Была изучена динамика процессов репаративной регенерации в ожоговой ране и в аутодермотрансплантате на фоне аутодермопластики, проводимой в разные сроки после термической травмы. Исследования проведены на 62 больных с дермальными ожогами III степени площадью от 10 до 20%, индекс Франка 30-60 ед. Морфологические изменения в ране в разные сроки после ожогов оценивали после окраски препаратов гематоксилин-эозином. Для количественной оценки регенераторного потенциала тканей ожоговой раны изучали экспрессию гена Ki-67. Проведена иммуногистохимическая идентификация иммунокомпетентных клеток (клеток Лангерганса, макрофагов, СD-4, CD-8). Пролиферативная активность клеток всех структур, формирующих ожоговую рану, а также эндотелия капилляров достигала максимума на 7-е сутки после травмы, а затем начинала снижаться. Максимальная плотность капилляров кожи на границе с раной также определялась на 7-8-е сутки. Эти сроки, согласно нашим клиническим, морфологическим и гистохимическим исследованиям, являются оптимальными для полного укрытия ожоговых ран. Активное хирургическое лечение включало раннюю некрэктомию и раннюю аутодермопластику. Наилучшие результаты лечения получены при завершении лечения в оптимальные сроки. При аутодермопластике, выполненной в поздние сроки, увеличивался процент лизиса пересаженной кожи, что было связано с нарушением репаративных процессов, патологическим ангиогенезом. Выявлено, что повышенная активность CD8+, макрофагов и клеток Лангерганса может приводить к неинфекционному разрушению трансплантата. Ключевые слова: термические ожоги, активное хирургическое лечение, локальный иммунный гомеостаз, макрофаги, клетки Лангерганса, CD4. CD8.
Objective. The study objective it to analyze the dynamics of microbial content of burn wounds and to assess the markers of hospital-acquired infection (HAI) in different periods of hospitalization.Methods: 617 microbiological samples from the surface of burn wounds of 515 patients in the period from the first to ninth days after the injury were analyzed. The presence of gramnegative bacteria Pseudomonas aeruginosa and Acinetobacter baumannii, multiresistant microorganisms and microbial associations was determined. Spectrophotometry was used to identify pathogens and plate method was used to assess microbial content of wounds.Results: During treatment, there was change of pathogens associated with duration of stay in the hospital. With an increase in hospitalization, the degree of microbial contamination of wounds, the rate of gram-negative bacteria, multiresistant microorganisms, and microbial associations increased.Conclusions: The greatest severity of all signs of nosocomial infection occurs on the 3–4th day of hospitalization in a burn care facility. This period can be considered ad a start of active contamination of burn wounds with nosocomial flora. To prevent this, it is necessary as early as possible, from 2–3 days after hospitalization to apply active strategy for treating burn wounds and closing burn surfaces.
Partial-thickness burns (II degree according to ICD 10) remain a significant problem in combustiology. New approaches to the treatment of burn patients are associated with a group of modern dressings or skin substitutes based on natural biopolymers. Hyaluronic acid (HA) based polymers which is a natural component of the extracellular matrix, are promising.Aims of study. А comparative study of the effectiveness of an atraumatic wound dressing based on a polyamide mesh and hyaluronic acid based wound dressings in the treatment of partial-thickness burns.Material and methods. The work is based on the observation of 215 patients who were hospitalized in the Burn Department of the Far Eastern Medical Center in 2014–2018. All patients underwent surgical treatment of burn wounds - dermabrasion on days 2–3. To close of the postoperative wound, two types of dressings were used: based on hyaluronic acid (HA), n=61 and atraumatic dressings (AD), n=154. The effectiveness of treatment was assessed in terms of the healing time of burns, the severity of the general and local inflammatory response, and the quality of the restored skin.Results. In the treatment with HA based dressings, burns healed five days faster; the wound healing time up to 21 days was noted in 90.2% of cases, with the use of AD — only in 57.1% of cases. HA dressings required replacement half as often as AD. With the use of HA dressings, the local and general inflammatory response to the burn wound developed less frequently and was managed faster. Resistant microorganisms and colonies with abundant growth, were found in the main group one and a half times less often than in the comparison group. When using HA dressings, the restored skin is much less likely to suffer from hypertrophy and scarring.Conclusions. Treatment with HA-based wound dressings in patients with partial-thickness burns are more effective than treatment with traditional atraumatic dressing. Biopolymer skin substitutes is optimal for the treatment of partial-thickness burns in the postoperative period, since the frequency of dressings and the likelihood of secondary microbial contamination of wounds decreases, the degree of contamination of wounds with microflora decreases, and favorable conditions are created for the wound process.
It was analyzed the terms of healing of partial-thickness burns and the results of 490 microbiological samples from the surface of wounds from 215 patients. All patients underwent tangential necrectomy (dermabrasion) on days 2-3 after the burn. To close the postoperative wound, wound coverage based on hyaluronic acid, n=61, and atraumatic dressings Voskopran, n=154 were used. During bacteriological examination, the degree of microbial contamination, the type of pathogen and sensitivity to antibacterial drugs were determined, special attention was paid to MRSA, MRSE, VRE, FQRPA, CRKP, CRA, CRE. The results are processed statistically. According to the results of the study, it was found that the average healing time for partial-thickness burns was 22,9±1,7 days, in 33,5 % (n=72) of observations, there was a delayed wound healing, more than 21 days. In patients in whose local treatment GBM was used, in 90,2 % (n=55) of cases, burns healed within 21 days, and where AP was used only in 57,1 % (n = 88) of patients, burn wounds healed in the specified terms. In the group of patients with delayed healing of burns, the microorganisms with high growth (CFU> 105 / ml) was 2,5 times higher than in patients with wound healing within 21 days. Comparing the microbial landscape in the groups, it was found that in the group with delayed healing of burns, resistant microorganisms of the ESKAPE group are 4 times more common. The cause of delayed of the healing time of partial-thickness burns are the degree of bacterial contamination of wounds over 105 CFU / ml, and the presence of nosocomial micro flora (ESKAPE group). When used in the treatment of coverage based on hyaluronic acid, impaired wound healing was found four times less often than with the use of AP, UPM with high growth (CFU> 105) and resistant ESCAPEs were found 1,5 times less often than when used AP.
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