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IMPROVEMENT OF PHYSICAL FACTORS IN THE LOCAL TREATMENT OF BURN WOUNDS
Osmanov K.
The Federal state budgetary educational institution of higher education St. Petersburg State Pediatric Medical University of the Ministry of Health ofRussia
Bogdanov S.
The state Department of health "Scientific research Institute of regional clinical hospital № 1
named after S. V. Ochapovsky „ Zinoviev E.
The Federal state budgetary educational institution of higher education St. Petersburg State Pediatric Medical University of the Ministry of Health ofRussia
Abstract
The article presents the results of evaluating the effectiveness of the use of low-temperature argon plasma of an arc discharge of atmospheric pressure in the treatment of 2nd and 3rd degree skin burns (ICD-10). Burns had a different etiology (flame, boiling water, contact) and area. The change in the microflora of burn wounds after a single application of the PLAZMORAN installation was determined in three groups of patients, depending on the type of surgical treatment (dermabrasion, early necrectomy with plastic surgery and plastic surgery on granulating wounds). Based on the analysis of bacteriological studies, it was found that the use of low-temperature air plasma of an arc discharge of atmospheric pressure reduces the contamination of wounds by pathogenic microflora.
Keywords: skin burns, low-temperature argon plasma, surgical treatment.
Introduction
Burn injuries in our country range from 3% to 4% of all types of injuries. Every year in Russia, about 400,000 people suffer from burns of various etiologies (thermal, electrical, chemical), of various depths and localizations, 1/3 of which need hospital treatment [2].
The surgeon in his arsenal, in addition to traditional methods of treating burnt skin, has a number of physical factors to influence on burn wounds, which include: ultraviolet radiation, ultrasound, magnetic laser therapy, hydrotherapy, and others [7,8,10]. With the help of them, an antibacterial, proliferative effect, stimulation of capillary circulation, improvement of microcirculation and stimulation of tissue metabolism can be achieved [5].
The use of plasma is one of the promising physical methods of exposure to the wound. It is an ionized gas of high temperature, which consists of charged particles, free electrons, ions, radicals, infrared, ultraviolet radiation [9]. In addition to high temperature and electromagnetic fields, a significant influence factor are plasma components that can damage the cytoplasmic membranes of pathogenic microorganisms and viruses, by affecting their vital systems [4].
In practice, a number of plasma generators of both Russian and foreign production are actively used in the treatment of burn wounds. These include the Plazon (RF), NPC Plasma (RF), The J-Plasma System "USA" and "Neoplas Tools" (Germany).
The above listed medical plasma generators has several disadvantages: the coverage area is from 2 to 10 millimeters, which is limited by the technical characteristics of this equipment; in order to use the equipment, a number of additional components are needed, when the apparatus is in operation it is impossible to provide instant coagulation of microvessels having a diameter of more than 2-3 millimeters.
The use of low-temperature argon plasma of an arc discharge of atmospheric pressure contributes to the improvement of reparative regeneration processes. A complex effect occurs: antimicrobial, hemostatic, proliferative; and the plasma temperature [14] ranges from ± 50 ° C. During the operation of the equipment, argon is used as the working gas during plasma generation. The method is able to ensure the achievement of stable hemostasis, while there is no high-temperature damage to surrounding tissues. Stopping bleeding is achieved by accelerating platelet aggregation and the formation
of a fibrin clot. Processing the wound surface with a plasma jet not only sterilizes it, but also protects against microbial contamination from the environment due to the thinnest layer of coagulated wound exudate protein.
The use of low-temperature argon plasma of an arc discharge of atmospheric pressure for the treatment of skin burns requires further investigations.
Purpose of the research
To study the effectiveness of reducing the micro-bial contamination of burn wounds after application of low-temperature argon plasma of an arc discharge of atmospheric pressure.
Materials and methods
In the burn department of The state Department of health "Scientific research Institute of regional clinical hospital № 1" named after S.V. Ochapovsky since 2018, the "Plasma-arc surgical installation for the treatment of wounds PLASMORAN" has been used to treat burn wounds. The PLAZMORAN is based on the generation of low-temperature argon plasma for the subsequent use of its main physical and technical factors: gas-dynamic effect - argon flow with high heat content; recombination radiation with a wide spectrum - from the field of vacuum ultraviolet to the near infrared range; argon as working gas, which has pronounced catalytic properties for a number of important biochemical reactions.
We have analyzed the results of treatment of 40 patients aged 19 to 60 years with II and III degree burns (ICD-10) of various etiologies (flame, boiling water, contact) and the area, in the burn department of The state Department of health "Scientific research Institute of regional clinical hospital № 1" named after S.V. Ochapovsky". Changes in the qualitative and quantitative microbial composition in the burn wound were evaluated before and after a single application of the PLAZMORAN on burn wounds up to 5% from the body area.
All patients were divided into 3 groups depending on the choice of surgical treatment technique. The first group - patients underwent dermabrasion in the first 27 days after second-degree burns (13 people). The second group is an early tangential necrectomy of wounds with simultaneous autodermoplasty (12 people), the third group is a tangential excision of granulating wounds with simultaneous autodermoplasty (15 people).
Table 1
Comparative evaluation of bacterial contamination before and after treatment of wounds with the PLAZMORAN.
In patients of the first group (13 people), a smear from a wound for bacteriological examination was taken before the start of the operation. Then dermabra-sion was performed, and the wound was treated with the PLAZMORAN (1 cm2 - 30 seconds). After that, re-smear was taken from the wound for bacteriological examination. Synthetic or biological wound coverings were applied to the wound, which were not removed (79 days) until the wounds were completely epithelized.
In patients of the second group (12 people), a smear from a wound for bacteriological examination was performed before the operation. Then the wound was treated with the PLAZMORAN (1 cm2 - 30 seconds). Further, early tangential wound necrectomy and the bottom of the wound for hemostasis were treated with the PLAZMORAN. Subsequently, a smear was taken from the bottom of the wound for bacteriological examination. Autodermoplasty was performed.
In patients of the third group (15 people), a smear from a wound for bacteriological examination was made before the start of the operation. Further tangential excision of granulating wounds was performed. Then the wound was treated with the PLAZMORAN (1 cm2 - 30 seconds). After that, a smear was taken from the wound for bacteriological examination and autoder-moplasty was performed. The application of wound dressing "VoskoPran". Bandaging was implemented in 2-3 days up to complete epithelialization of wounds.
Evaluation of the effectiveness of the methods for treating wounds using the PLAZMORAN was assessed with the help of dressings.
The results of bacteriological studies were collected before and after treatment, examination of the wounds, the nature of the discharge, the epithelization of burn wounds and the adaptation of autografts were noted.
Results and discussions
It was found that by treating burn wounds with the PLAZMORAN, the results of an analysis of bacteriological studies indicate a decrease in bacterial contamination or complete debridement of the wounds after plasma exposure, which reduces the risk of purulent inflammation and speeds up the epithelization of burn wounds. The results of a comparative assessment of bacterial contamination before and after treatment of wounds are shown in Table 1.
Pathogen Grou p 1 Grou p 2 Grou p 3
before after before after before after
Corynebacterium striatum 4 2
Pseudomonas aeruginosa 4 4
Staphylococcus aureus 2 1 3 1 3 2
Staphylococcus haemolyticus 3 1 1 0
Staphylococcus hominis 2 1 1 0
Klebsiella pneumoniae 1 0
Staphylococcus capitis 2 1
Acinetobacter baumannii 1 0 2 1
Stenotrophomonas maltophilia 1 0
Staphylococcus epidermidis 2 2 4 2 1 0
Staphylococcus epidermidis (MRSE) 2 1 1 1
Depending on the nature of the wound and the period after the injury, the studied groups had a different nature of pathogens. In patients of the 1st group, 7 different pathogens were identified: Staphylococcus au-reus, Staphylococcus haemolyticus, Staphylococcus hominis, Acinetobacter baumannii, Stenotrophomonas maltophilia, Staphylococcus epidermidis, Staphylococ-cus epidermidis (MRSE). In patients of the 2nd group, 5 pathogens were determined: Staphylococcus aureus, Staphylococcus capitis, Acinetobacter baumannii, Staphylococcus epidermidis, Staphylococcus epidermidis (MRSE). In patients of the 3rd group, 7 pathogens were detected: Corynebacterium striatum, Pseudomonas aeruginosa, Staphylococcus aureus, Staphylococ-cus haemolyticus, Staphylococcus hominis, Klebsiella pneumoniae, Staphylococcus epidermidis.
The data in Table 1 allow us to conclude that burn wounds are obligately contaminated with a wide range of pathogenic microflora, causing a pronounced inflammatory reaction and, as a result, a possible complicated course of the wound process. After treating the experimental wounds with the PLAZMORAN in the first group, a decrease in bacterial contamination was recorded in 7 patients (54%) and complete debridement in 6 patients (46%); in the second group, there was a decrease in bacterial contamination in 6 patients (50%) and complete debridement in 6 patients (50%); in the third group, there was a lack of dynamics of bacterial contamination in 1 patient (6%), a decrease in bacterial contamination in 7 patients (47%) and complete deb-ridement in 7 patients (47%).
In a number of observations after treatment with the PLAZMORAN, there was a complete absence of the pathogen that was detected before treatment. In one of the patients from the first group before treatment was identified Staphylococcus epidermidis (moderate growth) and Stenotrophomonas maltophilia (moderate growth), and after treatment with Staphylococcus epi-dermidis (poor growth). In a patient of the third group, before treatment it was noted: Staphylococcus hominis (moderate growth) and Pseudomonas aeruginosa (moderate growth), and after treatment with Pseudomonas aeruginosa (moderate growth). In a patient of group 3, it was noted before treatment: Pseudomonas aeruginosa (heavy growth with resistance to all antibiotics), Pseudomonas aeruginosa (heavy growth with sensitivity to Cefepime and Ceftazidime), Klebsiella pneumoniae (poor growth), and after the treatment: Pseudomonas aeruginosa (heavy growth with resistance to all antibiotics), Pseudomonas aeruginosa (heavy growth with sensitivity to Cefepime and Ceftazidime).
Conclusions
Thus, the results obtained allow us to conclude that the use of low-temperature argon plasma of an arc discharge of atmospheric pressure in the treatment of burn patients is a promising method for optimizing the wound healing process in the area of skin defects, including deep burns. The use of this technique reduces the contamination of wounds by pathogenic microflora, promotes local hemostasis after necrectomy, which reduces the incidence of purulent complications and improves the course of the wound process.
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