Introduction. A promising method of correcting microcirculatory disorders in the area of soft tissue injury is the use of agents with antihypoxant action, which include deproteinized calf-blood hemoderivate. The aim of the work was to reveal the peculiarities of subcutaneous and intramuscular local injection of deproteinized calfblood hemoderivate on the changes of microcirculation in the skin and muscles in the experimental blast wound area. Materials and methods. The experiments were performed on 90 male Wistar rats weighing (320±20) g in compliance with international rules of work with laboratory animals. Modeling of an explosive wound of the soft tissues of the femur with mild degree of blood loss was carried out according to the original author’s method (Patent RU No. 2741238 dated 22.01.2021). After primary surgical treatment was performed paravulnarly, deproteinized calf-blood hemoderivate was injected intramuscularly, intramuscularly and subcutaneously (Actovegin drug) once in six points with an insulin syringe. Microcirculation in the skin and muscles of the injured area was assessed by laser Doppler flowmetry using the device LAKK-M (Russia). To determine the normal values of microcirculation, data obtained from healthy animals were used. Results. Local intramuscular injection into the paravular area resulted in an increase of the constant perfusion component (M) by 24.1−35.9 % (p < 0.05) and by 18.0−56.4 % ( p < 0.05) in the skin and muscles during all periods of observation, an increase of the variable perfusion component (σ) in the skin by 31.4−38.0 % ( p < 0.05) during 28 days and in muscles by 8.8−58.7 % ( p < 0.05) during the first 14 days only, increase of K v ratio in skin by 12.4 % ( p = 0.01) early after injury (7 days) and decrease in muscles by 18.3−20.8% ( p < 0.05) at 14−28 days. Local combined administration (intramuscularly and subcutaneously) of the drug around the wound promoted the increase of the constant perfusion component ( M ) in the skin by 23.8 % ( p = 0.005) and 6.9 % ( p = 0.01) at the 7th and 28th days of observation, increase of σ index in skin by 14.2−45.1 % ( p < 0.007) on the 7−14 days and its decrease in muscles by 15.7 % ( p = 0.009) by the end of the 7th day of observation in comparison with animals after only intramuscular injection only. Also, the coefficient of variation ( K v ) with the combined route of injection was increased in the skin by 8.8−23.8 % ( p < 0.009) in the first 14 days and decreased in the muscles by 15.7 % ( p = 0.008) in the early period after injury (7 days) relative to its values in animals with intramuscular injection. Discussion. The results of the study allow noting the stimulating effect of deproteinized calf-blood hemoderivate on neovasculogenesis in the damaged tissues, which can be judged by the increase in the constant perfusion component ( M ). In addition, we can conclude that the direct endothelium-protective effect of the drug consists in the modulation of microcirculatory flow, which confirms the significant increase in the variable perfusion component (σ) throughout the experiment. Conclusion. Local paravular administration of deproteinized calf-blood hemoderivate in experimental blast wound promotes microcirculation increase in the soft tissues of the injury area. Combined (intramuscular and subcutaneous) local paravular injection of the drug allows more effective stimulation of microcirculation in the skin and muscles of the injury area.

Раннее хирургическое лечение ожоговых ран является одним из приоритетных направлений комбустиологии. Иссечение девитализированных тканей до развития в них гнойно-воспалительного процесса имеет направленное патогенетическое обоснование эффективности проводимой манипуляции. Удаление некроза в области поражения позволяет снизить интенсивность интоксикации, а также ускорить переход раневого процесса из воспаления в фазу регенерации (классификация М.И. Кузина). Одна из таких методик — ранняя тангенциальная некрэктомия, которая в настоящее время не получила широкого распространения в клинической практике в связи с рядом критических недостатков, к основным из которых можно отнести отсутствие объективного метода контроля селективности иссечения тканей, высокую частоту осложнений в раннем послеоперационном периоде, а такженеустойчивость гемостаза. Исследования по данной тематике позволили установить, что объем кровопотери при ранней тангенциальной некрэктомии зависит от сроков, глубины и метода иссечения ожогового струпа, выбора тактики интраоперационного гемостаза и системной терапии. Углубленный анализ указанных направлений позволил выявить основные причины неудовлетворительных результатов и определить возможные пути их улучшения. Early surgical treatment of burn wounds is one of the priority areas of kombustiology. Excision of devitalized tissues before the development of a purulent-inflammatory process in them has a directed pathogenetic justification for the effectiveness of the manipulation. Removal of necrosis in the affected area reduces the intensity of intoxication, as well as accelerates the transition of the wound process from inflammation to the regeneration phase (classification of M.I. Kuzin). One of such techniques is early tangential necrectomy, which is currently not widely used in clinicalpractice due to a number of critical shortcomings. The main ones include the lack of an objective method for controlling the selectivity of tissue excision, a high incidence of complications in the early postoperative period, as well as the instability of hemostasis. Studies on this topic have allowed us to establish that the volume of blood loss during early tangential necrectomy depends on the timing, depth and method of excision of the burn scab, the choice of tactics of intraoperative hemostasis and systemic therapy. An in-depth analysis of these areas made it possible to identify the main causes of unsatisfactory results and identify possible ways to improve them.

BACKGROUND Irregularity and mosaicity in the depth of the burn skin lesion limits the possibility of performing precision tangential necrectomy in the early stages after injury. Non-radical necrectomy leads to lysis of transplanted autodermal grafts. This problem is most relevant in the treatment of victims with extensive dermal and deep burns. AIM OF STUDY To study the relationship between microcirculation parameters in the burn wound and the outcomes of autodermal transplantation after tangential necrectomy. MATERIAL AND METHODS 74 patients with extensive skin burns included in the study underwent tangential necrectomy with simultaneous autodermal transplantation. All operations were performed early (up to 10 days) after injury before the formation of the demarcation line. Microcirculation parameters in the burn wound were studied by laser Doppler flowmetry before and after tangential necrectomy and in healthy skin of the same anatomical region. RESULTS Statistically significant differences (p≤0.001) were found between microcirculation parameters in the center of the burn wound after tangential necrectomy and in the control area of intact skin. In this case, the results of autodermal transplantation were characterized by a skin engraftment rate of up to 60–70%. In those areas of the body where there were no differences between microcirculation parameters , the engraftment exceeded 80%. CONCLUSION Assessment of microcirculation by laser Doppler flowmetry can be a reliable method for diagnosing the condition and viability of a burn wound after tangential excision of dead tissues in the early stages of treatment — before the formation of a demarcation line. The diagnostic technique is easy to use, but requires skills in working with a flowmeter, unification of such devices and methods for their use in the practice of surgical treatment of burns.

Background. The possibility of local application of autologous blood plasma (ABP) in soft tissue injuries is currently of particular interest.Objectives. Evaluation of the effects of peri-wound (perifocal) administration of ABP on red blood parameters, microcirculation and oxygen supply of soft tissues of the limb in experimental explosive wound (EW) in rats.Methods. EW was simulated on male Wistar rats (n=146) using a firecracker with a pyrotechnic mixture (patent RU No. 2741238 dated 22.01.2021). Animals were divided into 4 groups: control (2), comparison (1), main (1). The volume of blood loss in explosive wounds was 8 and 15% of the estimated circulating blood volume (CBV) of the animal. Blood was drawn from the rat tail to obtain ABP. 3 hours after the injury, ABP or 0.9% sodium chloride solution was injected intramuscularly into the explosive wound area at a rate of 2.0 ml/kg of animal weight. After 3, 7, 14, 28 days, the number of red blood cells, haemoglobin content, haematocrit were determined in the blood, and microcirculation and oxidative metabolism parameters were determined in the skeletal muscles of the injured area. The data were processed using Microsoft Excel 2013 (Microsoft, USA) and Statistica 10.0 (StatSoft Inc., USA).Results. Blood loss of 8% of the CBV in injured animals did not lead to changes in the quantitative composition of peripheral red blood. After an explosive wound with a blood loss of 15% of the CBV, there was a moderate decrease in the number of red blood cells (from 8.3×1012/l to 6.5×1012/l, p < 0.02), haemoglobin level (from 149.5 g/l to 118 g/l, p < 0.01), haematocrit (from 43.8% to 33.6%, p < 0.01) with recovery by day 7 of observation. The explosive soft tissue wound was characterized by marked post-traumatic microcirculatory disorders irrespective of the amount of blood loss. Perifocal intramuscular administration of ABP in animals with an explosive wound and blood loss of 15% CBV reduced the severity of post-traumatic microcirculatory and oxidative metabolic disorders mainly in the early post-traumatic period, as evidenced by an increase in the perfusion variation coefficient Kv by 1.2–1.3 times (p < 0.05), tissue oxygen consumption U by 20–22% (p < 0.05) and fluorescent oxygen consumption by FPC by 48% (p < 0.05).Conclusion. With an experimental explosive wound of the soft tissues of the thigh in rats, a single early (3 hours after the injury) peri-wound intramuscular administration of ABP reduces the severity of local post-traumatic microcirculatory and metabolic disorders in skeletal muscle.

Time, nature, and duration of changes in microcirculation and metabolism, as well as their differences in skin and muscle tissue of the injured area during experimental explosive trauma in rats in different wound process phases, are evaluated. Experimental explosive damage was simulated on 30 Wistar rats. The total condition of rats, their activity, interest in food and water, wound area with characteristic wound healing time calculation, the volume of injured pelvic limb, and changes of microcirculation and metabolism in the skin and skeletal muscles of the paravulnar region were evaluated. The explosive damage has led to a deterioration of microcirculation and metabolism in the skin, and especially, in the muscles of the injured area. Compared to the intact group, the microcirculation deterioration resulted in a decreased constant component of perfusion in the skin and muscles by 57.6% and 40.9% and a decreased vial by 76.9% and 76.5%, respectively (p 0.05), as well as in reducing the fluorescent oxygen intake in the skin and muscles by 25.7% and 51.8% and a complex indicator of effective oxygen exchange by 81.1% and 91.9%, respectively (p 0.05). During the experiment, the microcirculation and metabolism were gradually restored, which is more pronounced in the skin, except for the repeated deterioration of the non-vascular regulation of microcirculation in the muscle (a decreased vial by 29.3% of the norm, p 0.05). Changes in the main indicators of microcirculation and metabolism indicate normal skin defect healing and unsatisfactory muscle defect repair (decreased volume of the injured limb (68% of the norm, p 0.05)), accompanied by the recurrence of extravascular disorders in the muscle. Developing new and improved existing methods of delivering biologically active drugs and drugs to the area of muscular damage in the early days after the injury, which strengthen the local blood flow and create conditions for damaged muscle regeneration, reduce the wound healing time without forming pathological scars.

The aim of the study was to evaluate microcirculatory and metabolic changes in damaged skeletal muscles in rats with experimental explosive trauma with acute blood loss. Material and methods. An experimental model of explosive damage to the soft tissues of the pelvic limb in rats was used to assess microcirculation and metabolic activity in the muscles of the area of the explosive wound by laser Doppler flowmetry and laser fluorescence diagnostics using the LAKK-M device. Results and discussion. It was found that during the entire follow-up period (28 days), pronounced disorders of microcirculation and metabolism were formed in the damaged muscles. Tissue perfusion was significantly reduced, which is confirmed by a change in the coefficient of variation of the microcirculation index, the value of which was lower by 36–51 % ( p < 0.05) in all follow-up periods in animals from the intact group, and the maximum decrease in the indicator was observed by 28 days (6.7 (6.3; 7.4) %, at p < 0.05). Tissue metabolism was rearranged in the direction of activation of the anaerobic pathway: there was a decrease in the index of specific oxygen consumption by the tissue – by 2.3 times ( p < 0.05), the fluorescent index of oxygen consumption by the tissues – by 60 % ( p < 0.05), the integral index of oxygen exchange efficiency by an average of 8.5 times ( p < 0.05) relative to healthy animals, which generally indicated weak oxygen utilization by the tissues. These disorders of metabolism and oxygen consumption by the tissues of the damaged area persisted throughout the experiment with a slight positive dynamics by the end of the observation period. Conclusion. The obtained data are a pathogenetic justification for the development of means for the local correction of microcirculatory and metabolic disorders in the muscles in the case of explosive trauma in the post-traumatic period.

The aim of the study was to evaluate microcirculatory and metabolic changes in damaged skeletal muscles in rats with experimental explosive trauma with acute blood loss. Material and methods. An experimental model of explosive damage to the soft tissues of the pelvic limb in rats was used to assess microcirculation and metabolic activity in the muscles of the area of the explosive wound by laser Doppler flowmetry and laser fluorescence diagnostics using the LAKK-M device. Results and discussion. It was found that during the entire follow-up period (28 days), pronounced disorders of microcirculation and metabolism were formed in the damaged muscles. Tissue perfusion was significantly reduced, which is confirmed by a change in the coefficient of variation of the microcirculation index, the value of which was lower by 36–51 % (p < 0.05) in all follow-up periods in animals from the intact group, and the maximum decrease in the indicator was observed by 28 days (6.7 (6.3; 7.4) %, at p < 0.05). Tissue metabolism was rearranged in the direction of activation of the anaerobic pathway: there was a decrease in the index of specific oxygen consumption by the tissue – by 2.3 times (p < 0.05), the fluorescent index of oxygen consumption by the tissues – by 60 % (p < 0.05), the integral index of oxygen exchange efficiency by an average of 8.5 times (p < 0.05) relative to healthy animals, which generally indicated weak oxygen utilization by the tissues. These disorders of metabolism and oxygen consumption by the tissues of the damaged area persisted throughout the experiment with a slight positive dynamics by the end of the observation period. Conclusion. The obtained data are a pathogenetic justification for the development of means for the local correction of microcirculatory and metabolic disorders in the muscles in the case of explosive trauma in the post-traumatic period.

1 Государственный научно-исследовательский испытательный институт военной медицины Минобороны России 195043, г. Санкт-Петербург, ул. Лесопарковая, 4 2 Медицинский университет «Реавиз» 198095, г. Санкт-Петербург, ул. Калинина, 8 3 Военная академия материально-технического обеспечения имени генерала армии А.В. Хрулева Минобороны России 199034, г. Санкт-Петербург, наб. Макарова, 8 4 Санкт-Петербургский НИИ скорой помощи имени И.И. Джанелидзе 192242, г. Санкт-Петербург, ул. Будапештская, 3, лит. А

Relevance. Treatment of choice for patients with deep burns is early surgery, i.e. necrectomy with simultaneous plastic closure of the postoperative defect. However, technical implementation of necrectomy is still under debate.Intention. To assess current scientific views on the use of tangential necrectomy in the surgical treatment of burn victims.Methodology. A literature survey was carried out using PubMed database, the Google Academy search engine, and also resources of the Scientific electronic library (eLIBRARY.ru).Results and Discussion. The analysis allows us to conclude that at present tangential necrectomy for burn injuries is not generally approved. There is no convincing data on its indications, acceptable areas of simultaneously excised tissues and ex cision depth are not determined, the technique for performing tangential necrectomy using an electrodermatome has not been developed. There is no information on effective methods for closing postoperative defects using tangential excision of a scab.Conclusion. Thus, tangential necrectomy indications as well as acceptable areas of simultaneously dissected tissues and the depth of excision, tangential necrectomy technique via electrodermatome for closing postoperative wound defects need evidence-based justification.

Relevance.According to the Federal Statistics Service (Rosstat), (315.8 ± 8.5) thousand thermal and chemical burns or (220.6 ± 6.5) burns per 100 thousand people of the country’s population were recorded annually in Russia in 2005–2015. These injuries account for 2.4 % of the structure of all injuries in Russia.Intention.Analysis of the content of scientific journal articles of domestic authors on burn injuriesMethodology.We conducted a search in the electronic database of the Scientific Electronic Library, which made it possible to identify in 2005–2017 1649 scientific journal articles of domestic authors. The average annual number of articles on burn injury indexed in the Russian Science Citation Index was (127 ± 13). There is an increase in the interest of researchers to the problems of burns. The content of the articles correlated with the developed classifier for burn injury.Results and Discussion.General questions of burn injuries were described in 1.6 %, problems of organization of medical care for burn victims – in 4.9 %, characteristics of burn injuries – in 42.9 %, information on diagnostics, treatment, probable complications and rehabilitation of victims – in 41.3 %, experimental studies of burn injury in animals – in 9.3 % of publications. The presented indicators reflected the content of the articles, and, to some extent, objective data. For example, superficial and limited burns were studied to a lesser extent, although they actually prevail. As a rule, the object of research was complex cases that could be of increased interest among readers. The weighted average impact factor of the journals in which the articles were published was 0.304, the average number of citations per article was 1.42, 42.6 % of the articles were cited at least once, Hirsch index was 15. Some authors used inadequate study design. When preparing publications, the groups of authors were often redundant, which resulted in a significant decrease in the number of articles and citations per 1 coauthor.Conclusion. The study helps optimize research in the field of burn injuries. Among the created array of articles, 74.2 % of publications had a full text, 69.4 % of articles were provided free of charge to registered readers of the Scientific Electronic Library.