CC BY
21«MEDICINE, SCIENCE AND EDUCATION», № 2, 2023
UCD: 616-001.17 DOI: 10.24412/1609-8692-2023-2-33-50
IRSTI: 76.29.39.
BURN INJURIES: EPIDEMIOLOGY, DIAGNOSIS AND TREATMENT
M. Baimuratova, * I. Abashidze
LLP Kazakhstan's Medical University «KSPH», Almaty, Kazakhstan
Summary
Burn injury continues to maintain its position as one of the most common and severe types of damage, and its treatment remains complex, lengthy and costly. The outcome of even a small burn in terms of area and depth can lead to functional and aesthetic disorders, affect social adaptation and the quality of life of patients. Accordingly, several unresolved problems are of interest in relation to patients' understanding of the severity and possible severe complications that require timely intervention by combustiologists. On the part of the work of primary healthcare practitioners, there remains a low awareness of the population about the possibilities of rehabilitation to improve the functional and aesthetic results of the treatment of burn injuries. Target is to study the current state of the issues of diagnosis and treatment of burn injury and prevention of post-burn scars. A literature review was carried out on the diagnosis and treatment of burns, as well as the frequency of post-burn cicatricial pathology in the world over a period of 10 years. Key words for searching full-text open access articles in the PubMed, Wiley and e-library databases: Burns, scars, scarring after burns, treatment of burns, skin grafting. An analysis of the publications showed that today there is no single tactic in relation to the provision of surgical care to patients with burns, in particular, the question of the timing and need for surgical treatment of borderline burns remains debatable. In addition, the prevention of a complicated course of the wound process after a burn injury (in particular, bacterial etiology), as well as the result of burn healing in the context of the prevention of pathological scarring and related functional and aesthetic disorders, is of scientific and practical interest. Thus, burn injury remains relevant in combustiologists' practice. Among the therapeutic measures, free skin grafting and various wound dressings used at inpatient care, depending on the phase of the wound process in the burn wound, are of the greatest importance. In addition, preventive measures and therapeutic approaches aimed at preventing pathological scars include the use of minimally invasive techniques that reduce excessive trauma to the skin and minimize complications (bacterial etiology). We consider no less significant, in the framework of the organization of rehabilitation and prevention of excessive scar formation at the outpatient level, some types of applications and the creation of long-term compression.
Key words: burn, borderline burn, skin grafting, burn treatment, wound dressings, pathological scarring.
Introduction. According to the World Health Organization (WHO), burns account for about 30% of all traumatic injuries and are characterized by a high level of mortality, disability and various complications [1-3]. Up to 180,000 fatal burn injuries are registered annually in the world, which is a serious problem for public health [1]. According to several researchers, it is considered important
that superficial and borderline burns with a limited lesion area prevail in the structure of thermal injuries of adult, able-bodied patients [4-7]. At first glance, this category of burns, which seems easy to treat, usually requires prolonged hospitalization and often leads to disfigurement and disability of patients, accompanied by stigmatization and social maladaptation [1, 8-10].
o^EBMETTIK wo^ymp
According to the latest data of 2021, about 500 thousand people in Russia receive burns every year [11-13].
According to the American Burns Association, up to 450,000 people are burned every year in the USA, which are so serious that medical care is required, while 45,000 adults and children are hospitalized with burns, including 25,000 patients in specialized burn centers [14], however, there are no such autonomous centers in the Republic of Kazakhstan yet, and burn departments are included in the structure of multidisciplinary hospitals.
Regarding the causes of disability of patients in the Russian Federation, as reported by Ya.L. Butrin, S.A. Petrachkov (2017), in 22.8% of cases there is a burn injury, of which 82% of the victims are the population of working age (20-49 years). The authors found that cicatricial complications are formed in 1/5 of patients of this category, and in deep burns with a damage area of more than 10% of the body surface - in 40-55% of cases [15].
Thus, burn injury continues to maintain its position as one of the most common and severe types of injury, and its treatment remains complex, lengthy and economically costly. The outcome of even a small burn in area and depth can lead to functional and aesthetic disorders, affect the social adaptation and quality of life of patients [16, 17], many foreign scientists believe. Accordingly, several unresolved problems regarding
patients' understanding of the severity and possible severe complications that require timely intervention of combust ologists are of interest. On the part of the work of primary healthcare (PHC) practitioners, there remains a low awareness of the population about the possibilities of rehabilitation to improve the functional and aesthetic results of treatment of burn injuries.
Diagnosis, features of the course and treatment of burns. Highlighting the issues of diagnosis, evaluation of the clinical symptom complex of patients with burn injuries, it should be noted that exclusively standardized approaches based on the principles of evidence-based medicine are welcome. According to the clinical protocol for the diagnosis and treatment of burn injury (No. 6 dated 28.06.2016), 4 degrees of burns are distinguished by depth, 2 scales are guided by area: with a lesion area of up to 20% of the body surface (limited burns), the "Palm Rule" (J. Yrazer, 1997), over 20% of the body surface (extensive burns) - the "Rule of nines" (A. Wallace, 1951) [18] are applied.
As can be seen from Table No. 1, the classification of the year 1960 retains its practical value and relevance to this day. In particular, the authors proposed 4 degrees of burn injuries, and described the corresponding clinical "picture" with an emphasis on the temporal differences in the stages of the inflammatory reaction and regeneration of the burn wound.
Table 1. Classification of burns by 4 degrees (USSR, 1960)
Degree of burn Clinical characteristics
I degree Redness of the skin with clear contours, sometimes on an edematous basis, the epidermis is not affected. Disappears after a few hours or 1-2 days
II degree The presence of thin-walled burn blisters with transparent liquid contents. Copious exudation persists for 2-4 days. Independent epithelialization occurs after 7-14 days.
III-A degree The presence of thick-walled burn blisters with jelly-like plasma contents, partially opened. The exposed bottom of the wound is moist, pink, with areas of white and red color - the papillary layer of the skin itself, often covered with a thin, whitish-gray, soft scab, petechial hemorrhages, pain sensitivity is preserved, vascular reaction is more often absent. Independent epithelialization occurs after 3-5 weeks.
III-B degree Lesion of the entire thickness of the skin with the formation of coagulation (dry) or colliquation (wet) necrosis. With dry necrosis, the scab is dense, dry, dark red or brown-yellow, with a narrow zone of hyperemia, a small perifocal edema. With wet necrosis, the dead skin is swollen, of a testy consistency, the preserved thick-walled blisters may contain hemorrhagic exudate, the bottom of the wound is mottled, from white to dark red, ashy or yellowish, there is widespread perifocal edema. Vascular and pain reactions are absent.
IV degree It is accompanied by necrosis not only of the skin, but also of formations located below the subcutaneous tissue - muscles, tendons, bones. It is characterized by the formation of a thick, dry or moist, whitish, yellowish-brown or black scab of a testy consistency. Tissue edema is evident under it and in the circumference, the muscles have the appearance of "boiled meat".
According to the data from Table No. 2, ICD-10 (International Classification of Diseases 10th Revision) offers 3 degrees of depth of burns, but at the same time does not
deny the previous ranking, as evidenced by the subparagraphs mentioned regarding the degrees of skin necrosis (III-A degree, III-B degree).
Table 2. Classification of the degree (depth) of the burn according to ICD-10 (Ratio with the classification of 1960)
Characteristic Classification of the XXVII Congress of Surgeons of the USSR Classification according to ICD-10 (T20-T25) Burn depth
Hyperemia of the skin I degree I degree Surface burn
Burn blisters formation II degree
Skin necrosis III-A degree II degree
Complete necrosis of the skin III-B degree III degree Deep burn
Necrosis of the skin and underlying tissues IV degree
The US experience has advanced in classification issues, detailing the 4th degree of burn, expanding it to 5 and 6 degrees: the depth of involvement of muscles and ligaments at 4 degrees, the involvement of bones and their complete destruction at 5 and 6 degrees, respectively.
Figure No. 1 shows very significantly the differences (Status localis) based on the degrees of damage to the skin and deeper lying tissues, depending on the severity of the burn injury. Such visualization is a good illustrative tool in expanding knowledge about the issues of differential diagnosis, as well as helping to
form the competence of a novice clinician-combustiologist.
Table No. 3, taken from the review article by He J.J. (2021), was supplemented and adapted by us to the classification of burns, traditional for the practice of the domestic combustiological service, taking into account the depth, clinical features, general principles of local treatment and healing time. In our opinion, this approach in the classification of burns can be used in practice for rapid differential diagnosis and the construction of a general plan of local therapeutic tactics and prediction of healing time.
Figure 1. The degree of burns and the corresponding damage to the skin caused
by a burn injury [19]
Table 3. Comprehensive assessment of burn injury, taking into account the depth (degree) of damage and the recovery time of patients [19]
Degree Depth of injury Burn blisters Pain Color Other Symptoms Examples Healing time Scar Additional wound care
epidermis no yes red dryness, Sun- 2-3 days no no
(surface (erythe- itching and burn (up to 7
layers) ma) peeling days)
I epidermis Thin- ex- bright Edema, Hot from 5-6 No, some- Some-
(deep walled tremely red exudate water days or times times
layers) with transparent contents evident burns from 5-6 days or more more hyperpig mention remains PST, WC
II papillary Thick- Evident from The con- Burn 1 month Persistent PST,
A layer of walled, (touch whitish tents of with soft WC,
dermis large, sensi- to yel- the burn boiling ADP
tense, the tivity low blisters water, some-
appear- may be in the steam times
ance of a reduced) form of a
scab jelly-like-
(crust) is mass
possible
II reti- Large No charred, The Flame months Persistent PST,
E cular with (or brown, bottom is burn rough WC,
dermis bloody mod- some- dry, dull ADP
with par- contents, erate times always
tial there sensi- whitish,
damage to may be tivity) spotted
the a ("mar-
subcu- scab ble")
taneous fat (wrinkled, dense)
V deep Not de- No (no Char- Dense Flame months Persistent Mul-
structures tected sensitiv- red, crust burn very tiple
(fascia, ity black rough opera-
muscle, or tions
bones) brown
*Abbreviations: PST- primary surgical treatment; WC - wound covering; ADP - autodermoplasty.
Having paid special attention to the diagnosis of the depth of burn damage, I would like to emphasize that in the structure of this injury, a separate position is occupied by burns of the IIIa degree, characterized by the death of the epidermis and partially the dermis. At the same time, independent epithelialization is observed 18-21 days after the injury. According to a number of sources, burns of this group are correctly classified as "borderline burns". We consider the definition proposed by the authors attractive, which allows methodically reliably and objectively, based on clinical and morphological data, to choose a more effective treatment strategy for these burns [20-22]. Borderline burns continue to be a common and significant problem of combustiology, presenting difficulties in diagnosis and further treatment, according to foreign researchers (2021) [19]. This category of burns is characterized by a tendency to conversion (secondary deepening) and scar formation. The progression of burn wounds leads not only to deeper damage, but also to an increase in the area of the burn surface [23, 24]. The acquired knowledge about the conversion phenomenon will allow the practitioner to adequately assess the tactics of further management of patients with burns. In the long-term recovery periods, a high proportion of unsatisfactory functional and aesthetic outcomes remains, according to
Sakharov S.P. (2013) and He J.J. et al. (2021) [19, 25]. In this regard, it is quite acceptable to designate as a priority the development of unified regional standardized approaches at the stage of rehabilitation of patients with burn injuries.
The presence of a deep burn is an indication for surgical treatment, regardless of the time of injury, the area of damage, and other clinical and organizational aspects [26]. In this regard, I would like to note, despite the age and gender differences, deep burns should be regarded as an extreme degree of invasion, requiring a more personalized approach in the implementation of the stages of skin grafting.
Regarding the surgical treatment of patients with borderline burns, this issue remains debatable to date [19, 27, 28]. Because the complex dynamics of the wound during the first 3 days and the ambiguity of the pathophysiology of the conversion process of burn wounds does not always allow practitioners to assess the degree of burn wounds and prescribe appropriate treatment [24]. While underestimating burn injuries can lead to conversion of a burn wound, while overestimating the severity of a burn injury leads to unnecessary surgical treatment of the wound, as well as hospitalization [19]. Taking into account the complications in assessing a burn wound and optimizing treatment, to date there is no universal solution that
could effectively prevent the progression of secondary burn injuries. However, there is a general opinion that rapid wound rehabilitation and topical antibiotic treatment are crucial regardless of the conversion mechanisms. Early surgical treatment is necessary because necrotic tissue provides a suitable environment for bacterial growth, erosion and deterioration of the wound [23]. The lack of a unified tactic regarding surgical treatment of grade III burn wounds determines the fact of later surgical treatment of borderline burns, when it becomes clear that the skin organoids preserved in the wound are not able to provide full-fledged wound epithelization. It is obvious that indications for surgical treatment of burns of this group do not arise at all if sufficiently
active cell division of hair follicles, sebaceous and sweat glands is detected, supporting adequate epithelization of wounds in optimal time. Wound healing up to three weeks is considered by most researchers as the optimal epithelization period for borderline burns, indicating an uncomplicated course of the wound process. Delayed repair beyond this period becomes the cause of excessive, pathological, including keloid scar formation [19, 29, 30]. Thus, within the framework of the ongoing research, we plan to find answers to questions about measures to prevent the development of gross and pathological scarring of burn injuries of the skin to improve the final results of treatment of the examined group of patients.
Treatment of burns
Figure 2. General principles of burns treatment (based on the clinical protocol for the diagnosis and treatment of burns in adults with burns of II-IIIA-B-IV degree more than 30%, deep more than 10% of the body surface, adopted in
the Republic of Kazakhstan, 2016)
As can be seen from figure No. 2, we can divide the treatment of burns into 2 large groups: general therapy and local treatment. In turn, general treatment is carried out in 4 directions of the pathogenesis of burn injury: pain control, elimination of manifestations of burn shock, the fight against toxemia and
antibacterial therapy. Local treatment includes conservative and operative methods. The conservative approaches to the treatment of a burn wound, 2 opposite principles are used: open and closed. The open principle implies the creation of conditions for the formation of a dry scab - this is UVIs (ultraviolet irradiation)
and drying; and the closed principle of treatment involves the use of various dressings with medicines. Local treatment of burns in an open way by treating wounds with a solution of iodopyron or applying ointments is possible in the face, perineum and genitals. At the same time, currently the majority of specialists give their preference to a closed method of treating such wounds, using bandages of different composition [20].
Surgical methods of treatment of burn injury include necrotomy (dissection of necrotic tissues), necrectomy (removal of necrotic masses within healthy tissues) and skin grafting, which are various types of operations to restore the skin in the area of wounds that do not heal against the background of other types of treatment [18, 31].
Current trends in local treatment of burns. The prevailing number of combust ologists advocates early surgical tactics in the form of tangential excision of a burn scab within the dermis (EST). In borderline burns, EST is performed to create conditions for optimal epithelialization and the fastest possible healing in the area of the borderline burn wound [32, 33]. To date, there are various ways to close borderline burns after primary surgical treatment - these are autodermoplasty (ADP), allogeneic and xenogenic skin, cultured skin cells, various wound coatings (WC) [34, 35]. Such a variety of types of treatment shows that, despite the current huge selection of medical technologies and progress in this industry, there is no universal tactic that would be acceptable in all clinical cases. According to a number of authors, there are currently no unified approaches to local treatment of burns [36]. Numerous papers have been published on the successful use of allogeneic and xenogenic skin for the local treatment of burn wounds [37, 38]. The issue of the use of biopolymer WC is less covered in the literature. Some researchers have devoted their work to the study of collagen-based WC or chitosan [39]. According to some authors, polymers based on hyaluronic acid (HA), a component of the extracellular matrix, are effective [40, 41]. Several authors believe that the inflammatory process in the area of burn injury is one of the
main reasons for the delayed healing of these wounds [42]. As modern research shows, the microflora of burn wounds is represented by a polymorphic species composition characterized by associativity with the predominance of conditionally pathogenic strains of microorganisms (CPB). At the same time, hospital strains of CPB pose the greatest threat to patients of the burn department. In recent years, according to the results of some studies, an important group of CPB has been identified - ESKAPE - Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumonia, Acinetobacter baumanni, Pseudomonas aeruginosa and species of the genus Enterobacteriaceae spp. [41, 43]. According to K.V. Mitryashov (2020), permanent changes in the bacterial ecosystem of microbiological hospitals support the need for and importance of bacteriological research [44].
In addition, as previously mentioned, the predictors of conversion (the phenomenon of secondary deepening) of a burn wound and the relationship of this complication with the choice of the type of local treatment and the possibility of its prevention with the help of conservative therapy of superficial and borderline burns have been poorly studied. According to the research of K.S. Kobelev (2021), there are currently no systems for predicting the course of the wound process that would meet practical requirements and help in choosing the optimal method of local treatment of burns [45].
An actual approach to the treatment of deep burns is early necrectomy in combination with autodermoplasty [22, 46]. However, according to I.V. Vladimirov (2020), for various reasons, in practice, such a method of treating victims with burns can be difficult to implement. Therefore, according to the author's publication, the same technique of delayed surgical treatment of patients with burns remains to this day. At the same time, according to some publications, delayed necrectomy with simultaneous free transplantation of split skin often fails. Rejection of autodermotransplants after autodermoplasty (ADP) varies from 0 to 100% [34, 47]. Factors affecting the engraftment of an autodermotransplant can
be divided into two large groups: general (autoimmune diseases, infection of a burn wound) and technical (imperfect technique of surgical intervention, transplantation to a poorly prepared wound, defect of the autodermotransplant itself and a violation in the process of its laying, etc. [48]. Complication in the form of autodermotransplant rejection syndrome (ARS) occurs against the background of a severe course of the wound process, in the development of which the main role is played by the attachment of infection. Which, according to many researchers, has a serious impact on the outcomes of treatment of burn patients [49]. Based on the publications of some researchers, we can consider it generally accepted that burn departments are a "reservoir" for hospital strains of microorganisms with polyvalent antibiotic resistance [49]. Considering this, for effective treatment of patients with burn injury, it is necessary to have detailed information about the microbiological composition of the department with a picture of sensitivity to antibacterial drugs and differentiation of patient flows [49].
In addition, the transformation of the bacterial landscape of a burn wound is crucial for choosing the type of antiseptic, WC and local physical factors of treatment [44]. Some papers also present the results of studying the effect of microcirculatory disorders on the development of ARS [48]. However, according to the conclusions of I.V. Vladimirov, there is no consensus on uniform criteria for the suitability of a burn wound for simultaneous ADP after delayed necrectomy and the prediction of its results. In addition, the author points out the paucity of data on the effect of acoustic media used in low-frequency ultrasonic cavitation (LFUC) of wounds, on the indicators of microcirculation, bacterial composition and contamination of burn wounds in the postoperative period [34].
Considering the importance of using various dressings at all stages of treatment of burn wounds, we decided to cover the issue of wound coverings in more detail in the form of a comparative table compiled based on the publication of the American researcher He J.J. (USA, 2021).
Table 4. Comparative characteristics of the experience of evaluating existing wound coatings (WC), according to the research of He J.J. (USA, 2021) [19]
No. Type of bandages Trade name Composition Advantages Disadvantages
1. Gauze Kerlix Cotton fibers Cheap cost, affordable physical rehabilitation, absorbency Leaves the fibers of the material, traumatic removal and lateral migration of bacteria
2. Semi-permeable film BAND-AID Non-porous, plas-ticized polyvinyl chloride polymer Sterilizable, maintains a moist environment and prevents the migration of bacteria Can't prevent maceration
3. Calcium Alginate CURASORB Polymer derived from seaweed Absorbs excess moisture, prevents maceration and is sterilized Leaves the fibers of the material, requires soaking for atraumatic removal, is not suitable for dry wounds and requires a secondary bandage.
4. Hydrogel Hydrogel bandage Skinteg-rity Crosslinked polymers such as starch, cellulose or other polysaccha-rides of vegetable or animal origin. It can moisturize dry wounds, as well as absorb a small excess of exudate, depending on the type of wound. Atraumatic when used correctly. Promotes autolysis of necrotic tissues and does not support bacterial growth Suitable only for wounds with low exudation or dry wounds. It can cause maceration in profusely exudating wounds and can go from dry to wet gangrene in exudat-ing ischemic ulcers
5. Hydrocolloid Hydrocolloid bandage Me-di-Pak Performance Gelatin, pectin, sodium car-boxymethylcel-lulose and poly-isobutylene. Creates a moist hy-poxic environment for the wound Allows maceration in highly exudating wounds
6. Spray-on Nobecutane Acrylic resin dissolved in acetic acid esters. Proper first aid and reduction of infection in some operations in some operations Hemolysis is possible; does not provide uniform coverage
7. Foam Foam covering Tegaderm Polyurethane Can be cut to shape; heat-insulating properties; provides a moist surface, absorbs excess exudate. Not applied for dry wounds
8. Capillary effect Vacutex 80% Polyester with 20% cotton fibers, between two layers of perforated breathable non-woven polyester. Reduces bacterial load on the wound surface, helps in sanitation and peeling removal, and also prevents maceration Adheres to wounds with a low exudate level, traumatic removal is possible. An additional contact layer necessary for heavily bleeding wounds
9. Odor Absorber Carbonet Activated carbon layer inside the bandage. Deters odor-causing molecules and antimicrobial-resistant bacteria. The effectiveness of odor containment and exudate absorption varies.
10. Matrix (natural material) Alloderm (dermal substitute) Cell-free deepithe-lized dermis of the corpse. It is biocompatible, decomposable and has low antigenicity. Collagen can promote the transmission of infectious agents and thus requires strict disinfection protocols.
11. Matrix (synthetic material)) Integra (dermal substitute) Silicone, collagen and glycosamino-glycans. A variety of construction methods, electro-spinning matrices stimulate cell adhesion. Polylac-tides decompose to lactic acid, providing a limited host immune response. Local lactic acid production may affect the effectiveness of some proteins in the local environment.
12. Bandages with honey Derma Sciences MediHoney Medicinal honey, for example, manuka; honey included in hydro-gel or alginate or applied locally. Antimicrobial, antifungal, anti-inflammatory, deodorizing, maintaining the humidity of the environment. As a topical treatment, it dissolves quickly and requires frequent bandages to maintain effectiveness.
13. Iodine bandage Inadine Povidone iodo-phores (PVP-1) and cadexomeric iodine-containing bandages. Antiseptic, only a small amount of free iodine gets into the wound. Prevents wound healing due to cytotoxic effect on fibroblasts, kerati-nocytes and leukocytes; suitable only for short-term use
14. Silver bandage Sorbsan silver Ionic, metallic and nanocrystalline forms of silver are used in the form of foam, hydro fibers and hydrocolloids. Antibacterial effect has proven itself well. Possible systemic toxicity is currently being studied; efficacy varies between products
15. Soft silicone M e p i t e l , Mepilex Ag The contact layers consist of a polyamide mesh coated with soft silicone. Prevents maceration of surrounding tissues, atraumatic removal with nonattachment to the wound site, suitable for a wide range of wounds, can be used in hard-to-reach places of the wound, can stay for up to 10 days, can be impregnated with silver. It is used in combination with a secondary absorbent bandage and requires contact with the wound site.
in the characteristics of practical significance. The last 2 sections highlight their advantages and disadvantages, which make it possible to make the right choice depending on the stage of the course of the wound process of burn damage.
As can be seen from Table No. 4, we present a comparative description of the experience of evaluating existing WC, compiled according to research by He J.J. (USA, 2021), which includes 15 types of WC. Of course, they differ both in composition and
Conclusions. Thus, summarizing all the above, that is, a review of available literature sources for the period 2013-2021, we consider it possible to assert that burn injury, despite the achievements of modern medicine, remains relevant at the present time. Among the therapeutic measures, free autodermoplasty and various wound dressings used at the hospital stage, depending on the phase of the wound process in the burn wound, are of the greatest importance. In addition, preventive measures and therapeutic approaches aimed at preventing pathological scars include the use of minimally invasive techniques that reduce
excessive traumatization of the skin and minimize complications (bacterial etiology). In this regard, our planned research, within the framework of the master's project, in particular, the causes of complications in patients with burn injuries involves the study of exo- and endogenous etiological factors. We consider it equally important, within the framework of the organization of rehabilitation and prevention of excessive scarring at the outpatient level, to study some applied methods that are important in choosing the optimal (in composition) type of applications and creating long-term compression.
KYfflK ЖАРАЦАТТАРЫ: ЭПИДЕМИОЛОГИЯ, ДИАГНОСТИКА ЖЭНЕ ЕМДЕУ
М. Баймуратова, *И. Абашидзе
«^КДСЖМ» ^азакстандык медициналык университет ЖШС, Алматы, ^азакстан
Тушндеме
Ky&k жаракаты закымданудыц ец кеп таралган жэне ауыр тYрлерiнщ 6ipi ретшде ез орнын сактауды жалгастыруда жэне оны емдеу кYPделi, уза; жэне кымбат болып кала береди Ауданы мен терецдш бойынша limi кiшкентай ^йктщ нэтижесi функционалдык жэне эстетикалык бузылуларга экелуi мYмкiн, элеуметпк 6ейiмделу мен наукастардыц емiр CYPУ сапасына эсер етедi. Тиiсiнше, 6iркатар шешiлмеген мэселелер наукастардыц ауырлык дэре-жесiн тYсiнуiне жэне комбустиологтардыц уактылы араласуын талап ететiн ыктимал ауыр аскынуларга катысты кызыгушылы; тудырады. Медициналык-санитарлык алгашкы кемек-тщ (МСАК) дэр^ерлершщ жумысы жагынан халыктыц кYЙiк жаракаттарын емдеудщ функционалдык жэне эстетикалык нэтижелерiн жаксарту Yшiн оцалту мYмкiндiктерi туралы ха-бардарлыгыныц темендiгi сакталуда. КYЙiк жаракатын диагностикалау жэне емдеу жэне ^йктен кейiнгi тыртыктардыц алдын алу мэселелерiнiц казiрri жагдайын зерттеу. КYЙiктi диагностикалау жэне емдеу, сондай-ак элемде 10 жыл iшiнде ^йктен кейiнгi цикатриялык патологияныц жиiлiгi туралы эдебиеттерге шолу жасалды. PubMed, Wiley жэне электронды кiтапхана дереккорларында толык мэтiндi ашык колжетiмдi макалаларды iздеуге арналган кiлт сездер: КYЙiк, тыртык, кYЙiктен кейiнгi тыртык, кYЙiктердi емдеу, терi егу, кYЙiк, кYЙiктен кешнп тыртыктар, аутодермопластика. Эдебиет деректерiн талдау 6Yгiнгi кYнi кYЙiкке шал-дыккан наукастарга хирургиялык кемек керсетуге катысты бiрыцFай тактиканыц жок екенiн керсетп, атап айтканда, шекаралык кYЙiктердi хирургиялык емдеудщ уакыты мен кажеттiлiгi туралы мэселе элi де пiкiрталас тудыруда. Сонымен катар, кYЙiк жаракатынан кешнп жара процесшщ кYPделi аFымыныц алдын алу (атап айтканда, бактериялык этиология), сондай-ак патологиялык тыртыктардыц жэне онымен байланысты функционалдык жэне эстетикалык бузылулардыц алдын алу аясында кYЙiктi емдеудщ нэтижеа. Fылыми жэне практикалык кы-зыFушылык тудырады. Осылайша, кYЙiк жаракаты, заманауи медицинаныц жетiстiктерiне карамастан, езект болып кала 6ередi. Терапиялык шаралардыц iшiнде кYЙiк жарасындаFы жара процесшщ фазасына байланысты стационарлык жаFдайда колданылатын тегiн аутодермопластика жэне эртYрлi жара тацFыштары Yлкен мэнге ие. Сонымен катар, патологиялык тыртыктардыц алдын алуFа баFытталFан профилактикалык шаралар мен терапевта тэсiлдер терiнiц шамадан тыс жаракаттануын азайтатын жэне аскынуларды (бактериалды этиология)
азайтатын аз инвазивт эдiстердi колдануды камтиды. Бiз амбулаториялык децгейде оцалту-ды уйымдастыру жэне шамадан тыс тыртыктардыц пайда болуыныц алдын алу, колданудыц кейбiр тYрлерiн жэне узак мерзiмдi компрессияны к¥Руды кем емес мацызды деп санаймыз.
Tyrnndi свздер: куйщ шекаралыц куйщ аутодермопластика, KYuiKmi емдеу, жараны тацу, патологиялыц тыртыц.
ОЖОГОВЫЕ ТРАВМЫ: ЭПИДЕМИОЛОГИЯ, ДИАГНОСТИКА И ЛЕЧЕНИЕ
М. Баймуратова, *И. Абашидзе
ТОО Казахстанский медицинский университет «ВШОЗ», г. Алматы, Казахстан
Аннотация
Ожоговая травма продолжает сохранять позиции одного из самых распространенных и тяжелых видов повреждения, а ее лечение остается сложным, продолжительным и экономически затратным. Исход даже небольшого по площади и глубине ожога может приводить к функциональным и эстетическим нарушениям, влиять на социальную адаптацию и качество жизни пациентов. Соответственно, интерес представляют ряд нерешенных проблем в отношении понимания пациентами тяжести и возможных тяжелых осложнений, требующих своевременного вмешательства комбустиологов. Со стороны работы врачей ПМСП остается низкая информированность населения о возможностях реабилитации для улучшения функциональных и эстетических результатов лечения ожоговых травм. Целью написания статьи было изучение современного состояния вопросов диагностики и лечения ожоговой травмы и профилактики послеожоговых рубцов. Проведен литературный обзор по вопросам диагностики и лечения ожогов, а также частоты послеожоговой рубцовой патологии в мире глубиной 10 лет. Ключевые слова для поиска полнотекстовых статей открытого доступа в базе PubMed, Wiley и e-library: Burns, scars, scarring after burns, treatment of burns, skin grafting, ожоги, послеожоговые рубцы, аутодермопластика. Анализ литературных данных показал, что на сегодняшний день нет единой тактики в отношении оказания хирургической помощи пациентам с ожогами, в частности остается дискутабельным вопрос сроков и необходимости оперативного лечения пограничных ожогов. Кроме того, научно-практический интерес вызывает профилактика осложненного течения раневого процесса после ожоговой травмы (в частности, бактериальной этиологии), а также результат заживления ожога в контексте превенции патологического рубцевания и связанных с ним функционально-эстетических нарушений. Таким образом, ожоговая травма, несмотря на достижения современной медицины, сохраняет свою актуальность. Среди лечебных мероприятий наибольшее значение имеет свободная аутодермопластика и различные раневые повязки, применяемые на госпитальном этапе в зависимости от фазы раневого процесса в ожоговой ране. Кроме того, профилактические меры и лечебные подходы, направленные на предупреждение патологических рубцов, включают применение малоинвазивных методик, сокращающих чрезмерную травматизацию кожных покровов и минимизацию осложнений (бактериальной этиологии). Не менее значимыми считаем, в рамках организации реабилитации и профилактики чрезмерного рубцеобразования на амбулаторном уровне, некоторые виды аппликаций и создание длительной компрессии.
Ключевые слова: ожог, пограничный ожог, аутодермопластика, лечение ожогов, раневые повязки, патологическое рубцевание.
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Corresponding author. Abashidze Inara Israfilovna - master student on specialty «Medicine», LLP Kazakhstan's Medical University «KSPH», Kazakhstan, Almaty, E-mail: inara_ abashidze@mail.ru, ORCID https://orcid.org/0000-0002-6600-7040.
Baimuratova Mairash Aushatovna - c.m.s, professor of the Department «Public health and social sciences », LLP Kazakhstan's Medical University «KSPH», Kazakhstan, Almaty, E-mail: mairash@list.ru, ORCID https://orcid.org/0000-0003-0219-7874.
Article submitted: 12.05.2023.
Accepted for publication: .01.06.2023.
