Vol 17, No 2 (2024)

Introduction. The use of autologous stromal-vascular cell fraction of adipose tissue seems to be one of the promising technologies to increase the effectiveness of skin grafting and other skin restoration options in burnt patients. The main regenerative component of the stromal-vascular fraction are mesenchymal stem cells, which have a high reparative potential and low immunogenicity.

The aim of the study was to increase the effectiveness of surgical treatment of patients with skin burns through the injection of autological stromal-vascular cell fraction of the adipose tissue.

Materials and methods. The study was conducted as part of a prospective, open, randomized study involving 61 patients with extensive skin burns treated in burn centers Dzhanelidze Saint-Petersburg Research Institute of Emergency Medicine and Vishnevsky National Medical Research Center of Surgery, Ministry of Health of Russia, in 2021-2023. Cells of the stromal-vascular fraction of the adipose tissue were obtained mechanically and enzymatically. The prepared cell suspension was introduced into the granulation tissue during skin grafting with split autodermal grafts having a high perforation coefficient. During the study, planimetric parameters, as well as the results of histological and immunohistochemical tests, were assessed. The obtained findings were processed using generally accepted algorithms of variation and descriptive statistics. The alternative hypothesis was accepted at p<0.05.

Results. The proposed technique of autologous stromal-vascular cell fraction of the adipose tissue with simultaneous autodermoplasty with a split perforated graft allowed reducing the time of perforating cell epithelization by 28% (p<0.05), the time of final engraftment by 11% (p<0.05), the frequency of infectious complications in the postoperative period by 20% (p<0.05), as well as the frequency of lysis and rejection reactions by 15% (p<0.05). As stated, the introduction of an autologous stromal-vascular fraction during skin grafting resulted in early relief of the inflammatory reaction in the area of a deep burn wound, the fact being supported by clinical, cytological, histological and immunohistochemical tests.

Conclusion. The use of cells from the stromal-vascular fraction of the adipose tissue can significantly increase the effectiveness of surgical treatment of patients with extensive skin burns. The proposed technique to obtain and apply the stromal-vascular fraction of the adipose tissue at the stage of autodermoplasty can be introduced into clinical practice in both burn centers and surgical/trauma departments, since it does not require special equipment.

The paper describes a clinical case of intraoperative constant ultrasound-guided removal of deep-lying foreign bodies of the soft left neck tissue in a patient with a shrapnel wound resulted from mortaring. When deciding on a surgical option, the potential C-arm-guided foreign body removal was also considered; however, due to the topical localization of the foreign body between the internal jugular vein and the bifurcation area of the common carotid artery, the use of this technique was associated with a high risk of vascular trauma. The surgery was performed under local anesthesia using constant “free hand” US method in duplex mode. The foreign body was successfully removed. The wound completely healed by secondary intention, and a series of control ultrasound examinations revealed no signs of postoperative complications.

Necrotizing soft tissue infection is a rare (0.4 cases per 100,000 population) but very severe pathology with a mortality rate up to 10%. The paper presents a clinical case of successful management of necrotizing soft tissue infection of the right arm, lateral wall of the chest and abdomen. The dynamics of the wound process was controlled by clinical, bacteriological, X-ray and ultrasound examinations. The cause of necrotizing soft tissue infection in this patient was the associated anaerobic nonclostridial and aerobic flora. Numerous surgical interventions were used to manage the patient; they were aimed at the excision of the necrotic tissue at the start of treatment, plastic surgery of postoperative wounds with local tissues was used at the end of treatment. The progression of the necrotic process was stopped after the third intervention. In addition to surgical treatment, the patient received antibacterial, detoxification, and immunostimulating therapy. Despite numerous staged surgeries with the excision of the necrotic skin, subcutaneous fat and fascia, it was possible to completely restore the patient’s ability to work.