OBJECTIVES: We aimed to assess the wound-healing process using modern temporary wound dressings in local treatment of patients with burns.
MATERIALS AND METHODS: From 2014 to the first half of 2022, the Department of Combustiology of the Republican Research Center of Emergency Medicine, Republic of Uzbekistan, conducted local treatment of 225 patients with superficial burns and 105 patients with deep IIIB/IV degree burns (age range, 1-60 years; mean age 17.5 ± 16.4 years). Most were children and adolescents (n = 146, aged 1-18 years); 79 were people of working age (age range, 19-60 years). The control group (115 patients with superficial burns, 55 patients with deep burns) received traditional local treatment using water-soluble ointments. The study group (110 patients with superficial burns, 50 patients with deep burns) received temporary wound dressings produced by New Dressing Materials CJSC, Russia (Parapran and Voskopran), with various options for local treatment.
RESULTS: In 105 patients with deep burns, 122 necrectomy (early-delayed and delayed), 18 osteonecrectomy, and 134 autodermoplasty surgeries were performed. Fifty-two patients with traditional treatment received chemical necrectomy using 20% to 40% salicylic ointment. Less cases of toxic hepatitis, along with improving local reparative properties, were shown in patients who had active surgical tactics in the early stages after injury and temporary wound dressing than in the control group. Local treatment with temporary wound dressing in patients with extensive burns contributed to reduced purulent-septic complications, with no patients having burn sepsis. However, in severely burned patients in the control group, 3 patients (1.8%) had burn sepsis.
CONCLUSIONS: Traditional methods of treatment are not acceptable for providing high-quality and qualified care for deep burns. Temporary wound dressings can reduce recovery time, being the most physiologically acceptable covering of burn surface wounds and achieving its main goal of early formation of granulation tissue, reducing secondary inflammatory processes.
KEY WORDS: Autodermoplasty, Necrectomy, Osteo-necrectomy, Wound dressings
Burn injury is an urgent medical and social problem in most countries of the world.1 At present, despite the successes achieved in the treatment of burn disease, mortality in people with burns remains high.2
According to the World Health Organization, 180 000 deaths from burns occur annually worldwide. Most of these cases occur in low- and middle-income countries and almost half in the African region and in South-East Asia.3-5
Despite advances in the treatment of severely burned patients, which have made it possible to reduce mortality from burns, the problem with long-term inpatient treatment remains, as well as the high percentage of disability in burned patients.6 The economic costs of treating burns are usually significant.7,8
One of the important directions in the provision of medical care to patients with burns is local conservative treatment, since the course of thermal injury, the prevention of the development of infectious complications, the timing of restoration of the lost skin, and the outcomes of this long treatment depend on its effectiveness. Currently, a number of different dressings are being used in burn care, and their list is constantly expanding. However, not all wound coverings meet the requirements for them. In particular, it is not always possible to prevent suppuration in the wound, alleviate pain of burn patients during changes of dressings, speed up the process of epithelization in the area of injury, and shorten hospitalization times, which is especially important for children.9
Modern approaches in local treatment of burn wounds, taking into account the wound process phases, improvements in antiseptic agents, and developments of wound dressings, in most cases, make it possible to treat soft tissue infections in burn injury.10,11 Elimination of infected tissue and wound infection, the fast and effective preparation of burn wounds for autodermoplasty, and the early closure of wound defects are the main key points in the treatment of patients with burn injury.12 Therefore, in the organization of emergency and specialized care, medical evaluation and treatment require unification and improvements in the means and materials used for temporary protection of the burned wound surface.13-15
The main tasks of wound dressings are the creation of favorable and optimal conditions for accelerating the wound process at all stages and reducing the duration of hospitalization of patients.16 The aim of our study was to assess the course of the wound process using modern temporary wound dressings in local treatment of patients with burns.
MATERIALS AND METHODS
From 2014 to the first half of 2022, the Department of Combustiology, Republican Research Center of Emergency Medicine, Republic of Uzbekistan, conducted local treatment of 225 burned patients with superficial burns and 105 patients with deep burns (IIIB/IV degree). The mean age of patients was 17.5 ± 16.4 years (age range, 1-60 years). Of the total number of those studied, most were children and adolescents, with 146 patients from 1 to 18 years of age; the remaining 79 patients were people of working age from 19 to 60 years of age (Table 1).
In the control group, 115 patients with superficial and 55 patients with deep burns received traditional local treatment using water-soluble ointments (Table 2). In the study group, 110 patients with superficial and 50 patients with deep burns received temporary wound dressings produced by New Dressing Materials CJSC (Russia), Parapran and Voskopran, with various options used for local treatment.
Flame burns were observed in 85% of cases, boiling water in 12.5% of cases, and contact burns in 2.5%. The total area of burn wounds in patients with superficial burns ranged from 5% to 30% of the body surface; and the total area of patients with deep burns (IIIB/IV degree) ranged from 5% to 20% of the body surface.
In 105 patients with deep burns, 122 necrectomy surgeries (early-delayed and delayed), 18 osteonecrectomy surgeries, and 134 autodermoplasty surgeries were performed.
Fifty-two patients who received traditional treatment received chemical necrectomy with application of 20% to 40% salicylic ointment. The main task after necrectomy was the problem of closing the wound defect.
For local conservative treatment of burn wounds, the objectives are relief of local inflammation and preparation of the wound surface for plastic closure at the optimum time for deep burns. The main requirements for dressings include the ability to drain wound discharge and improve tissue respiration and the ability to have painless dressings. For this aspect, the use of modern dressings is important. In 160 patients with superficial and deep burn lesions, wound dressings produced by New Dressing Materials CJSC (Russia) were applied. The following types of temporary wound dressings were used: Parapran with lidocaine, chymotrypsin, and chlorhexidine and Voskopran with dioxidine, methyluracil, and levomikol.
The wound dressing Voskopran with levomikol is an open cellular base (polyamide mesh) containing beeswax and a special composition of various drugs immobilized in it that have analgesic, antibacterial, wound-healing, and wound-protective effects. The wax base of the Voskopran coating is quickly molded and well fixed on the surface of the wound. The active content of the dressing ensures long-term maintenance of effective drug concentrations in the wound. Wax coating forms a protective layer on the wound and can maintain the active substance doses of drugs that are part of the coating for a long period, directly at the site of action (Figure 1).
The Parapran bandage with chlorhexidine is made of large-mesh cotton gauze containing a paraffin composition. Soft paraffin on the wound softens under the influence of heat and releases chlorhexidine, which is in the form of a suspension of medicinal substances, allowing application of its composition on the wound for a long time; the mesh base of the dressing allows wound discharge to go to the secondary sorbent dressing (Figure 2).
For application of these 2 wound dressings, clinicians were guided by the ingredients contained in them. Parapran with lidocaine was used in the early stages (1-2 days from the moment of injury). Parapran with chlorhexidine, Voskopran with dioxidine ointment, Voskopran with levomikol, and Voskopran with methyluracil ointment were used for local antibacterial and anti-inflammatory therapy, strengthening the local regenerative processes of superficial and borderline burns. Parapran with chymotrypsin was used after necrectomy in areas of deep burns to accelerate the formation of granulation tissue and subsequent autodermoplasty.
The ability of these dressings to fix to the wound surface decreased the course of the period of wound inflammation and reduced the formation of dry scabs on burn wounds, contributing to the earlier healing of the patient. Wound healing under the wound dressing occurred 6 to 7 days faster than when using traditional ointment dressings. Under the condition of a well-conducted primary cleaning of wounds in patients with superficial burns, the wound dressings were not removed until the epithelialization of the wounds was completed. A positive point was also the absence of the need for regular traumatic dressings, which contributed to the earlier healing of patients.
The combination of the mesh structure of the fabric base (polyamide) of the dressing material saturated with drugs that have anesthetic and antibacterial properties stimulated the reparative processes, reduced the healing time of superficial burns, and sped up the formation of granulations in areas of deep burns.
As shown by our observations, the use of wound dressings Parapran with chlorhexidine and Polypran with dioxidine in the local treatment of extensive burn wounds promotes accelerated healing of burn wounds, prevents secondary infection of the wound surface, allows early activation of the patients, provides painless wound dressing, reduces the frequency of purulent-septic complications of burn disease, and reduces the time of inpatient treatment.
Patients in the wound dressing study group at the first stage of treatment underwent early, early-delayed, or delayed necrectomy, with the closure of the wound defect with synthetic temporary wound dressings Parapran and Voskopran.
Patients in the traditional treatment group (control group) received traditional treatment in the early period after thermal burn injury, with performance of early (5-7 days from the moment of injury) and early-delayed (7-9 days from the moment of injury) necrectomy followed by permanent drug treatment of the affected surfaces. Patients in the control group had slowed regeneration processes, frequent suppuration, and prolonged healing of wound surfaces. As a rule, healing depended on the area of the lesion and the depth of the burn and occurred on average on days 20 to 23 with superficial burns, if no other complications were present. For patients with deep burns of IIIB/IV degree, the healing process stretched from 35 days (33.4 ± 3.3) to 1.5 months; the longer the wound healing took, the more often secondary purulent processes occurred.
For burn patients who had the wound dressing treatment, complete epithelialization of the wound surface was observed on days 11 to 14, whereas burn patients who received traditional methods of local conservative treatment showed epithelization on days 20 to 23 (Table 3). Patients with wound dressing treatment had accelerated cleansing and preparation of granulating wounds for autodermoplasty noted 5 to 7 days earlier than patients who had traditional methods of treatment, which can allow reduced duration of inpatient treatment of burn patients.
In patients who received the temporary wound dressings, the percentage of engraftment of autografts was higher by 15.7%, relative to the indicators of the affected control group.
As noted by our observations, in 18 patients (11.2%) in the control group, the course of burn disease was complicated by toxic hepatitis spread, which we suggest was a manifestation of extensive circular wound manifestations with suppuration. From the outside, autoinfection is of great importance, the gate that causes a violation of the integrity of the skin. Prolonged plasmorrhea with loss of protein and water and formation of hemoconcentration electrolytes and impaired blood circulation in the lungs can exacerbate the hypoxia of the body with the subsequent development of protective and adaptive systems in patients with severe burns. Indicators of hepatic function in patients are disturbed in periods after exacerbation, which is associated with reactive changes.
Conducting active surgical tactics of treatment in the early stages after injury and the use of a temporary wound dressing, along with improved local reparative properties, contributed to a decrease in cases of toxic hepatitis compared with the control group.
Closing a large wound surface with temporary wound dressings, along with a decrease in plasmorrhea, led to the formation of a protective layer over the burn surface in a short time, reducing the likelihood of secondary infections and absorption of tissue destruction products into the bloodstream, which can decrease the severity of the clinical picture of toxicity syndrome. Thus, in patients in the wound dressing study group, we observed complications of burn disease such as hepatitis to be lower than in the patients in the control group.
The use of temporary wound dressings in the local treatment of extensive burns contributed to the reduction of purulent-septic complications of burn disease. In patients in the wound dressing group, we noted not a single case of burn sepsis, whereas in patients with severe burns in the control group, burn sepsis was found in 3 patients (1.8%) (Table 4).
There were no lethal outcomes in both groups of observed patients. Thus, the conducted studies make it possible to compare the results of treatment in patients with different methods of wound healing.
DISCUSSION AND CONCLUSIONS
Traditional methods of treatment are not acceptable for providing high-quality care for deep burns; the process of tissue healing is rather lengthy, often complicated by the addition of secondary infections. The use of temporary wound dressings can reduce the recovery process time and provides a physiologically acceptable covering of the wound burn surface, achieving its main goal of early formation of granulation tissue and reducing secondary inflammatory processes.
Volume : 3
Issue : 1
Pages : 9 - 13
From the 1Combustiology Department and the 2Department of Emergency Surgery No. 1, Republican Research Center of Emergency Medicine of the Ministry of Health of the Republic of Uzbekistan, Tashkent, Republic of Uzbekistan
Acknowledgements: The authors have not received any funding or grants in support of the presented research or for the preparation of this work and have no declarations of potential conflicts of interest.
Corresponding author: Fayazov Abdulaziz
Table 1. Distribution of Patients by Age
Table 2. Distribution of Patients According to Degree of Damage
Figure 1. Closure of Wound Surface in Superficial Burns With Voskopran Coating With Levomikol
Figure 2. Parapran Wound Dressing in the Local Treatment of Deep Burns
Table 3. Comparative Evaluation of the Effectiveness of Temporary Wound Dressings
Table 4. Indicators of the Effectiveness of the Use of Temporary Wound Dressings