The benefits of early surgical treatment of deep cervical burns in children

Abstract

Background. The frequency of deep cervical burns in children is four times higher than that of deep face burns. Currently, there is no consensus on the methods for surgical treatment of deep burns in cervical areas; meshed skin autografts continue to be used.
 Aim. To evaluate the benefits of early surgical treatment of deep сervical burns in children between the third and fifth days from the moment of injury.
 Materials and methods. Case-control study. Surgical treatment was performed in 81 children with deep cervical burns. The main group with early surgical treatment included 46 children and underwent surgical treatment at 3.37 0.14 days from the moment of injury; the control group received autograft during stage treatment for 35 children at 27.17 0.18 days. The treatment results were evaluated by the following indicators: the number of dressing changes, the period of skin restoration, and the area of graft success. In the long term, functional and cosmetic treatment results were evaluated.
 Results. In the study and control groups, 7.93 0.45 and 18.75 0.61 dressings were required to complete the treatment, respectively (p 0.001). The skin restoration periods were 16.54 0.68 and 36.94 0.89 days, respectively (p 0.001). The graft success areas were 99.50% 0.13% in the main group and 93.91% 2.68% in the control (p 0.001). During the staged surgical treatment, one patient showed a loss of 90% of the graft, which required regrafting. Other complications in the treatment process have not been noted. When assessing long-term cosmetic results using the Vancouver Scar Scale, the average score was 4.0 0.26 points in the main group and 7 0.28 points in the control (p 0.001). The presence of post-burn cicatricial contracture in the main group was noted in 12 (26%) people and the absence in 34 (74%) children. In the control group, 20 (57%) patients required surgical removal of post-burn deformity, and 15 (43%) children did not need further surgical interventions.
 Conclusions. Early surgical treatment of deep cervical burns in children on the third and fifth days from injury allows not only to accelerate the process of restoration of the skin but also to directly affect the cosmetic and functional results in a better way.