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Vol. 24, Art. 88 (pp. 1296-1307)    |    2023       

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Pathogenetic rationale for optimum management tactics of border burn wounds

Semiglazov A.V.1, Zinoviev E.V. 1,2, Kostyakov D.V.1,3, Gogokhiya T.Z.1, Krylov P.K.1,2, Kostyakova A.V.1, Vasilyeva A .G.2

1 Saint-Petersburg I.I. Dzhanelidze research institute of emergency medicine, 192242, Russia, St. Petersburg, Budapestskaya st., 3, lit. A
2 Saint-Petersburg State Pediatric Medical University, Russia, 194100, St. Petersburg, Litovskaya street, 2
3 Saint Petersburg State University, Russia, 199034, St. Petersburg, Universitetskaya embankment, 7-9

Brief summary

Burn injuries remain one of the most complex medical and social problems of modern society. Despite the development and implementation of modern wound-healing drugs, the results of treatment of this type of injury are often unsatisfactory. One of the reasons for this is the rejection of pathogenetically based methods of managing burn wounds, taking into account their nature: superficial, borderline (dermal) and deep lesions. Assessing the characteristics of the course of the wound process, taking into account the depth of the burn and subsequent determination of the optimal tactics for managing such injuries is one of the most important tasks of surgery, incl. combustiology. Purpose of the study. To substantiate the need to develop a pathogenetically based approach to the treatment of borderline burn wounds, taking into account the peculiarities of the course of the wound process. Materials and methods of research. This work is based on a retrospective analysis of the results of treatment of 509 victims with skin burns hospitalized in the department of thermal injuries of the State Budgetary Institution of St. Petersburg Research Institute for Emergency Medicine named after. I.I. Dzhanelidze in the period from 2016 to 2019. The study assessed the duration of phases I, II and III of the wound process, as well as the frequency of purulent-inflammatory complications. Statistical processing of the database was carried out using generally accepted variation statistics algorithms. Research results. It has been established that the duration of cleansing of borderline (superficial) lesions is on average 13 days, which is 2.8 times (p<0.05) longer than for superficial burns and 2 times (p<0.05) less than for deep thermal effects. At the same time, the onset of epithelization began only on the 17th day of observation, and final healing was noted by the 20th day. The same indicator for superficial damage turned out to be 2.9 times less (p<0.05) and 2.1 times (p<0.05), respectively. It is obvious that epithelization in deep burn wounds, given the pathogenesis of the injury, is absent. The frequency of purulent complications in borderline burn wounds remains relatively high and amounts to 47%. In superficial and deep lesions, the analyzed indicator was 87% and 12%, respectively. The generally accepted method of treating dermal burns, based on the use of wet-dry dressings with antiseptic solutions, turned out to be the least effective. The time for final wound healing using this method was 53.8% (p<0.05) longer compared to the application of hydrogels. A similar trend was noted when analyzing the frequency of purulent-inflammatory complications. Conclusion. Thus, borderline (dermal) burn wounds represent a special type of thermal injury. Traditional methods of managing such wounds are relatively ineffective compared to modern hydrogel wound-healing drugs and wound coverings. In this connection, the search for promising, multicomponent agents for local treatment of such wounds is one of the main tasks of surgery, incl. combustiology.


Key words

burns, borderline burns, dermal burns, wound process, inflammation, cleansing, epithelization, complications, hydrogels

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