Outcomes of surgical treatment in severely burned patients considering burn injury pathogenesis

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Abstract

Background. Treatment of burn patients is aimed at the earliest possible debridement of the dead tissue, followed by the immediate closure with skin grafts or by creating optimal conditions for spontaneous wound healing. However, the influence of the causes and circumstances of the burn injury on the choice of surgical treatment options and its outcomes remains poorly understood.

The aim of the study was to evaluate the origin of skin lesions and outcomes of surgical treatment in patients with extensive burns considering the causes and circumstances of the injury.

Methods. To achieve this objective, a comprehensive observational retrospective study was conducted. The study focused on the surgical outcomes of all patients hospitalized in the intensive care unit of the burn center of I.I. Dzhanelidze Research Institute for Emergency Medicine between 2018 and 2020. Statistical analysis was performed using IBM SPSS 20.0.

Results. A total of 518 patients were randomized to five groups depending on flame burn models (indoor fire, flammable liquid burns, stove-fired clothing burns, cigarette-fired bedding burns, and gas-fuel burns) and three hot liquid burn models (immersion injury, non-immersion injury, and scalds). No significant differences were found when comparing the baseline parameters of the patients across the various factors. However, escharotomy (Pearson's χ2 = 50.77) and early surgical treatment (Pearson's χ2 = 24.93) were significantly more frequently used in managing flame injuries. Patients with various flame burns differed significantly in age (Kruskal-Wallis χ2 = 84.14), deep burn area (Kruskal-Wallis χ2 = 43.05), duration of treatment (Kruskal-Wallis χ2 = 13.59), rate of necrotomy (Pearson χ2 = 19.28), and early escharotomy (Pearson χ2 = 16.70). Those injured by hot liquids also differed significantly in age (Kruskal-Wallis χ2 = 41.13), deep burn area (Kruskal-Wallis χ2 = 57.79), and rate of early surgical treatment (Pearson χ2 = 16.51), but were comparable in terms of hospital stay and number of indications for escharotomy.

Conclusion. The causes and circumstances of a burn injury have a significant impact on the nature of injury. By identifying patient models based on the injury etiopathogenesis, it is possible to create groups that are homogeneous in a variety of parameters. The surgical treatment approach for patients in different model groups may differ significantly. Considering these factors when planning treatment can help improve the outcomes for burn patients.

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About the authors

Denis O. Vagner

Saint-Petersburg institute of emergency care named after I.I. Dzhanelidze; North-Western state medical university named after I.I. Mechnikov

Author for correspondence.
Email: 77wagner77@mail.ru
ORCID iD: 0000-0001-7241-4008
SPIN-code: 1820-8818

Ph.D., surgeon of the department of thermal injury, associate professor of the department of general surgery

Russian Federation, Saint Petersburg; Saint Petersburg

Evgeniy V. Zinoviev

Saint-Petersburg institute of emergency care named after I.I. Dzhanelidze; Saint Petersburg Stat Pediatric Medical University

Email: evz@list.ru
ORCID iD: 0000-0002-2493-5498
SPIN-code: 4069-2346

M.D., professor, head of the department of thermal injury, professor of the department of hospital surgery

Russian Federation, Saint Petersburg; Saint Petersburg

Vitaly V. Soloshenko

Saint-Petersburg institute of emergency care named after I.I. Dzhanelidze

Email: burncenter.vs@gmail.com
ORCID iD: 0000-0002-5800-5803
SPIN-code: 8774-2645

M.D., surgeon of the department of thermal injury

Russian Federation, Saint Petersburg

Lolita V. Israpilova

Saint-Petersburg institute of emergency care named after I.I. Dzhanelidze

Email: israpilova.lolita.98@mail.ru
ORCID iD: 0009-0000-1713-9533

resident

Russian Federation, Saint Petersburg

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