Volume 03 Issue 06-2023
30
International Journal of Medical Sciences And Clinical Research
(ISSN
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2771-2265)
VOLUME
03
ISSUE
06
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OCLC
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1121105677
Publisher:
Oscar Publishing Services
Servi
ABSTRACT
Purpose of the study.
To develop a system of active surgical tactics for burn patients over 60 years of age based on
the intestation of methods of general and local treatment.
Research materials.
In the burn department of the Samarkand branch of the RSCFEMC in the period 2002-2022, 419
elderly and senile patients were treated with burn disease.
Research results.
Treatment of burn disease in the elderly is often aggravated by various complications, which
contributes to high mortality.
Conclusions.
Active surgical tactics (RCN, ADP) in patients with deep lesions up to 7-10% does not increase mortality
compared to conservative tactics, but reduces the bed-day by 2 times and mortality from 23.6 to 14.3%.
KEYWORDS
Burn disease, elderly and senile age, early surgical necrectomy, autodermoplasty.
INTRODUCTION
Elderly and senile people are at risk for thermal injury.
Age, burn area, interval between injury and admission
to the burn center, comorbidities are the main factors
that determine the severity of the injury and affect the
prognosis and treatment tactics [2, 4, 6, 9].
Research Article
ASPECTS OF COMPLEX TREATMENT OF BURN DISEASE IN ELDERLY AND
SENILE AGE
Submission Date:
June 01, 2023,
Accepted Date:
June 06, 2023,
Published Date:
June 11, 2023
Crossref doi:
https://doi.org/10.37547/ijmscr/Volume03Issue06-06
Daminov Feruz Asadullaevich
Samarkand State Medical University, Samarkand, Uzbekistan
Journal
Website:
https://theusajournals.
com/index.php/ijmscr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
Volume 03 Issue 06-2023
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International Journal of Medical Sciences And Clinical Research
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1121105677
Publisher:
Oscar Publishing Services
Servi
According to a number of authors [1, 3, 4, 5], lethality
in elderly and senile patients is two to three times
higher than in burn victims of other ages and ranges
from 23.4 to 62.5%. Particularly high mortality in people
over 60 years old is observed during the period of
shock, which develops in this group of patients even
with limited burns up to 5-7% of the div surface [7, 8,
9].
Significant difficulties in the treatment of patients
over 60 years of age are not only extensive, but also
limited burns, which are accompanied by severe
disorders of hemodynamic parameters and internal
organs [3, 7]. Already in the next few hours after a burn
injury, they develop a syndrome of mutual burdening,
which consists in the fact that premorbid diseases
adversely affect the course of the wound process, and
the resulting burn, in turn, aggravates their severity [4,
8]. Concomitant diseases such as severe
atherosclerosis, hypertension, diabetes, and others
worsen the course of burn disease, and thermal injury
often leads to a pronounced exacerbation of these
diseases [2, 9].
The successful outcome of the treatment of patients
over 60 years of age largely depends on the tactics of
preoperative preparation, which should be aimed at
increasing the div's immune defenses, correcting the
general somatic status, as well as methods of surgical
restoration of the skin [4, 7, 8, 9].
An analysis of the literature allows us to conclude that
the use of numerous techniques in patients with severe
burns in the elderly and senile age makes it possible
only to prolong the resuscitation period and somewhat
smooth out clinical and laboratory changes, but does
not significantly affect mortality [2, 5, 7, 8].
Despite numerous publications on various aspects of
burn disease, the issues of its clinic, diagnosis,
conservative and surgical treatment in the elderly with
a burdened premorbid background are unresolved,
which was the reason for this study.
Purpose of the study. To develop a system of active
surgical tactics for burn patients over 60 years of age
based on the intestation of methods of general and
local treatment.
Research materials. In the burn department of the
Samarkand branch of the RSCFEMC in the period 2002-
2022. 419 elderly and senile patients were treated with
burn disease. The first group included 186 patients
who were treated in the burn department of the
Samarkand branch of the RSCEM from 2011 to 2012.
The second (comparison group) group included 233
burn victims treated in the interregional burn center in
Samarkand in 2002-2010.
The main method of restoring the skin in case of deep
burns is surgical treatment with the use of skin plastics.
For this purpose, we performed skin autoplasty in 419
victims aged 60 to 92 years with an area of deep burns
Volume 03 Issue 06-2023
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International Journal of Medical Sciences And Clinical Research
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OCLC
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Publisher:
Oscar Publishing Services
Servi
from 2 to 25%. Of these, 186 patients (group I) with
deep burns from 2 to 15% underwent necrotomy, 27
patients on the 1st day after injury, early necrectomy
within 7 to 15 days (Table 1). Skin plastic surgery was
performed immediately after removal of necrotic
scabs on an area of up to 5% of the div surface in 116
(62.4%) patients and in 70 (37.6%) victims - from 5 to 15%
of the div surface, a total of 201 plastics (from 500 to
850 cm²).
Table 1. Distribution of patients according to the nature of the surgical intervention (Group I, n=186)
№
No. Nature of surgical interventions
Number
of
operation
1
Necrotomy
27
2
Early surgical necrectomy (RSN)
154
3
3 Amputation+exarticulation
12
4
Autoalloplasty
12
5
ADP
201
TOTAL
Number of operation for 1 patient
Number of ADP per 1 patient 406
406
1:2,18
1:1,08
Good engraftment of skin flaps was observed in 156
(83.9%) patients, partial detachment of grafts occurred
in 25 (13.4%) patients, and complete lysis of
transplanted autoalloloscuts was observed in 5
patients, in whom early necrectomy was performed on
an area of 10-15% surfaces of the div, in which, as a
result of rejection of transplants, a deterioration in the
general condition occurred. In 171 (91.9%) victims,
operations were performed in one stage, and in 15
(8.1%) - in two stages (autoalloplasty - in 12 patients),
which was caused by heavy bleeding from the wound
surface and insufficiently complete removal of necrotic
scabs. The second stage of the operation was
performed 6-7 days after the first one with the removal
of the remaining necrotic scabs. In this case, good
engraftment was noted in 13 patients, and in 2 there
was a partial detachment of the grafts.
When preparing burn wounds for autoplasty, 221
victims (group II) underwent staged sparing
necrectomy, with the removal of dead tissues as they
were rejected (Table 2).
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Servi
Table 2. Distribution of patients according to the nature of the surgical intervention (Group II, n=233)
№
No. Nature of surgical interventions Number of operas.
1 221
2 22
Quantity
of
operation.
1
Sparing necrectomy conservative preparation (CP)
221
2
Chemical necrectomy
22
3
Autodermoplasty (ADP):
- "vintage"
- according to Mowlem-Jackson
17
15
4
ADP
398
5
TOTAL
Number of operas for 1 patient
Number of ADP per 1 patient
673
1:2,88
1:1,70
Along with sparing necrectomy, in order to more
quickly reject necrotic tissues in 22 patients, non-
political therapy was used using proteolytic enzymes
and keratolytic drugs.
233 patients (group II) with extensive deep burns of 10-
25% of the div surface underwent skin autoplasty for
granulating wounds. In one stage - in 133, in two stages
- in 45, and in three stages or more - in 55 patients (398
operations).
In order to increase the area of closed wounds in
patients with extensive burns, we performed
autoalloplasty of the skin in 32 patients, of which the
"vintage" method was used in 17 patients, and in 15
cases skin plasty was used according to the Moulem-
Jackson method (autoalloplasty). So-called mesh
grafts were used in 102 patients to increase the
possibilities of skin plastics with limited skin resources.
The conducted studies showed the expediency of
restrained tactics used in patients of this age, which
consisted in reducing the volume of surgical
interventions, choosing sparing methods of anesthesia
and the most rational methods of skin grafting. Since
patients of elderly and senile age belong to a group
with an increased operational risk, the first autoplasty,
as a rule, did not exceed 4-5% of the div surface, since
unsuccessful skin plasty on such an area did not
significantly affect the general condition of the victims,
and with a successful outcome, it appeared he
possibility of performing the next stage of skin grafting
in a large volume.
Volume 03 Issue 06-2023
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Publisher:
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Servi
The presence of age-related changes and concomitant
diseases in elderly and senile people had a decisive
influence on the extent of simultaneous skin grafting.
The area of simultaneous taking of grafts ranged from
500 cm2 to 1100 cm2, while in 102 patients mesh grafts
were used, which made it possible to cover a large
surface of burn wounds with a smaller area of donor
skin.
In our observations, out of 398 skin autoplasties for
granulating wounds, complete engraftment of grafts
was noted in 287 cases (72.1%), engraftment of 70% of
transplanted flaps was observed in 92 cases (23.1%),
and complete lysis of skin flaps occurred only in 19
cases (4.8%).
To take skin flaps, we used an electrodermat, which
allows us to maintain the thickness of the cut graft with
high accuracy, which is especially important in elderly
and senile people whose skin is atrophied and thinned.
The thickness of the skin flaps was 0.2-0.3 mm.
Along with the task of restoring the skin after burns,
the problem of treating wounds in donor sites remains
no less important. In the treatment of donor wounds,
we used various methods (dressings with antiseptics,
antibiotics, aseptic dressings, algipor and silicone).
RESEARCH RESULTS
The treatment of burn disease in the elderly is often
aggravated
by
various
complications,
which
contributes to high mortality (Tables 3 and 4).
Table 3. The frequency of complications and mortality of burn disease and the age of patients (I group)
Complications
Age of patients
Total
60-74
years
75-89
years
90 years
and older
Pneumonia, bronchopneumonia,
pulmonary edema
36/3
70/7
106/10
Acute myocardial infarction,
thrombophlebitis, PE, fat
embolism
13/6
17/2
2/2
32/10
Encephalopathy, acute psychosis
3
15
18
Pyelonephritis
39
22
61
Bleeding and perforation of
gastric and duodenal ulcers
4/1
9/2
13/3
bedsores
5
16
21
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Sepsis
25/3
19/5
44/8
TOTAL
125/13
168/16
2/2
295/31
* - the denominator indicates the number of deaths.
Table 4. The frequency of complications and mortality of burn disease and the age of patients (group II)
Complications
Age of patients
Total
60-74 y
75-89 y
90 y and
older
Pneumonia, bronchopneumonia,
pulmonary edema
70/5
88/12
3/3
161/20
Acute myocardial infarction,
thrombophlebitis, PE, fat
embolism
10/8
23/8
33/16
Encephalopathy, acute psychosis
6
17
23
Pyelonephritis
60
15
75
Bleeding and perforation of
gastric and duodenal ulcers
7/4
13/2
20/6
bedsores
14
15
29
Sepsis
39/20
20/10
59/30
TOTAL
206/37
191/32
3/3
400/72
* - the denominator indicates the number of deaths.
In various periods of burn disease, 31 (14.3%) of 217
patients of group I died, 72 (23.6%) of 305 of group II
patients. The overall mortality was 19.7%. The main
causes of death were: shock, pneumonia, a
combination of sepsis and pneumonia, as well as
complications from the cardiovascular system and
thromboembolism.
CONCLUSIONS
Early necrectomy and necrolytic therapy, as methods
of accelerated preparation of burn wounds for skin
plastic surgery in people over 60 years old, can only be
recommended for physically strong patients without
pronounced dysfunction of internal organs, with a
deep burn area of no more than 5-10% of the div
surface. Early necrectomy in victims 60 years of age
and older should be performed on a deep burn area of
10-15% in two stages: first, necrotic tissues are removed,
Volume 03 Issue 06-2023
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and after 2-3 days, auto-allo- or auto-dermoplasty is
performed.
When preparing wounds for skin plasty in elderly and
senile patients, the most rational method should be
considered staged sparing bloodless necrectomy,
performed on dressings as necrotic tissues are
rejected, which allow you to start surgical treatment
on the 25-28th day from the moment of injury and
maintain the div's defenses for longer time.
When restoring the skin in burnt elderly and senile
patients, preference should be given to the use of split
mesh grafts with a thickness of 0.2-0.3 mm, even in
patients with limited burns, since they often have the
preservation of life in the foreground, sometimes to
the detriment of functional results.
Active surgical tactics (RCN, ADP) in patients with
deep lesions up to 7-10% does not increase mortality
compared to conservative tactics, but reduces the bed-
day by 2 times and mortality from 23.6 to 14.3%.
When determining the tactics of treatment and
choosing the method of surgical intervention, one
should take into account not the calendar but the
biological age, and not the arithmetic sum of pre-
existing diseases, but the phase of their development
and severity. Active surgical tactics do not lead to
exacerbation of the pre-existing pathology.
The overall mortality among elderly and senile victims
with deep burns reaches 19.7%. Unlike young patients,
17.6% of deaths in elderly and senile patients are due to
non-infectious causes.
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