Retrospective analysis of the causes of unsatisfactory results of treatment of patients with borderline skin burns

Introduction. Thermal injuries are an important medical and social problem of modern society. One of the most difficult challenges for surgery is presented to victims with borderline skin burns, since the use of incorrect algorithms for their management leads to a high incidence of complications. In this connection, the search for the main reasons for unsatisfactory results of treatment of this type of injury is an urgent task of surgery.
Purpose of the study. To determine the main reasons for unsatisfactory treatment results for victims with borderline (dermal) skin burns.
Materials and methods of research. The study is based on the results of an analysis of medical records of 509 victims with borderline skin burns. The microbiological composition of burn wounds was assessed; duration and reasons for delaying treatment; methods for managing this type of injury at the prehospital stage. The results obtained were processed using generally accepted methods of variation statistics.
Results and discussion. It has been established that in the first week after hospitalization and the start of treatment, the pathogenic microflora does not change to multidrug-resistant microorganisms. A significant number of patients were hospitalized later than 24 hours from the moment of injury - 28% of cases. The main reason for this was self-medication - 61% of observations; the remaining patients were observed in clinics and trauma centers, 14% and 26% of patients, respectively. The transfer of victims from primary care institutions to specialized hospitals was associated with inadequate tactics for managing such wounds. Wet-dry dressings with antiseptic solutions were used in more than 90% of cases, and cases of application of ointments, hydrogels and wound dressings were noted only in isolated observations.
Conclusion. Thus, the main reasons for unsatisfactory treatment results for patients with borderline skin burns include infection with multidrug-resistant strains of microorganisms, long delays in the provision of specialized medical care associated with self-medication and refusal to use pathogenetically based methods for treating such wounds in primary care medical institutions.

1. Timofeev K.N., Karelina D.S. Comprehensive diagnosis of thermal skin lesions. Radio engineering, optical and biotechnical systems. Devices and methods of information processing, 2021, № 1, pp. 172–176. (In Russian)

2. Sajjad W., He F., Ullah M.W., Ikram M., Shah S.M., Khan R., Wahid F. Fabrication of bacterial cellulose-curcumin nanocomposite as a novel dressing for partial thickness skin burn. Frontiers in bioengineering and biotechnology, 2020, № 8, pp. 553037.

3. Sidelnikov V. O., Fisun A. Ya., Tsygan V. N. et al. Combat burn injuries. Saint Petersburg: SpetsLit, 2019, 249 p. (In Russian)

4. Rzheusskij S.E., SHul’min A.V., Antonova E.G., Atroshchenko V.A. Analysis of the cost structure for pharmacotherapy of thermal burns. Bulletin of Pharmacy, 2022, 2(96), pp. 38–45. (In Russian)

5. Costa B.A., Lima Júnior E.M., de Moraes Filho M.O., Fechine F.V., de Moraes M.E.A., Silva Júnior F.R., Rocha M.B.S. Use of tilapia skin as a xenograft for pediatric burn treatment: a case report. Journal of burn care & research, 2019, № 40(5), pp. 714–717.

6. Alam K., Jeffery S.L. Acellular fish skin grafts for management of split thickness donor sites and partial thickness burns: a case series. Military medicine, 2019, № 184 (Suppl. 1), pp. 16–20.

7. Kostyakov D.V., Zinov’ev E.V., Krylov K.M., Krylov P.K., Orlova O.V., Soloshenko V.V. Clinical evaluation of a hydrogel wound covering with a complex of natural antimicrobial peptides FLIP7 and allantoin for dermal burns. Bulletin of the National Medical and Surgical Center named after N.I. Pirogova, 2020, № 15(3–2), pp. 62–67. (In Russian)

8. Kobelev K.S., Midlenko O.V., Midlenko V.I. Ways to optimize local conservative treatment of borderline burns. Emergency surgery named after I.I. Janelidze, 2021, № S1, pp. 32. (In Russian)

9. Tolstov A.V., Novikov I.V., Milyudin E.S., YUnusov R.R., Kivaeva O.I. Results of bacterial contamination of superficial and borderline local burns. Bulletin of the medical Institute «Reaviz»: rehabilitation, doctor and health, 2023, № 13(1), pp. 51–55. (In Russian)

10. Mitryashov K.V., SHarkova V.A., Usov V.V. Causes of impaired healing of border burns when using wound dressings. Far Eastern Medical Journal, 2021, № 1, pp. 41–45. (In Russian)

11. Griban’ P.A., Usov V.V., Afanasov I.M., Terekhov S.M., The effectiveness of using the modern dressing «Chitopran» in the treatment of borderline burns. Emergency surgery named after I.I. Janelidze, 2021, № S1, pp. 18–19. (in Russian)

12. Kokorin V.V., Krajnyukov P.E., Matveev S.A., Kokorina O.V. Microbial landscape of wounds in patients with purulent inflammatory diseases of the hand. Journal of Advanced Research in Dynamical and Control Systems, 2020, vol. 12, № 7, рр. 98–104. https://doi.org/10.5373/JARDCS/V12SP7/20202087

13. Kraynyukov P.E., Artsimovich I.V., Zinoviev E.V. [et al.] The use of cellular technologies in the treatment of wounds of various etiologies. Bulletin of the National Medical and Surgical Center named after N.I. Pirogov, 2021, vol. 16, № 2, pp. 132–137. https://doi.org/10.25881/20728255_2021_16_2_132 (in Russian)

14. Zinoviev E.V., Kraynyukov P.E., Asadulaev M.S. [et al.] Clinical evaluation of the effectiveness of mesenchymal stem cells in thermal burns. Bulletin of the National Medical and Surgical Center named after N.I. Pirogov, 2018, vol. 13, № 4, pp. 62–67. https://doi.org/10.25881/BPNMSC.2018.88.91.011 (in Russian)