Lysis/rejection of split autoderm grafts – solutions

Abstract

Abstract. Analysis of available literature and our own experience, the main causes of the lysis / rejection of autoderm grafts are systematized. It is shown that there is no consensus among combustiologists about the causes of these complications. It is believed that the leading cause of such complications is the general condition of the body, the unpreparedness of wounds for surgical treatment and the development of disseminated intravascular coagulation syndrome in seriously ill people. The frequency of unsatisfactory treatment results also correlates with the level of contamination of the burn wound. An increase in microbial seeding to 107 or 108 colony forming units per gram is a relative contraindication to surgery, while the optimal level for skin grafting is considered to be 104 colony forming units per gram. In addition, locally plastic interventions are possible with a microbial load of 105 colony forming units per gram, subject to compensation for violations of the general condition of the victim. Of great importance are the timing of autodermotransplantation. Conducting skin plastics later than 14 days after the injury increases the risk of postoperative complications. This is due to the peculiarities of the pathophysiological processes characteristic of burn wounds. During the first two weeks from the moment of the injury, the processes of reparative regeneration prevail in them, however, their intensity progressively decreases over time. It has been demonstrated that immune system disorders also have a significant effect on the rate of graft lysis. Domestic experts have developed an original method for predicting the likelihood of an unsatisfactory result of skin grafting, based on an assessment of a number of parameters of the immune system. The results of our observations indicate that the main causes of lysis / rejection of autodermotransplantants in the postoperative period are insufficient preparation of wounds for surgical treatment, changes in the general condition of the body, impaired immune system (autoaggression), and a high level of microbial contamination. The development of common criteria for assessing a patients readiness for skin grafting to prevent rejection of transplanted autoderm grafts remains an urgent task of combustiology.