Estimation of Microcirculation Parameters in a Burn Wound for Prediction of Skin Grafting Outcomes After Tangential Necrectomy

Abstract

BACKGROUND Irregularity and mosaicity in the depth of the burn skin lesion limits the possibility of performing precision tangential necrectomy in the early stages after injury. Non-radical necrectomy leads to lysis of transplanted autodermal grafts. This problem is most relevant in the treatment of victims with extensive dermal and deep burns. AIM OF STUDY To study the relationship between microcirculation parameters in the burn wound and the outcomes of autodermal transplantation after tangential necrectomy. MATERIAL AND METHODS 74 patients with extensive skin burns included in the study underwent tangential necrectomy with simultaneous autodermal transplantation. All operations were performed early (up to 10 days) after injury before the formation of the demarcation line. Microcirculation parameters in the burn wound were studied by laser Doppler flowmetry before and after tangential necrectomy and in healthy skin of the same anatomical region. RESULTS Statistically significant differences (p≤0.001) were found between microcirculation parameters in the center of the burn wound after tangential necrectomy and in the control area of intact skin. In this case, the results of autodermal transplantation were characterized by a skin engraftment rate of up to 60–70%. In those areas of the body where there were no differences between microcirculation parameters , the engraftment exceeded 80%. CONCLUSION Assessment of microcirculation by laser Doppler flowmetry can be a reliable method for diagnosing the condition and viability of a burn wound after tangential excision of dead tissues in the early stages of treatment — before the formation of a demarcation line. The diagnostic technique is easy to use, but requires skills in working with a flowmeter, unification of such devices and methods for their use in the practice of surgical treatment of burns.