RU2721870C1 - Surgical method of burn wound - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to surgery, combustiology, plastic surgery, and can be used for surgical management of burn wound based on excision of granulation tissue with further implementation of free autodermoplasty. Before performing the free autodermoplasty, all layers of the granulation tissue and edges of the burn wound on the border with the intact skin are excised.

EFFECT: method provides preventing transplanted graft lysis in the postoperative period and preventing repeated operations by excision of all layers of the granulation tissue, as well as prevents formation of pathological cicatricial tissue of dermal origin during rehabilitation by cutting edges of burn wound before free autodermoplasty, which reduces length of treatment of patients with deep and border burns with good cosmetic effect.

1 cl, 1 ex

Description

The invention relates to medicine, in particular to surgery, combustiology, plastic surgery and can be used to treat burn defects.

A known method of surgical treatment of a burn wound, which consists in performing early removal of a scab with simultaneous skin autoplasty [Vikhreev BS, Burmistrov VM Burns: A Guide. - M .: Medicine, 1986. - S. 231].

The disadvantages of the method include: surgical treatment of only burns IIIB Art., Self-epithelialization of "border burns" IIIA-IIIB Art. with a high risk of developing scar tissue in the postoperative period; the use of mesh (perforated) grafts after necrectomy in plastic surgery, which reduces functional and cosmetic results, due to the high risk of developing pathological scar tissue in the area of perforations, a high risk of graft lysis due to the high probability of leaving necrosis in the wound. Determining the viability of the bottom of the wound is a subjective symptom. This method cannot be applied when the patient is delayed due to inflammation in the wound and in the surrounding tissues.

Closest to the claimed is a method of surgical treatment of a burn wound, which consists in partial excision of granulation tissue, fibro-leukocyte layer and the upper part of the vascular layers [Menzul V.A., Shekhter A.B., Petlakh V.I., Shastin I.G. et al. Resection of granulation tissue with ADP in the treatment of deep burns in children \\ Materials of the 6th Congress of Traumatologists and Orthopedists of Russia. - N. Novgorod, 1997. - S. 116-117].

The disadvantage of the method selected as a prototype is the partial removal of infected layers, that is, it does not take into account that the translocation of microorganisms occurs throughout the thickness of the granulation tissue, and the lower layers (the lower part of the vascular layer and the fibrous layer) have inflammatory changes and microbial contamination, as a result which preserves the conditions for lysis of grafts. This leads to repeated operations, purulent complications, an increase in the area of wounds.

Another disadvantage of this method is not the radicality of excision of elements from which pathological scar tissue later grows. With a tangential excision of granulating tissue, layers around the wound are not excised, leaving cells of dermal origin, from which pathological scars of dermal origin may subsequently appear. In addition, the excision of the layers occurs subjectively, and the number of excised layers is determined by eye.

The objective of the invention is to prevent the formation of transplant lysis and the formation of pathological scar tissue.

The technical result of the task is achieved by the fact that in the method of surgical treatment of a burn wound based on excision of granulation tissue with further performing free autodermoplasty, all layers of granulation tissue and edges of the burn wound at the border with intact skin are excised before performing free autodermoplasty.

Performing excision of all layers of granulation tissue prevents lysis of the grafts in the postoperative period, performing repeated operations, and excision of the edges of the burn wound before free autodermoplasty prevents the development of pathological scar tissue of dermal origin during the rehabilitation period.

The method is as follows. After cleansing the wound from necrotic tissue and the formation of mature granulations ready for surgery, the patient is taken to the operating room, usually on days 27-30. The operation begins after standard preparation and processing of the surgical field. First, an electrodermatome takes out skin autografts in places free of burns, an area equal to the estimated area of the wound. Dressings with antiseptics are applied to donor wounds. Autografts are wrapped in dressings with furacilin.

During the operation, before free autodermoplasty, all layers of granulation tissue are excised with a Volkman spoon and a scalpel, and the edges of the burn wound are excised, retreating 2-3 mm from the edges, directing the incision obliquely towards the wound, increasing the thickness of the cut towards the bottom wounds at an angle of 45 °. When performing a slice, the edges of the wound and the bottom of the wound surface are aligned. Checking the radical removal of granulation tissue is carried out using laser Doppler flowmetry. Produce hemostasis, crushing the wound with dressings with an adrenaline solution for 3-5 minutes, large vessels coagulate. A parallel border allows autoplasty to be performed with a non-perforated skin graft according to the rules of plastic surgery: epidermis to epidermis, dermis to dermis. Apply dressings with an antiseptic. The wound is tightly bandaged in 5-7 rounds with a medical bandage. After surgery, the limbs create an elevated position. The first dressing is performed on the 5th day. Full adaptation of skin autografts is usually observed on the 5-7th day.

Example. The patient, 47 years old, was admitted to the Research Institute of Emergency Medicine. I.I. Dzhanelidze 05/08/17 with a diagnosis of Flame burn 35% (2%) / IIIA-IIIB Art. neck, torso, limbs. The delay from the moment of injury is 3 days. Performing an early necrectomy with simultaneous SADP of deep burn wounds was not possible due to the delay in admission and the developed perifocal inflammation of burn defects. The patient underwent staged necrectomy, dressings with solutions of antiseptics, ointments on a water-soluble basis, coatings with antiseptics. Superficial burns were epithelized. After complete cleansing of the wound from necrotic tissue, granulations were formed on the entire surface of the burn defects.

On the 27th day the patient was taken to the operating room. The operation is performed according to the claimed method. The first dressing after surgery on the 5th day. Full adaptation of autografts is noted. There are no signs of lysis of the graft. The patient was discharged for outpatient treatment 10 days after graft engraftment. In the long-term period (after 6 months), the function is fully restored, the formation of pathological scar tissue is not observed, there is an even transition zone of the transplant to healthy skin, with the edges coinciding. An ideal cosmetic result is noted due to plastic surgery with an unperforated graft that does not require correction by conservative methods.

The inventive method prevents the formation of lysis of the transplanted graft and the formation of pathological scar tissue during the period of convalescence.

This method allows to reduce the treatment time for patients with deep and borderline burns with a good cosmetic result. The method is available to surgeons, does not require expensive equipment and a large number of laboratory and instrumental studies. It is also technically simple, requiring no additional equipment.

The implementation of the proposed method makes it possible not only to effectively prevent the development of complications during treatment of burns, to quickly restore a burn defect and normalize a transplanted flap with the restoration of its function, but also to avoid the development of long-term complications of a burn injury in the form of pathological scars, trophic ulcers, thereby avoid disability of patients, repeated operations, lack of functional and cosmetic disorders.

Claims (1)

A method for surgical treatment of a burn wound, based on excision of granulation tissue with further performing free autodermoplasty, characterized in that before performing free autodermoplasty, all layers of granulation tissue and the edges of the burn wound at the border with intact skin are excised.