Surgical treatment of burns: operation necrectomy

Thermal injury is one of the most severe types of traumatic lesions. Everyone knows that even a minor burn, for example, from touching a hot object, heals for a long time, causing considerable discomfort to the patient. Serious burns, characterized by a large area of ​​damage, are dangerous, first of all, by the development of burn shock. In order to avoid dangerous consequences, it is necessary to start medical measures as soon as possible, and it is plastic surgery that deals with the surgical treatment of burns. Surgical interventions during which burnt, non-viable tissues are removed are called necrectomy, and estet-portal.com talks about them in detail today.

Peculiarities of necrectomy for burns

The main goal of treating patients with deep burns is to eliminate non-viable tissues as a source of infectious-toxic complications of thermal injuries.

Necrectomy is the main surgical treatment for burns. During this operation, the wounds are quickly cleansed of necrotic tissues, after which skin grafting is performed, which makes it possible to completely close even extensive burn wounds.

Plasty is performed on the prepared wound bed in several ways as soon as possible after the injury. The earlier and more effectively the necrectomy was performed, the more favorable the prognosis for the patient.

Necrectomy:

• main groups of surgical interventions for the treatment of burns;
• what classifications of necrectomy are used today;
• Plastic surgeons' actions after necrectomy.

The main groups of surgical interventions for the treatment of burns

All surgical methods performed for the purpose of surgical treatment of burns can be divided into three groups:

1. 1 group – necrectomy – surgeries aimed at early removal of necrotic tissues with subsequent simultaneous or delayed plastic closure of surgical wounds;
2. 2 group – operations aimed at closing a wound defect by various methods of skin transplantation after the use of necrolytic agents or spontaneous rejection of necrotic tissues;
3. 3 group – bloodless removal of necrotic tissues during dressings, after their spontaneous rejection has occurred under the influence of necrohormones and proteolytic enzymes of microbial origin, and the tissue has lost contact with the underlying viable areas. Such treatment of burns takes a very long time.

What classifications of necrectomy are used today

Necroctomies are classified depending on the initial state of the wound, the technique of performing the operation, the depth of tissue excision and the extent of the surgical intervention.

• According to the initial state of the wound, they are distinguished:

• excision of a burn wound that is under the scab;
• primary surgical necrectomy – before the appearance of signs of inflammation in the wound;
• delayed necrectomy – there are signs of inflammation in the wound;
• secondary necrectomy – re-intervention in case of doubt about the radicalness of the first operation;
• staged necrectomy - for extensive burns.

• Necrectomy by technique:

• tangentially – tangentially, necrotic eschar and non-viable tissues are removed to viable;
• with a border slit – removal of tissues is performed using a vertical incision along the perimeter of the wound to healthy tissues.

• By cutting depth:

• dermal excision;
• fascial excision;
• fascio-muscular excision;
• osteonecrotomy and osteoectomy.

• Depending on the scale of necrectomy:

• small – excision area up to 5%;
• limited – excision area up to 10%;
• extensive – excision area up to 20%;
• large-scale - the area of ​​excision is more than 20%.

Plastic surgeons after necrectomy

After necrectomy, there are two options for subsequent actions of surgeons:

• plasty with perforated grafts until the tourniquet is removed, followed by the application of a pressure bandage;
• imposition of hemostatic napkins, followed by the imposition of a tight bandage with an elastic bandage and removal of the tourniquet, after which the bandage is removed round by round and hemostasis is performed on the opened wound areas.

At present, the second option is more preferable, as it prevents the formation of hematomas under the graft, which greatly affects the process of engraftment. If the application of a tourniquet is not possible – it is necessary to gradually excise necrotic areas with a pressure bandage and immediate coagulation of bleeding vessels.