A modern approach to the treatment of burns
Background. Wound healing as soon as possible is an ultimate goal of treating patients with burns. European guidelines of recent years state that a humid environment is optimal for the treatment of burns.
Objective. To describe the modern approach to the treatment of burns.
Materials and methods. Analysis of literature sources on this topic.
Results and discussion. Over the last 15 years, there has been a significant breakthrough in the armamentarium of wound dressings (WD). The main advantages of modern WD include simplification of the dressing procedure, control of infection, removal of secretions from the wound, creating a favorable environment for healing, and accelerating the cleansing or healing of wounds. Such WD include skin substitutes and interactive dressings. Skin substitutes are divided into synthetic, biological and combined, as well as in temporary and permanent. Dressings, in turn, can be super-absorbent, spongy, hydrocolloid, gel, atraumatic mesh, semi-permeable, etc. After treating wounds with an aqueous antiseptic, such as Dekasan (“Yuria-Pharm”), the exfoliated epidermis is removed and an atraumatic dressing is applied. Sometimes a single application is sufficient for epithelialization of superficial wounds. Dermal burns affecting the epidermis and dermis are burns with incomplete injury depth and can heal on their own. After dermabrasion, the lyophilized xenoskin is soaked in saline with the addition of Dekasan and instantly fixed to the wound surface. Subsequently, the wound is healed by primary tension. Dermabrasion of the wound can be performed mechanically (dry napkin, wet napkin with Dekasan, brush or metal sponge) or surgically (scalpel, dermatome, Water Jet device). Nowadays, it is believed that the creation of a moist environment above the surface of the burn allows epithelial cells to spread horizontally on a thin layer of wound exudate, accelerating wound healing. Hydrogel dressings and shape-resistant hydrogel coatings are widely used in the treatment of limited superficial and border burns. In the exudation phase, a wound coating with nanosilicon is used, which actively absorbs the wound exudate. There are also hydrogel face masks, which have a prolonged effect, cool the damaged area in 60 seconds, eliminate pain, prevent blisters, reduce the likelihood of infection and the spread of burns deep into the tissues. The process of tissue repair and wound healing consists of three phases, which are interrelated and may coincide in time: the inflammatory phase, the proliferation phase and the remodeling phase. Wound healing is affected by the pH of the environment, as many processes, namely, activity of matrix metalloproteinases and their tissue inhibitors, activity of fibroblasts, microbial proliferation, depend on this factor. Interactive WD change the pH of the wound.
Conclusions. 1. WD, which support wounds in a humid environment, are an effective means of regulating the wound process. 2. Low pH of wounds changes the qualitative and quantitative composition of the microflora, reduces the microbial contamination of wounds in 100 times. 3. Keeping wounds under modern WD does not increase the level of endogenous intoxication, but on the contrary, improves the course of burn disease. 4. Humid environment promotes the penetration of neutrophilic granulocytes with high enzymatic activity.
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