Tactics of local and surgical treatment of local marginal and deep circular burns of the extremities due to blast trauma

Abstract

To improve the effectiveness of treatment of patients with marginal and deep circular burns of the extremities due to combat trauma by improving methods of diagnosis, local and early surgical treatment, and prevention of deepening burn damage.Materials and methods. The study used the results of treatment of 40 patients with marginal and deep circular burns of the extremities at the Kharkiv Burn Center between 2022 and 2025. All patients were divided into two groups depending on the depth of the injury: the first group consisted of 28 patients with marginal burns of the hands, and the second group consisted of 12 patients with deep circular burns, who in turn were divided into two subgroups–control and main–depending on the timing and extent of surgical intervention. Patients in group 2 had their interstitial pressure measured dynamically using the Kompartmentdruck Monitor System from MIPM (Mammendorfer Institut f r Physik und Medizin) GmbH (Germany).Results. Under the influence of local atraumatic treatment, patients in group 1 with marginal burns of the hands showed a decrease in the depth of thermal damage and an improvement in the subsequent course of the wound healing process with spontaneous epithelialization within an optimal time frame. Thanks to timely surgical intervention in patients in group 2 with deep burns, aimed at decompression of thermally damaged tissues, with dynamic measurement of intra–tissue pressure, the time required for free autodermoplasty with mesh grafts was reduced from (11.6 ± 0.6) days (control subgroup) to (7.3 ± 0.5) days (main group). The skin cover in patients of the control subgroup recovered within (28.6 ± 0.8) days, and in patients in the main subgroup – within (22.8 ± 1.2) days, which made it possible to reduce the duration of inpatient treatment from (34.5 ± 0.9) days (control subgroup) to (27.5 ± 0.7) days (main subgroup).Conclusions. Effective, accessible, and atraumatic local treatment of patients with marginal burns of the extremities in functional areas in a moist environment and preventive infusion drug therapy reduces the destruction of thermally damaged tissues, prevents deepening of the burn surface, leading to spontaneous epithelialization within an optimal time frame. Thanks to active surgical tactics with objectification of intra–tissue pressure indicators in patients with deep circular burns of the extremities, compartment syndrome disappears, against which a secondary deepening of the burn wound forms. Non–deepening of burns is an optimal condition for the formation of granulation tissue and the performance of autodermoplasty with satisfactory results.