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МЕДИЦИНСКИЕ НАУКИ
SURGICAL TREATMENT OF DEEP BURNS AND THEIR CONSEQUENCES IN THE AREA OF LARGE JOINTS OF THE LIMBS IN CHILDREN Isomiddinov Z.D.1, Madazimov M.M.2 Email: Isomiddinov17161@scientifictext.ru
'Isomiddinov Ziyoviddin Darvishaliyevich - Assistant, DEPARTMENT OF PEDIATRIC SURGERY; 2Madazimov Madamin Mominovich - Doctor of Medical Sciences, Professor, DEPARTMENT OF FACULTY AND HOSPITAL OF SURGERY, ANDIJAN STATE MEDICAL INSTITUTE, ANDIJAN, REPUBLIC OF UZBEKISTAN
Abstract: despite the great success in the treatment of severe burns, the number ofpatients with post-burn contractures does not decrease. So, post-burn contractures of the shoulder joint are from '0 to 37% in relation to all burn injuries of large joints, elbow joint - from 7 to 28% of all post-burn deformities, hand - 32-40%, hip joint - 6%, knee joint - '0-25%, foot and ankle joint - 5-7% of cases. According to the majority of researchers dealing with burns and restorative treatment of their consequences, most often contractures develop in the area of large joints, which cause severe dysfunction of the limbs, often leading to profound disability.
Keywords: Z-plasty, local plastic surgery, epithelialization, dermal burns, necrotomy.
ХИРУРГИЧЕСКОЕ ЛЕЧЕНИЕ ГЛУБОКИХ ОЖОГОВ И ИХ ПОСЛЕДСТВИЙ В ОБЛАСТИ КРУПНЫХ СУСТАВОВ КОНЕЧНОСТЕЙ У ДЕТЕЙ Исомиддинов З.Д.1, Мадазимов М.М.2
'Исомиддинов Зиёвиддин Дарвишалиевич — ассистент, кафедра детской хирургии; 2Мадазимов Мадамин Муминович - доктор медицинских наук, профессор, кафедра факультетской и госпитальной хирургии, Андижанский государственный медицинский институт, г. Андижан, Республика Узбекистан
Аннотация: несмотря на большие успехи в лечении тяжелых ожогов, число больных с послеожоговыми контрактурами не уменьшается. Так, послеожоговые контрактуры плечевого сустава составляют от '0 до 37%о по отношению ко всем ожоговым поражениям крупных суставов, локтевого сустава - от 7 до 28% от числа всех послеожоговых деформаций, кисти - 32-40%, тазобедренного сустава — 6%, коленного сустава - '0-25%, стопы и голеностопного сустава - 5-7% случаев.
По мнению большинства исследователей, занимающихся ожогами и восстановительным лечением их последствий, чаще всего контрактуры развиваются в области крупных суставов, что вызывают тяжелые нарушения функции конечностей, нередко приводящие к глубокой инвалидности.
Ключевые слова: Z-пластики, местно-пластических операций, эпителизация, дермальных ожогов, некрзктомиию.
UDC 6'6-00'.2'
Relevance. Reconstructive and plastic surgery of post-burn contractures of large joints has not yet been developed enough and has many unresolved issues. Treatment of patients with post-burn dermatogenous contractures of large joints (MPC KS) due to multistage requires special attention and ingenuity on the part of the surgeon and patience on the part of the patient. The variety of forms and degrees of development of contractures does not allow one to be limited to any one of the existing operational methods for their elimination and replacement of defects.
Numerous methods of surgical interventions are used for the surgical treatment of MPC of the CS, such as: simple or serial Z-plasty, modified methods of Z-plasty, autodermoplasty, movement of non-
free and transplantation of free fascial skin flaps. However, the authors do not specifically indicate indications for the use of certain methods, depending on the shape and localization of the scar cord, as well as the severity of contractures. Most specialists are in favor of the use of plastics with opposite triangular flaps (Z-plasty).It is known that along with the positive aspects, conventional Z-plasty is not the optimal method, because it does not always allow to eliminate the tissue deficit in sufficient volume, and the sharp tops of triangular flaps are often necrotic.
It should be noted that in previous studies, the staff of the Department of Reconstructive Plastic Surgery of Tajikistan developed objective criteria for assessing the severity of post-burn cicatricial contractures of the fingers of the hand, systematized and determined indications for existing methods of their surgical elimination, identified the most optimal methods of surgical interventions to eliminate mild and moderate severity of flexion. contractures of the fingers, a new local plastic method has been developed to eliminate severe post-burn flexion contractures of the fingers of the hand, which simultaneously eliminates cicatricial fusion of the interdigital spaces. However, the problems of the MPC of the knee joint are in many respects different from the problems of post-burn cicatricial contractures of the fingers and require other ways of their solution.
The lack of an algorithm and clear indications for the use of each type of local plastic surgery (MPO) led, in general, not only to a decrease in successful treatment results, but also in some cases to the compression of certain MPO methods.
Thus, many issues of surgical treatment of patients with the consequences of burn injuries of large joints of the extremities remain insufficiently resolved, the search and development of new approaches in this direction require further research, which is the subject of this work.
Purpose of the study. To improve the results of surgical rehabilitation of children with post-burn cicatricial contractures by using individual tactics and techniques of surgical interventions based on data on the morphology of blood vessels and blood supply in scar tissue.
Research results. Analysis of the outcomes of IIIA degree burns in children In recent years, especially in the works of foreign authors, there has been a tendency to expand the indications for early surgical interventions. These are, according to many authors, not only deep burns (IIIB-IV degree according to the domestic classification, or III degree according to the classification adopted in most foreign countries), but also deep dermal burns.
In this work, we propose an infrared sensing technique for the diagnosis of deep dermal wounds, the presence of which is an indication for early surgical treatment even when they are localized in complex functional anatomical areas. The reliability of the method is not less than 80%, which is confirmed by the data of histological studies of biopsies taken during surgical toilets of burn wounds.
Reliable diagnosis of burns made it possible to analyze their outcomes. The study showed that IIIA degree burns, including deep dermal burns, occurred in 52.2% of cases.
Moreover, in 39.5% of cases, the wounds independently epithelized in periods exceeding 21 days from the moment of injury, and later, hypertrophic scars were formed. The diagnosis of deep dermal burn in these children was established on the basis of clinical observations (quality of the wound, timing of epithelialization) and data from the infrared sensing method. It was also found that in the presence of deep dermal burns in 51.7% of cases in the first six months, hypertrophic scars were formed, which, against the background of the child's growth, created a threat of the development of cicatricial deformities. The incidence of scar formation was in direct proportion to the timing of epithelialization.
Subsequent analysis of the group of patients with IIIA burns made it possible to establish two more regularities.
Firstly, most often (in 70% of cases) cicatricial deformities occur in the first six months after deep dermal burns localized on the face, neck, back of the hands, back of the feet, inner surfaces of the thighs.
Analysis of the results of surgical treatment of deep and deep dermal burns In the present work, the analysis of the results of treatment of 672 children with deep and deep dermal burns has been carried out. The study took into account the functional, cosmetic results, the maturation of the scar tissue, the volume and frequency of subsequent reconstructive treatment.
Functional and cosmetic results were assessed using a single five-point scale of expert assessments. The choice of the method of early necrotomy and adequate skin grafting depends on the depth and location of the burn. The nature of the primary treatment significantly influenced the frequency of surgical interventions performed for children with burn convalescents during the rehabilitation period. After early excision and primary plasty, half of the contractures and scarring (51.7%) were eliminated in one stage. After traditional treatment, contractures and deformities were eliminated in one stage in 21.0% of cases.
Analysis of the results of the dynamics of the formation of scar tissue after various methods of preventive treatment of burns in children showed the following. The distribution of measurements made by the infrared sensing method, taking into account the time elapsed from the moment of injury, revealed significant differences in the timing of collagen maturation in scars, depending on the method of preventive surgical treatment.
Comparative analysis of the results of surgical treatment of deep burns in the area of the shoulder and shoulder joint did not reveal convincing reliable data on the advantages of early surgical treatment in this area over traditional tactics. Evaluating the results of early active surgical tactics in relation to deep burns of the forearm and elbow joint, the prevalence of excellent and good results over satisfactory estimates was revealed: 43.8% and 25.0%, respectively, versus 31.3%.
In the same group of patients, there were significantly fewer satisfactory results than after traditional treatment - respectively: 9.1% and 30.0%. After early surgical interventions in the hip and hip joint, there were no significant differences in the total number of excellent and good results (93.1 % of cases) than after plastic closure of granulating wounds (82.6% of cases).
Output. It was found that complex post-burn deformities and contractures require the simultaneous elimination of all components due to the interdependence of the latter. An algorithm for reconstructive treatment was formulated taking into account the degree of contracture and the prevalence of the scar process. The tactics and technique of surgical rehabilitation for the most severe forms of cicatricial deformities of the hand have been improved.
A new method has been developed for obtaining free full-thickness skin autografts (SCCT) of the required size and quality using the pre-dermatological method.
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