Current aspects of medical care for children with extensive soft tissue injuries (Description of three clinical observations with an analysis of mistakes)

Abstract

BACKGROUND: Injury is an epidemic of the 21st century. It is associated with the increasing high-speed transportation, natural and man-made emergencies, and local wars. All this leads to the appearance of patients with complex, multiple, and not rarely combined injuries. Traumatic skin detachment is the result of high-energy trauma. The treatment of this patient group presents certain difficulties due to the provisional peculiarities of medical care because of the severity of these patients’ condition of such patients and the underlying muscle tissue destruction.

CLINICAL CASES: This paper presents several clinical examples of successfully treated patients with traumatic skin detachments as a part of polytrauma. The timely correction of the improper treatment procedures enabled avoiding unfavorable results.

DISCUSSION: Treatment of victims with traumatic skin detachment who are in a relatively stable state and the absence of destruction of the underlying muscle tissues should be performed using traditional full layer free skin grafting, according to Krasovitov. In contrast, the treatment of victims with traumatic full-thickness skin detachment in an unstable (decompensated) state and the destruction of the underlying muscle tissues, it is necessary to perform it using the technology of staged full layer free skin grafting with the possible use of a biological coating based on chitosan.

CONCLUSION: The presented clinical examples reflect the importance of developing a unified method of treating injuries at all stages of organizing medical assistance to the victim.

Keywords

traumatic skin detachment / free autodermoplasty / plastic according to Krasovitov / treatment errors / clinical case

References

[1] Korostylev MJu, Shihaleva NG. Sovremennoe sostojanie problem lechenija pacientov sobshirnymi otslojkami pokrovnyh mjagkih tkanej (obzorliteratury). Genij ortopedii. 2017;23(1):88–94. (In Russ.). doi: 10.18019/1028-4427-2017-23-1-88-94

[2] Коростылев М.Ю., Шихалева Н.Г. Современное состояние проблемы лечения пациентов с обширными отслойками покровных мягких тканей (обзор литературы) // Гений ортопедии. 2017. Т. 23. № 1. С. 88–94. doi: 10.18019/1028-4427-2017-23-1-88-94

[3] Loktionov PV, Gudz’ JV. Opyt lechenija ran nizhnih konechnostej s obshirnoj travmaticheskoj otslojkoj kozhi i podkozhnoj kletchatki. Mediko-biologicheskiei social’no-psihologicheskie problem bezopasnosti v chrezvychajnyh situacijah. 2015;1 22–28. (In Russ.). doi: 10.25016/2541-7487-2015-0-1-22-28

[4] Локтионов П.В., Гудзь Ю.В. Опыт лечения ран нижних конечностей с обширной травматической отслойкой кожи и подкожной клетчатки // Медико-биологические и социально-психологические проблемы безопасности в чрезвычайных ситуациях. 2015. № 1. С. 22–28. doi: 10.25016/2541-7487-2015-0-1-22-28

[5] Sokolov VA. [Internet]. Obshirnaja travmaticheskaja otslojka kozhi i kletchatki konechnostej i tulovishha. (In Russ.). [Cited 2020 April 8]. Available from: https://medbe.ru/materials/politravma/obshirnaya-travmaticheskaya-otsloyka-kozhi-i-kletchatki-konechnostey-i-tulovishcha

[6] Соколов В.А. Обширная травматическая отслойка кожи и клетчатки конечностей и туловища [дата обращения 08.04.2020]. Доступ по ссылке: https://medbe.ru/materials/politravma/obshirnaya-travmaticheskaya-otsloyka-kozhi-i-kletchatki-konechnostey-i-tulovishcha/

[7] Kudsk KA, Sheldon GF, Walton RL. Degloving injuries of the extremities and torso. J Trauma. 1981;21(10):835–839. doi: 10.1097/00005373-198110000-00002

[8] Kudsk K.A., Sheldon G.F., Walton R.L. Degloving injuries of the extremities and torso // J. Trauma. 1981. Vol. 21. No. 10. P. 835–839. doi: 10.1097/00005373-198110000-00002

[9] Mello DF, Assef JC, Solda SC, Helene AJr. Degloving injuries of trunk and limbs: comparison of outcomes of early versus delayed assessment by the plastic surgery team. Rev Col Bras Cir. 2015;42(3):143–148. doi: 10.1590/0100-69912015003003

[10] Mello D.F., Assef J.C., Solda S.C., Helene A.Jr. Degloving injuries of trunk and limbs: comparison of outcomes of early versus delayed assessment by the plastic surgery team // Rev. Col. Bras. Cir. 2015. Vol. 42. No. 3. P. 143–148. doi: 10.1590/0100-69912015003003

[11] Mir Y, Mir L, Novell AM. Repair of necrotic cutaneous lesions, secondary to tangential traumatism over detachable zones. Plast Reconstr Surg. 1950;6(4):264–274. doi: 10.1097/00006534-195010000-00002

[12] Mir Y., Mir L., Novell A.M. Repair of necrotic cutaneous lesions, secondary to tangential traumatism over detachable zones // Plast. Reconstr. Surg. 1950. Vol. 6. No. 4. P. 264–274. doi:10.1097/00006534-195010000-00002

[13] Bogdanov SB, Afaunova ON. Ispol’zovanie ranevyh pokrytij pri rannem hirurgicheskom lechenii pogranichnyh ozhogov konechnostej v funkcional’no aktivnyh oblastyah. Vrach-aspirant. 2016;79(6):4–9. (In Russ.)

[14] Богданов С.Б., Афаунова О.Н. Использование раневых покрытий при раннем хирургическом лечении пограничных ожогов конечностей в функционально активных областях // Врач-аспирант. 2016. Т. 79. № 6. С. 4–9.

[15] Bogdanov SB, Babichev RG, Marchenko DN, Polyakov AV, Ivashchenko YuV. Plastika polnoslojnymi kozhnymi autotransplantantami ranrazlichnoj etiologii. Innovacionnaya medicina Kubani. 2016;(1):30–37. (In Russ.)

[16] Богданов С.Б., Бабичев Р.Г., Марченко Д.Н., Поляков А.В., Иващенко Ю.В. Пластика полнослойными кожными аутотрансплантатами ран различной этиологии // Инновационная медицина Кубани. 2016. № 1. С. 30–37.

[17] Patent RF naizobretenie No. 2248757/27.03.05. Bogdanov SB, Kurinnyi NA. Sposob plastiki kozhnykh pokrovov konechnostei posle rannei nekrektomii. Available from: https://elibrary.ru/item.asp?id=37962093. (In Russ.)

[18] Патент РФ на изобретение № 2248757/27.03.05. Богданов С.Б., Куринный Н.А. Способ пластики кожных покровов конечностей после ранней некрэктомии. Доступ по ссылке: https://elibrary.ru/item.asp?id=37962093

[19] Patent RF naizobretenie No. 2618166/02.05.20. Bogdanov SB, Babichev RG. Sposob zabora kozhnogo autotransplantata. Available from: https://elibrary.ru/item.asp?id=38263544. (In Russ.)

[20] Патент РФ на изобретение № 2618166/02.05.20. Богданов С.Б., Бабичев Р.Г. Способ забора кожного аутотрансплантата. Доступ по ссылке: https://elibrary.ru/item.asp?id=38263544

[21] Patent RF naizobretenie No. 2665676/03.09.18. Bjul. No. 25. Blazhenko AN, Kurinnyj SN, Porhanov VA, Bogdanov SB, Muhanov ML. Sposob svobodnoj otsrochennoj plastiki kozhnym autotransplantatom pritravmaticheskih otslojkah kozhi [сited 2020 April 8]. Available from: https://patentinform.ru/inventions/reg-2665676.html

[22] Патент РФ на изобретение № 2665676/ 03.09.18. Бюл. № 25. Блаженко А.Н., Куринный С.Н., Порханов В.А., Богданов С.Б., Муханов М.Л. Способ свободной отсроченной пластики кожным аутотрансплантатом при травматических отслойках кожи [дата обращения: 08.04.2020]. Доступ по ссылке: https://patentinform.ru/inventions/reg-2665676.html

RIGHTS & PERMISSIONS

Bogdanov S.B., Blazhenko A.N., Kurinniy S.N., Mukhanov M.L., Boyko A.A., Karakulev A.V., Aladina V.A.