Purpose of a study: to evaluate the possibility of preserving breast implants in patients with severe burns.Material and methods. A patient G., 52 years old, was hospitalized in the Department of Thermal Injuries of the I.I. Dzhanelidze St. Petersburg Research Institute for Emergency Medicine due to burn disease, flame burns 37% (32%)/I–II–III degree of the neck, torso, upper and lower extremities. On the 2nd day after the injury, a patient with severe burns underwent excision on pre-augmented mammary glands to the level of adipose tissue with simultaneous skin grafting.Results. On the 4th day after treatment, at least 80% of the area of skin grafts transplanted to the mammary glands was found to be engrafted, and further skin grafting was not required on them. In our case, early surgical treatment made it possible to avoid reactive capsulitis, the need to remove implants and achieve acceptable aesthetic and functional results.Conclusion. Presented observation demonstrates the potential for the preservation of implants in the case of localization of burns on the augmented mammary glands.

Background: Various physical phenomena come into use in medicine; however, to date, universal physical methods have not been developed to optimize the course of the wound healing at all treatment stages. In combustiology, the first stage of burn treatment is debridement; then it is important to create an optimal biological environment, normalize blood circulation, suppress pathogenic flora, and stimulate proliferative processes in the wound.Objective: To determine the effectiveness of low-temperature argon plasma (LTAP) and ultrasonic cavitation in deep burn wound treatment based on clinical observations and cytological findings.Materials and methods: We studied impression smears from burn wounds of 36 patients with deep burns of various etiologies who were treated using LTAP and ultrasonic cavitation in the Thermal Injuries Unit at the Saint Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine (Saint Petersburg, Russian Federation) between 2022 and 2023.Results: We found that cytogram findings in the study area changed from the inflammatory type to the regenerative-inflammatory one on day 3-7 when LTAP and ultrasonic cavitation were used, while such change in the control area was observed only after 10 days of treatment. Thanks to the use of LTAP and ultrasound after necrosectomy for deep dermal burns, the wound preparation for autologous skin grafting takes less time than it does with standard methods of local burn wound care. Ultrasonic cavitation should be used in cases of severe exudation and slough, whereas LTAP should be used when reparative processes in a burn wound slow down.Conclusions: Burn wound treatment using ultrasonic cavitation and LTAP enables to prepare the wound surface for autologous skin grafting with a high engraftment rate. The procedure allows to effectively and atraumatically debride the wound and suppress pathogenic microflora. Further research is planned in patients with large deep burn wounds.

Применение природных антимикробных пептидов с высокой антибактериальной активностью в отношении большинства микроорганизмов, в том числе антибиотикорезистентных штаммов и полимикробных ассоциатов (биологические пленки), можно отнести к новым методам ведения больных с ожогами. В эксперимент включены 40 крыс массой 220–240 г, распределенных в 4 группы в зависимости от методики лечения: контроль (без лечения), влажно-высыхающие повязки с раствором антисептика (йодопирон), мазь «Левомеколь», гель редкосшитых акриловых полимеров с природными антимикробными пептидами. Результаты оценивались на 4, 7, 14 и 28-е сутки. Гель редкосшитых акриловых полимеров с природными антимикробными пептидами обладал наибольшей эффективностью: площадь экспериментальной раны к 28-м суткам сократилась с 200 см2 до 0,3 ± 0,1 см2 (в 12,6 раза меньше, чем в группе контроля), зона задержки роста Staphylococcus aureus 209P составила 34,9 мм (что лишь на 3,9 мм меньше, чем при использовании йодопирона), а частота инфекционных осложнений и летальности были снижены до 10 и 5% соответственно. The use of natural antimicrobial peptides with high antibacterial activity against most microorganisms, including antibioticresistant strains and polymicrobial associates (biological films), can be attributed to new methods of management of patients with burns. The experiment included 40 rats weighing 220–240 g, distributed into 4 groups depending on the treatment method:control (without treatment), wet-drying dressings with an antiseptic solution (iodopyron), “Levomekol” ointment, gel of rare acrylic polymers with natural antimicrobial peptides. The results were evaluated on the 4th, 7th, 14th and 28th days. The gel of rare-stitched acrylic polymers with natural antimicrobial peptides had the highest efficiency: the area of the experimental wound by the 28th day was reduced to 0.3 ± 0.1 cm2 (12.6 times less than in the control group), the growth retardation zone of Staphylococcus aureus 209P was 34.9 mm, which is only 3.9 mm less than when using iodopyron, and the frequency of infectious complications and mortality were minimal — 10 and 5 %, respectively.

Purpose: to develop models of patients with severe flame burns.Material and methods: the analysis of scientific publications and own observations of the causes of flame burns was carried out.Results: based on the data obtained, six models of patients with severe flame burns were formed: residential fires, liquefied petroleum gas-related burns, cookstove-related burns, flammable liquids-related burns, self-immolation and smoking-related burns. According to the results of the study, 94% of patients with flame burns corresponded to these six models. These models turned out to be homogeneous by gender, age, area, depth and localization of skin lesions, severity of the condition and other characteristics.Conclusion: the using models of patients make it possible to form homogeneous groups of victims. Due to the homogeneity of these groups, it is possible to develop surgical treatment tactics for each of the formed models, which should improve the results of treatment of burned patients.

Purpose: to develop models of patients with severe hot liquid scald. Material and methods. Тhe analysis of scientific publications and own observations of the causes of hot liquids scald was carried out. Results. Based on the data obtained, four models of patients with severe hot liquids scald were formed: immersion injury (falling or prolonged stay in the bath), non-immersion injury (scalds in the shower or hot liquid splashing), cooking-related burns and a special type of immersion scald caused by communal incidence. According to the results of the study, 97% of patients with hot liquids scald corresponded to these four models. These models turned out to be homogeneous by gender, age, area, depth and localization of skin lesions, severity of the condition and other characteristics. Conclusion. Тhe use models of patients make it possible to form homogeneous groups of victims. Due to the homogeneity of these groups, it is possible to develop surgical treatment tactics for each of the formed models, which should improve the results of treatment of burned patients.

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.

В данном обзоре представлен анализ особенностей лечения пострадавших с обширными глубокими ожогами кожи, так как именно тяжесть ожоговой травмы является основным условием развития иммуносупрессии, активации латентных вирусных инфекций, что приводит к тяжелым осложнениям ожоговой болезни. За последние 3 года с новой коронавирусной инфекцией SARS-CoV-2 столкнулись все медицинские учреждения. В ожоговых отделениях она характеризовалась специфическими изменениями иммунного статуса. Цель настоящего обзора — обобщить данные о влиянии различных видов латентных вирусов на течение ожоговой болезни у пострадавших с обширными глубокими ожогами. В ходе работы проанализированы особенности влияния на течение раневого процесса и результаты кожной пластики семейства вирусов герпеса человека, вируса ветряной оспы, цитомегаловируса, вирусов Эпштейна–Барр. Установлено, что проявления вирусной инфекции многообразны, влияние на организм тяжелообожженного многогранно, а сведения, поступающие от различных авторов, противоречивы. Учитывая ежегодный рост количества таких пострадавших, находящихся на лечении в отделениях интенсивной терапии, требуется активное проведение скрининговых исследований для выявления вирусных инфекций и определения их влияния на течение ожоговой болезни. This review presents an analysis of the treatment of patients with extensive deep skin burns, since it is the severity of the burn injury that is the main condition for the development of immunosuppression, the activation of latent viral infections, which leads to severe complications of burn disease. Over the past 3 years, all medical institutions have encountered a new coronavirus infection SARS-CoV-2. In the burn departments, it was characterized by specific changes in the immune status. The purpose of this review was to summarize data on the effect of various types of latent viruses on the course of burn disease in patients with extensive deep burns. In the course of the work, the features of the impact on the course of the wound process and the results of skin plasty of the human herpes virus family, varicella-zoster virus, cytomegalovirus, and Epstein-Barr viruses were analyzed. It has been established that the manifestations of a viral infection are diverse, the effect on the body of a severely burned person is multifaceted, and the information received from various authors is contradictory. Given the annual increase in the number of such victims being treated in intensive care units, active screening studies are required to identify viral infections and determine their impact on the course of burn disease.

The Objective was to evaluate the effects of the concentration of blood hemoglobin, total serum protein and albumin on skin graft engraftment frequency. Methods and Materials . The study included 186 patients with full-thickness skin burn more than 5 % of total body surface area who were treated in five different burn departments of the Russian Federation. Depending on the readiness of the wounds, all performed surgical treatments were divided into four groups: 1) simultaneous skin graft after tangential necretomy; 2) simultaneous skin graft after radical necretomy; 3) skin graft for granulation wounds; 4) skin graft for a long time existing pathologically (hyper)granulation. Venous blood was taken from all the patients 12 hours before and 12–24 hours after skin graft. The concentration of blood hemoglobin, total serum protein and albumin was determined in the obtained samples. The evaluation of skin graft engraftment frequency was carried out by a combined method on the 7th day after skin graft. The data obtained were processed using descriptive and nonparametric statistics. Results . The concentration of total serum protein (p=0.001) and albumin (p=0.000) had a significant impact on the skin grafting results. This relationship was most pronounced during skin grafting on granulating wounds and after radical necretomy. The data obtained were identical for meshed and non-meshed skin grafts. Decrease in hemoglobin concentration did not lead to a degradation of skin grafts (p=0.068) in any of the study groups. According to the results of the laboratory parameters ranking, it was found that maintaining the concentration of total serum protein more than 6 g/dL allows 1.3 times to improve the results of skin grafting, and albumin concentrations more than 3.5 g/dL – 1.4. Conclusion . During the study, we were unable to confirm the existence of a relationship between the concentration of blood hemoglobin and the results of skin graft engraftment by any of the statistical analysis methods in any of the study groups. Accordingly, the inability to transfuse erythrocytes to a patient with anemia below 9–8 g/dL cannot be considered as an absolute contraindication for early surgical treatment of burned patients. Apparently, the concentration of total serum protein and albumin has a much greater effect on the skin grafting results. Trigger values of total serum protein can be recognized as 6 g/dL (albumin – 3.5 g/dL), which provides good results of engraftment in at least 90 % of operated patients.

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.

Relevance. Indications, application techniques and contraindications for the use of vacuum therapy in surgery and orthopedics are formulated in clinical guidelines and are generally available. Indications for the use of a vacuum in patients with severe burns are scattered and depend on personal experience and preferences of the medical staff, and not on objective reasons.Intention. To analyze the results of using Negative Pressure Wound Therapy (NPWT) in patients of burn departments.Methodology. The study included 56 patients treated with local negative pressure in the Department of thermal injuries of the Saint-Petersburg institute of emergency care named after I.I. Dzhanelidze in 2017–2020. Statistical data processing was performed using Microsoft Office Excel 2007 and IBM SPSS 20.0 using descriptive and non-parametric statistics.Results and their Discussion. The frequency of using VAC-therapy in patients with burn injuries was 0.8 % (56 of 6764). The most common reasons for hospitalization of patients were contact injuries – 20 (36 %) and flame burns – 18 (32 %). The main indications for NPWT were stimulation of granulation formation – 21 (38 %), control of wound infection – 20 (36 %), and temporary wound closure after early excisions or atypical amputations – 11 (20 %). The main contraindications to the use of the method were cognitive disorders or impaired consciousness. The primary complication was the depressurization of the dressings, which we encountered in 9 cases (16 %). The expected results of vacuum therapy were achieved in 49 patients (88 %).Conclusion. Local negative pressure is relatively rarely used in burn treatment. A positive effect from the use of NPWT can be expected in the control of wound infections and in the preparation of wounds for skin grafting. The prospects for the introduction of the method can be considered its application in the treatment of partial-thickness burns and additional fixation of skin grafts. To objectify the choice of modes and duration of vacuum therapy in burned patients, it is necessary to conduct further multicenter studies with the preparation of clinical guidelines.

Background Scientists around the world are interested in applying physical phenomena to various fields of science. The development of entire areas united by one concept (‘plasma medicine’, etc.) stands as a bright example. Present work focuses on only two concepts of interest, which are plasma jet and electric field, as far as results of their combined use in clinical practice and in surgery remain understudied. Objective Experimental evaluation of the effectiveness of physical methods of treatment in skin wound healing. Material and methods The study was carried out on 45 small laboratory animals (rats). They were divided into 5 groups of 9 individuals in each according to method chosen for experimental wound healing. To generate the plasma jet, a portable generator was used, which is the original development of specialists of the Peter the Great St. Petersburg Polytechnic University. Planimetric and histological measurements were analysed. The antibacterial effectiveness of methods under research was investigated using Staphylococcus aureus 209P, cultivated in vitro on 6- and 12-millimeter discs. Discussion The combined use of non-thermal atmospheric pressure plasma and frequency-modulated electric field signal exhibited the ability to accelerate eschar separation by 52.1% (p < 0.05) and stimulate restorative regeneration by 56% (p < 0.05). Combination of physical methods of treatment demonstrated pronounced antibacterial effect. A histological examination on biopsy sample on the 21st day of observation revealed formed (mature) granulations and large number of newly formed vessels. The cellular composition of epidermal basement membrane showed high level of differentiation. Conclusion The data obtained suggest that the use of the proposed methods in clinical practice will improve the treatment process of the patients with wounds of different etiology.

Abstract. Fetal fibroblast culture transplantation results were evaluated in the treatment of 18 burn victims. Comparison group consisted of 18 burn patients received medical care without cellular technologies utilization. The main comparison parameters in the study groups: the timing of the first stage of autodermoplasty; the number of autodermoplasties during the treatment; hospitalization duration; the newly formed epidermis area estimation. Fetal fibroblast culture transplantation in burn patients with extensive skin defects was performed on average 14,883,56 days after the injury. The timing of the first stage of autodermoplasty did not differ in the main and control groups, not exceeding an average of 19,122,01 days (p=0,48). An average of 2,710,67 surgeries using cell technologies performed in patients of the study group. The use of fetal fibroblasts culture in patients with extensive skin defects reduces the need for autodermoplasty by 1,6 times due to the granulation tissue formation and the epidermal growth beginning 7 days after and complete epidermal formation 14 days after transplantation. Regenerative medicine technologies utilization in patients with extensive skin lesions is possible and appropriate. Due to the fetal fibroblasts culture transplantation a kind of temporary biological coating is formed in the wound. It accelerates the wound healing process phase change from exudation to proliferation and the preparation of skin defects for autodermoplasty, expanding the possibilities of effective patients treatment.

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.

Abstract. Analysis of available literature and our own experience, the main causes of the lysis / rejection of autoderm grafts are systematized. It is shown that there is no consensus among combustiologists about the causes of these complications. It is believed that the leading cause of such complications is the general condition of the body, the unpreparedness of wounds for surgical treatment and the development of disseminated intravascular coagulation syndrome in seriously ill people. The frequency of unsatisfactory treatment results also correlates with the level of contamination of the burn wound. An increase in microbial seeding to 107 or 108 colony forming units per gram is a relative contraindication to surgery, while the optimal level for skin grafting is considered to be 104 colony forming units per gram. In addition, locally plastic interventions are possible with a microbial load of 105 colony forming units per gram, subject to compensation for violations of the general condition of the victim. Of great importance are the timing of autodermotransplantation. Conducting skin plastics later than 14 days after the injury increases the risk of postoperative complications. This is due to the peculiarities of the pathophysiological processes characteristic of burn wounds. During the first two weeks from the moment of the injury, the processes of reparative regeneration prevail in them, however, their intensity progressively decreases over time. It has been demonstrated that immune system disorders also have a significant effect on the rate of graft lysis. Domestic experts have developed an original method for predicting the likelihood of an unsatisfactory result of skin grafting, based on an assessment of a number of parameters of the immune system. The results of our observations indicate that the main causes of lysis / rejection of autodermotransplantants in the postoperative period are insufficient preparation of wounds for surgical treatment, changes in the general condition of the body, impaired immune system (autoaggression), and a high level of microbial contamination. The development of common criteria for assessing a patients readiness for skin grafting to prevent rejection of transplanted autoderm grafts remains an urgent task of combustiology.

Intention. To compare results of treatment among patients with burn injury associated with alcohol and smoking in bed vs general burn injuries. Methodology: The main study group included 60 patients with burns > 10 % TBSA, resulting from the ignition of the bed from an unfinished cigarette. The control group consisted of case histories of 330 patients with burns of similar area not associated with smoking in bed. Statistical data processing was performed using Microsoft Office Excel 2007 and IBM SPSS 20.0 using descriptive and non-parametric statistics. Results: Multifactorial injuries due smoking in bed combine deep burns, inhalation injury and poisoning with combustion products (so-called sofa injury) and are much more common in men (p = 0.002). Alcohol intoxication significantly increases the risk of such injuries (p = 0.001). “Sofa injuries” need longer (p = 0.001) and more expensive (p = 0.05) treatment than other burn categories. Early excision is preferable with one-stage skin graft. If the radical excision fails, then a vacuum dressing should be considered for temporary wound closure. Mortality in this group reaches 53 % and significantly exceeds that from any other type of thermal injury (p = 0.002). Conclusion: The so-called “sofa injury” is most common in middle-aged patients. Associated burn disease includes extensive deep burns of the trunk and upper extremities, usually with alcohol intoxication, inhalation injury and carbon monoxide poisoning. Most victims develop burn sepsis and multiple organ failure. Stratified excision is ineffective in most these patients. When excised to the fascia level, radical necrotomy can be achieved only in 60 % of cases. Taking these features into account helps to organize treatment correctly, optimize systemic therapy and create personalized surgical tactics, which should improve the results of treatment in patients with “sofa injury”. However, further clinical trials are necessary to confirm this theory.

Objective of study was definition of opportunities to use laser doppler flowmetry for accurate determination оf degree of a burn at prehospital stage. This is the result of an study of 25 patients with burn injury in emergency room. It was found communication between indicator of the perfusion and depth of burn wound. It was installed value of the perfusion with help laser doppler flowmetry (ПМ — 1,0 PU), which is diagnostics significant criterion of depth of burn. If indicator of the perfusion is lower 1.0 PU, that is-deep burn, If indicator of the perfusion is above 1.5 PU, that is — superficial burn, indicator of the perfusion is between 1.0 and 1.5 PU, that is — borderline burn. It was developed diagnostic algorithm of treatment.