Kovalenko A. Perfection of surgical treatment of dermal burns with the use of wound coverings

The dissertation presents a theoretical analysis and proposes a new solution to the scientific problem, which is related to the improvement of the surgical treatment of patients with superficial and deep dermis burns by using modern wound dressings. New methods of diagnostics the depth of a dermal burn with the use of contact pH-meter and temperature of burn wounds are developed. Differentiated application of biological or synthetic wound dressing is substantiated. In patients with superficial dermal burns, over-thin excision of superficial necrotic tissue was performed and closure wounds with wound dressing. In patients with deep dermal burns at wound pH values =<9.0 un. and wound temperature T>=33.6 C, after the excision of necrotic tissue until to subcutaneous fat synthetic wound coatings were used; at wound pH>=9.0 un. and wound temperature T=<33.6 C, it is expedient to use xenograft during excision to fascia. Autohraft advisable conducts been postponed. Surgical treatment and using wound dressing changes the dynamics of the wound process. 5-6 days after injury in patients with superficial dermal burns, the pH of wounds varies from alkaline reaction to an acidic reaction, that stimulates processes of healing wounds. The number of microbial associates decreases to 1.6±0.3 units, microbial colonization decreased to 10^4 per 1 g of tissue. Application of the developed tactics of surgical treatment contributes to the preservation of enzymatic oxygen activity of effector cells of nonspecific resistance: in the capillaries of the zone of burn wound accumulated NG with a higher activity of the enzyme myeloperoxidase. It has been proven to reduce the number of B-lymphocytes in the stage of septicotoxemia and optimize the ratios of T-lymphocytes, which reduces the risk of autoimmune reactions.The use of wound dressings is associated with an increase in the production of IL 1beta with the stimulation of the release of neutrophils in the inflammatory site. Surgical treatment reduces the cytokine burden on the patient. The use of surgical algorithms improved the results of treatment dermal burns: the total bed-day in patients with superficial dermal burns decreased by 4.7±1.4 days and in patients with deep burns by 6.4±1.2 days, the duration of stay in the department intensive care decreased by 2.3 days and by 3.1 days, the recovery period of the skin was reduced by 2.5 days and 7.4 days, the incidence of infectious complications decreased by 1.5 and 2.1 times, respectively.