exclude in the postoperative period the formation of hematomas under skin grafts;

- provide uniform dense pressure on skin grafts;

- reduce the duration of treatment;

- improve functional and aesthetic results;

- to improve the methodology for the use of allofibroblasts in the treatment of deep body burns.

The essence of the invention, including necrectomy, autodermoplasty, application of a vacuum dressing, application of allofibroblasts, is as follows: after necrectomy, the wound edges are sutured to the size of the VivanoMed VivanoMed vacuum dressing kit for Vivano system, the Hydrofilm film dressing is glued to the remaining sections of the scab, create a permanent scab, create 120 mm. Hg. Art. in the vacuum system for 3 days and then perform necrectomy of the remaining deep body burns with primary or delayed autodermoplasty using cell cultures of frozen 5th passage dermal allofibroblasts in physiological saline solution 0.9% NaCl at a final concentration of 2.0 million cells in 1 ml based on the consumption of 30 thousand cells per 1 square. see wound surfaces by irrigation.

Technical result: this method provides the possibility of fixing a vacuum dressing on a burn scab when it is impossible to perform necrectomy in one step, allows for the healing of free skin grafts with simultaneous wound repair after necrectomy on an area exceeding 10% of the body surface, and to create a comfortable patient position in bed after operations, reduce the treatment time for patients with deep burns of the trunk due to the quick healing of transplanted skin, reduce the likelihood of wound depletion Nia and septic complications in patients, accelerate the healing process of preparing a delayed autodermoplasty and optimize healing of skin grafts when performing regular autodermoplasty by using cell cultures allofibroblastov.

The implementation of the method of surgical treatment of total deep body burns is as follows. 2-3 days after injury, after stabilization of the general condition of the patient is taken to the operating room. Perform standard processing of the surgical field. Then, with an electrodermatome, skin autografts are taken, 0.25-0.3 mm thick. Dressings with an aqueous solution of an antiseptic are applied to donor wounds. Skin grafts are perforated with a perforation index of 1: 2 or 1: 4. Then, non-viable tissues to viable layers (superficial fascia, subcutaneous fat) are removed with an electric knife or necrotome, hemostasis is performed. The edges of the wound are sutured with twisted or interrupted sutures to reduce the total area of the wound to the size of the VivanoMed dressing kit for the Vivano vacuum system, which is 1800 cm ² . Then autodermoplasty is performed, skin grafts are closed with mesh wound coverings, after which two VivanoMed sponges are applied, each 30 × 30 cm in size. Next, a Hydrofilm film dressing is glued onto the remaining sections of the scab, the Vivano vacuum system is installed and a constant pressure of 110-120 mm is created in it. Hg. Art. for 3 days. Three days later, the next stage of surgical treatment is performed. In the operating room, the vacuum dressing is removed, after standard processing of the surgical field, necrectomy of the remaining deep body burns is performed with primary or delayed up to 7-10 days (in case of doubtful tissue viability at the bottom of the wound after necrectomy) with autodermoplasty. To accelerate the healing of skin grafts at this stage, cell cultures of frozen 5th passage frozen dermal allofibroblasts in physiological NaCl saline 0.9% at a final concentration of 2.0 million cells in 1 ml are used by irrigation of the wound at a rate of 30 thousand cells per 1 sq. see the surface of the wound, after which free skin autoplasty is performed with split perforated grafts taken from intact areas. Another ligation is performed on 4-5 days after autodermoplasty.

According to this method, 5 patients were operated on under clinical conditions.

Example 1 (see Appendix 1). Patient C, 48 years old, was admitted to the burn department of GBUZ "NII-KKB№1 named after prof. S.V. Ochapovsky ”with a diagnosis of Thermal burn (contact) of the trunk, perineum, limbs 17% III degree, burn disease in the stage of acute toxemia (Fig. 1). On the 2nd day after injury, after stabilization of the general condition of the patient was taken into the operating room. We performed standard processing of the surgical field (Fig. 2). Then, an electrodermatome took out skin autografts with a thickness of 0.3 mm. Dressed with donor wounds with an aqueous solution of an antiseptic (0.02%) chlorhexidine solution). Skin grafts were perforated with a perforation index of 1: 4. Then, non-viable tissues (Fig. 3) were removed with an electric knife to viable layers (superficial fascia, subcutaneous fat), and hemostasis was performed. The wound edges were sutured with interrupted sutures (Fig. 4) in order to reduce the total wound area to the size of the VivanoMed dressing kit for Vivano vacuum system, which amounted to 1800 cm ² . Then, autodermoplasty was performed (Fig. 5), skin grafts were covered with mesh wound coverings (Fig. 6), after which two VivanoMed sponges were applied, each 30 × 30 cm in size. Then we glued the Hydrofilm film dressing onto the remaining sections of the scab, installed the Vivano vacuum system (Fig. 7) and created a constant pressure of 110 mm in it. Hg. Art. for 3 days. Three days later, the next stage of surgical treatment was performed. In the operating room, the vacuum dressing was removed (Fig. 8), no signs of suppuration were observed under the wound cover (Fig. 9). After standard treatment of the surgical field, a necrectomy of the remaining deep body burns was performed (Fig. 10) with primary autodermoplasty. To accelerate the healing of skin grafts at this stage, cell cultures of frozen 5th passage frozen dermal allofibroblasts in physiological NaCl saline 0.9% in a final concentration of 2.0 million cells in 1 ml were used by irrigation of the wound based on a flow rate of 30 thousand cells per 1 sq. see the surface of the wound, after which free skin autoplasty was performed with split perforated grafts (Fig. 11) taken from intact areas. The next ligation was performed on the 5th day after autodermoplasty. Full adaptation of skin grafts was observed (Fig. 12). Complete engraftment of skin grafts after two stages of autodermoplasty was observed on day 15 after injury.

Example 2. Patient Sh., 45 years old, was admitted to the burn department of GBUZ "NII-KKB No. 1 named after prof. S.V. Ochapovsky "with a diagnosis of Thermal burn (flame) of the head, trunk, right buttock, left upper and right lower extremities 21% II-III degree, burn disease in art. acute toxemia. On the 3rd day after injury, after stabilization of the general condition of the patient was taken into the operating room. We performed standard processing of the surgical field. Then, an electrodermatome took out skin autografts with a thickness of 0.3 mm. Dressings with an aqueous antiseptic solution (0.02% chlorhexidine solution) were applied to donor wounds. Skin grafts were perforated with a perforation index of 1: 2 and 1: 4. Then, non-viable tissues were removed by an electric knife to viable layers (superficial fascia, subcutaneous fat), and hemostasis was performed. The edges of the wound were sutured with a close-fitting suture to reduce the total area of the wound to the size of the VivanoMed XL dressing kit for the Vivano vacuum system, which amounted to 1800 cm ² . Then, autodermoplasty was performed, skin grafts were covered with mesh wound coverings, after which two VivanoMed sponges 30 × 30 cm each were applied. Next, a Hydrofilm film dressing was glued to the remaining sections of the scab, the Vivano vacuum system was installed and a constant pressure of 120 mm Hg was created in it. for 3 days. Three days later, the next stage of surgical treatment was performed. In the operating room, the vacuum dressing was removed, and no signs of suppuration were observed under the wound dressing. After standard treatment of the surgical field, a necrectomy of the remaining deep burns of the trunk and hemostasis were performed. The bottom of the wound was a superficial fascia of dubious viability with areas of inflammation and parabiosis; primary autodermoplasty was not performed. Mesh wound dressings and gauze dressings were applied with an aqueous solution of an antiseptic (0.02% chlorhexidine solution). In order to prepare wounds for delayed autodermoplasty, dressings were performed after 2-3 days. On the 8th day after the second stage, the patient was taken to the operating room. After removing the bandages, it was found that the wounds were made by granulations, the wound discharge was serous, moderate, and the performance of autodermoplasty was shown. To accelerate the healing of skin grafts at this stage, cell cultures of frozen 5th passage frozen dermal allofibroblasts in physiological NaCl saline 0.9% at a final concentration of 2.0 million cells in 1 ml were used by irrigation of wounds at a rate of 30 thousand cells per 1 sq. see the surface of the wound. Free skin autoplasty was performed with split perforated grafts taken from intact sites. The next ligation was performed on the 5th day after autodermoplasty. A complete adaptation of skin grafts was observed. Complete engraftment of skin grafts was observed on day 24 after injury.

Claims (1)

A method of surgical treatment of total deep body burns, including necrectomy, autodermoplasty, applying a vacuum dressing, application of allofibroblasts, characterized in that after necrectomy, the wound edges are sutured to the size of the VivanoMed XL dressing kit for Vivano vacuum system, the remaining patches are applied to Hydrofilm scab, create a constant pressure of 110-120 mm Hg in the vacuum system for 3 days and then perform necrectomy of the remaining deep body burns with primary or delayed autodermoplasty using cell cultures of frozen 5th passage dermal allofibroblasts in physiological saline solution 0.9% at a final concentration of 2.0 million cells in 1 ml from calculation of the consumption of 30 thousand cells per 1 square. see the surface of the wound by irrigation.

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