itchy skin

diaper rash

dermatitis

peeling and dry skin

cuts

frostbite

abrasions

calluses

Burns: types of burns and degrees, treatment of burns with KEEPER balm

Burns is damage to body tissue caused by exposure to high temperature or chemical substances. Electrical shock and exposure to ionizing radiation(ultraviolet, x-ray, etc., including solar).

Often burns are also called skin lesions caused by the irritating effect of a plant (nettle burn, hogweed burn, hot pepper burn), although in essence this is not a burn - it is phytodermatitis.

Depending on the area of ​​tissue damage, burns are divided into burns of the skin, eyes, mucous membranes, burns of the respiratory tract, esophagus, stomach, etc. The most common are, of course, skin burns, so in the future we will consider this type of burn.

Heaviness burn determined by the depth and area of ​​tissue damage. The concept of “burn area” is used to characterize the affected area skin, and is expressed as a percentage. To classify the depth of a burn, the concept “degree of burn” is used.

Types of burns

Depending on the damaging factor, skin burns are divided into:

• thermal,
• chemical,
• electrical,
• sun and other radiation burns (from ultraviolet and other types of radiation)

Thermal burn

Thermal burn is the result of exposure to high temperature. This is the most common household injury. They occur as a result of exposure to open flame, steam, hot liquid (boiling water, hot oil), or hot objects. The most dangerous, of course, is open fire, since in this case the organs of vision and the upper respiratory tract can be affected. Hot steam is also dangerous for the respiratory tract. Burns from hot liquids or hot objects are usually not very large in area, but deep.

Chemical burn

Chemical burn occurs as a result of exposure to chemically active substances on the skin: acids, alkalis, salts of heavy metals. They are dangerous if the affected area is large, as well as if chemicals come into contact with mucous membranes and eyes.

Electrical burns

Electrical shock is characterized by the presence of several burns of a small area, but of great depth. Voltage arc burns are superficial, similar to flame burns and occur during short circuits without current passing through the victim’s body.

Radiation burns

This type of burn includes burns that occur as a result of exposure to light or ionizing radiation. Thus, solar radiation can cause the well-known sunburn. The depth of such a burn is usually 1st degree, rarely 2nd degree. A similar burn can also be caused by artificial ultraviolet irradiation. The extent of damage from radiation burns depends on the wavelength, intensity of radiation and duration of exposure.

Burns from ionizing radiation are usually shallow, but their treatment is difficult, since such radiation penetrates deeply and damages the underlying organs and tissues, which reduces the skin's ability to regenerate.

Degree of skin burn

The degree of burn is determined by the depth of damage to the various layers of the skin.

Recall that human skin consists of epidermis, dermis and subcutaneous fat (hypodermis). The top layer, the epidermis, in turn consists of 5 layers of varying thickness. The epidermis also contains melanin, which colors the skin and causes the tanning effect. The dermis, or the skin itself, consists of 2 layers - the upper papillary layer with capillary loops and nerve endings, and the reticular layer containing blood and lymphatic vessels, nerve endings, hair follicles, glands, as well as elastic, collagen and smooth muscle fibers, giving the skin strength and elasticity. Subcutaneous fat tissue consists of bundles connective tissue and fat deposits permeated blood vessels and nerve fibers. It provides nutrition to the skin, serves for thermoregulation of the body and additional protection of organs.

Clinical and morphological classification of burns, adopted at the XXVII All-Union Congress of Surgeons in 1961, distinguishes 4 degrees burn.

First degree burn

I degree burn is characterized by damage to the most superficial layer of the skin (epidermis), consisting of epithelial cells. In this case, redness of the skin, slight swelling (edema), and tenderness of the skin in the burn area appear. Such a burn heals in 2-4 days, no traces remain after the burn, except for minor itching and peeling of the skin - the upper layer of the epithelium dies.

Second degree burn

A second degree burn is characterized by deeper tissue damage - the epidermis is partially damaged to the full depth, down to the germ layer. Not only redness and swelling are observed, but also the formation of blisters with a yellowish liquid on the skin, which can burst on their own or remain intact. Bubbles form immediately after a burn or after some time. If the bubbles burst, a bright red erosion forms, which is covered with a thin brown crust. Healing for a second degree burn usually occurs in 1-2 weeks, through tissue regeneration due to the preserved germ layer. There are no marks left on the skin, but the skin may become more sensitive to temperature influences.

Third degree burn

III degree burn is characterized by complete death of the epidermis in the affected area and partial or complete damage to the dermis. Tissue necrosis (necrosis) and the formation of a burn scab are observed. According to the accepted classification, III degree burns are divided into:

• degree III A, when the dermis and epithelium are partially damaged and independent restoration of the skin surface is possible if the burn is not complicated by infection,
• and degree III B - complete death of the skin down to the subcutaneous fat. As healing occurs, scars form.

IV degree burn

A fourth degree burn is the complete destruction of all layers of skin and underlying tissues, charring of muscles and bones.

Determination of the area affected by a burn

Approximate area estimate burn can be produced in two ways. The first method is the so-called “rule of nines”. According to this rule, the entire surface of the skin of an adult is conditionally divided into eleven sections of 9% each:

• head and neck - 9%,
• upper limbs - 9% each,
• lower limbs - 18% (2 times 9%) each,
• posterior surface of the body - 18%,
• anterior surface of the body - 18%.

The remaining one percent of the body surface is in the perineal area.

The second method - the palm method - is based on the fact that the area of ​​​​the palm of an adult is approximately 1% of the total surface of the skin. For local burns, use the palm to measure the area of ​​damaged skin areas; for extensive burns, measure the area of ​​unaffected areas.

The larger the area and deeper the tissue damage, the more severe the burn injury. If deep burns occupy more than 10-15% of the body surface, or the total area of ​​even shallow burns makes up more than 30% of the body surface, the victim develops a burn disease. The severity of a burn disease depends on the area of ​​the burns (especially deep ones), the age of the victim, the presence of concomitant injuries, diseases and complications.

Prognosis for recovery from burns

To assess the severity of the lesion and predict the further development of the disease, various prognostic indices are used. One of these indices is the lesion severity index (Frank index).

When calculating this index, each for each percentage of the burn area gives from one to four points - depending on the degree of the burn, a burn of the respiratory tract without breathing impairment - 15 points additionally, with a violation - 30. The index values ​​are interpreted as follows:

• < 30 баллов - прогноз благоприятный
• 30-60 - conditionally favorable
• 61-90 - doubtful
• > 91 - unfavorable

Also, to assess the prognosis of burn injury in adults, the “hundred rule” is applied: if the sum of the numbers of the patient’s age (in years) and the total area of ​​damage (in percent) exceeds 100, the prognosis is unfavorable. Burns of the respiratory tract significantly worsen the prognosis, and to take into account its influence on the “rule of hundreds” indicator, it is conventionally accepted that it corresponds to 15% of a deep burn of the body. The combination of a burn with damage to bones and internal organs, with carbon monoxide poisoning, smoke, toxic combustion products or exposure to ionizing radiation aggravates the prognosis.

Burn disease in children, especially young children, can develop when only 3-5% of the body surface is affected, in older children - 5-10%, and is more severe the more severe it is. younger child. Deep burns of 10% of the body surface are considered critical in young children.

Treatment of burns

Burns Grades I and II are considered superficial and heal without surgery. Burns of III A degree are classified as borderline, and III B and IV degrees are deep. In case of burns of degree III A, independent tissue restoration is difficult, and treatment of burns of degrees III B and IV without surgical intervention is impossible - a skin graft is required.

Self-treatment, without consulting a doctor, is only possible for I-II degree burns, and only if the burn area is small. If the area of ​​the second degree burn is more than 5 cm in diameter, you should consult a doctor. Treatment of adult patients with first-degree burns, even extensive ones, can be carried out on an outpatient basis. For more severe burns, adult patients can be treated on an outpatient basis in cases where the skin of the face, lower extremities or perineum is not affected, and the burn area does not exceed:

• for second degree burns - 10% of the body surface;
• for III A degree burns - 5% of the body surface.

The method of treating a burn depends on its type, the degree of the burn, the area affected and the age of the patient. Thus, even small-area burns in young children require mandatory medical intervention, and often inpatient treatment. Elderly people also suffer from burns with difficulty. It is advisable to treat victims over 60 years of age with limited degree II-IIIA burns, regardless of their location, in a hospital setting.

First of all, in case of a burn, you must urgently stop the action of the damaging factor (high temperature, chemical substance) on the skin. For a superficial thermal burn - boiling water, steam, a hot object - wash the burned area generously cold water within 10-15 minutes. In case of a chemical burn with acid, the wound is washed with a soda solution, and in case of a burn with alkali - with a weak solution of acetic acid. If the exact composition of the chemical is unknown, wash with clean water.

If the burn is extensive, the victim should be given at least 0.5 liters of water to drink, preferably with 1/4 teaspoon dissolved in it baking soda and 1/2 teaspoon table salt. Give 1-2 g of acetylsalicylic acid and 0.05 g of diphenhydramine orally.

You can try to treat a first-degree burn yourself. But if the victim has a significant burn of the second degree (blister with a diameter of 5 cm or more), and even more so with burns of the third degree or higher, you need to urgently consult a doctor.

For IIIA degree burns, treatment begins with wet-dry dressings that promote the formation of a thin scab. Under a dry scab, IIIA degree burns can heal without suppuration. After rejection and removal of the scab and the beginning of epithelization, oil-balsamic dressings are used.

For the treatment of burns of I-II degrees, as well as at the stage of epithelization in the treatment of burns of III A degree good results showed the Guardian balm. It has analgesic, anti-inflammatory, antiseptic, regenerating properties. Balm Guardian relieves inflammation, accelerates skin regeneration, promotes wound healing, and prevents scar formation. Apply directly to the affected area, or use for ointment aseptic dressings.

The reasons that cause a burn can be very diverse.

What types of burns there are, how many degrees of burns there are and how to determine the degree of burn - we will find out today.

A burn itself is permanent damage to the tissues of the human body when exposed to any external factor.

And it is precisely on this very factor that the classification of the etiology of burns depends. So, based on their origin, the following types of burns are distinguished:

• Thermal burn– exposure to elevated temperatures on the surface of the human body: steam, boiling water, hot oil, touching a hot object, exposure to open fire on the human body.
• Electrical burn– exposure to an electric discharge on the human body, which also causes damage to internal organs by the electromagnetic field.
• A chemical burn is the interaction of the human body with chemicals that can affect not only the epidermis, but also the subcutaneous layers.
• Radiation burn– damage to the epidermis and sometimes the subcutaneous layer by exposure to ultraviolet or infrared radiation.

Classification of burns by degree and their characteristics

Each burn is unique in its own way, because the degree of damage is individual each time - it all depends on those external factors that cause it. Treatment depends on the degree of burns and their symptoms, which is why the classification of burns by degree is so important.

There are only four types of burns according to degrees. All degrees of burns and their signs depend on the characteristics of tissue damage and the level of area of ​​this damage.

1st degree burn. The mildest form (or degree) of a burn. There is redness and very slight swelling of the affected surface. The pain is not great, and recovery from this burn occurs literally on the 4th or 5th day. There are no clearly visible marks or scars left.

photo of 1st degree burn

2nd degree burn. Blisters form on reddened skin, and they may not appear immediately - up to a day after the burn. Each bubble contains a yellowish liquid, and when they rupture, the reddish surface of the skin that is located under the bubble is visible. If an infection occurs at the site of the rupture, healing takes longer, but scars and cicatrices subsequently do not form.

photo of 2nd degree burn

3rd degree burn. With such a lesion, necrosis of the affected area of ​​the skin occurs. In its place, a scab forms, which takes on a grayish tint. Sometimes this scab becomes covered with a black crust, which then falls off to reveal a reddish area of ​​a very thin layer of skin.

photo of 3rd degree burn

4th degree burn. This is not only external damage to the layers of skin and epidermis, it is penetration into the deep tissues and even charring them. Many of the dead tissues are partially melted and then sloughed off. Not only muscle tissue is damaged, but also tendons and even bone.

The healing process of a 4th degree burn is very long; not only scars are formed at the site of the lesion, but also cicatrices, which often lead to disfigurement. Scar contractures form in the joint capsules, which prevent joint mobility. This is the most severe degree of burn, which necessarily requires specialist supervision and long and difficult treatment.

photo of 4th degree burn

Depending on the types of burns and their degrees, there are special treatment methods. Moreover, this classification of burns by degree is universal for the entire global medical community and it is the “starting point” for treatment and for determining the method of recovery after a burn.

The classification of burn injuries by degree of burn was introduced into medical terminology to make it easier for doctors to determine the severity of this type of injury and prescribe the correct treatment. In fact, the severity of the burn indicates the severity of the burn injury.

A burn is damage to an area of ​​human body tissue that has been directly affected by high temperature. In the minds of the average person, a burn can only be caused by fire, but in fact there are many types of burns, each of which has its own characteristics lesions and methods of their treatment. The causes of burns can be:

• thermal;
• electrical;
• chemical;
• radial.

Thermal burns are the most common type of such injuries. This type includes injuries resulting from careless handling of open fire, boiling water or hot steam, as well as from exposure to hot objects on the human body.

Injuries caused by electric shock are classified as electrical burns. With such injuries, in addition to external visible damage, the electric field also affects internal organs. Burns resulting from careless handling of chemicals: acids, alkalis, electrolytes, etc. qualify as chemical burns. Ultraviolet burns and injuries caused by radiation, sun rays, and quartz radiation are a type of radiation.

But the number of burn injuries is not limited to this list. For example, you can get a similar injury from the improper use of warming ointments or mustard plaster, you can get a burn from garlic, the use of bodyaga or celandine juice - such injuries, although not life-threatening, do not become less painful.

It would be wrong to think that only skin burns pose a danger. No less dangerous in its consequences can be a burn of the lungs or retina. In addition, it is much more difficult to treat such injuries, since there is not yet a technique for replacing damaged areas on these organs, as is practiced for skin burns.

Read also:

Classification of burns by severity

All types of burns, regardless of the cause of their occurrence, are divided into 4 degrees. This classification is so convenient and practical that even a non-specialist can accurately determine the type of injury received; to do this, it is enough just to know the basic characteristics of each degree of burns.

The severity of the injury depends on many factors:

• the magnitude of the temperature affecting the body;
• the duration of its effect on the body;
• the nature of the injuries received (which part of the body or organ was burned);
• area and depth of damage.

To make it easier to apply classification to burns received, doctors all over the world adhere to a uniform ratio of damage to individual organs to the entire body. For example, a burned hand is 9% of the entire body, the head is also 9%, the leg, chest or back are 18% each. To roughly determine the damaged area, use the following rule: the area of ​​a person’s palm is approximately equal to 1% of the total area of ​​his body.

According to statistics, people most often receive burns on their hands or feet, as well as their face and eyes. Injuries to the head and torso are much less common, but such lesions can be much more life-threatening, since the wound in such cases is large not only in area, but also in the depth of tissue damage.

Characteristics of burns

A 1st degree burn is characterized by redness of the skin and slight swelling of the tissue. This is the mildest superficial type of injury. Most often, such a wound heals within 4-5 days even without the use of special medications. Therefore, in the vast majority of such cases, victims do not even consider it necessary to see a doctor.

However, in some cases, even such minor, at first glance, symptoms of burns require hospitalization of the victim. This is necessary when the skin of the eyelids or eyes is injured, or more than 10% of the body is damaged, or more than 1% of the body if it is a burn of the palm or foot. Hospitalization of the victim is also advisable in the case when such a burn is located on the face, unless, of course, the victim is not indifferent to his appearance after recovery.

A 2nd degree burn is also a minor injury. This damage affects the top two layers of skin – the epidermis and dermis. The main signs of this type of burn are: severe redness and swelling of the skin, the appearance of filled clear liquid blisters. People who receive it require hospitalization only in the same cases as for 1st degree injuries.

However, when treating such injuries, you need to know that you cannot break the blisters on your own and remove the liquid from them; it is better to endure until the integrity of the membrane is damaged naturally, or seek help from a doctor.

A 3rd degree burn is a serious injury that requires immediate assistance to the victim. medical care, regardless of its location and size. 3rd degree burns are divided into 2 subtypes - 3A and 3B. A 3A degree burn is characterized by damage to the deep layers of the epidermis and dermis, and an increase in soft tissue swelling. On initial stage the victim feels acute pain, but later, due to the necrosis of the soft tissues in the wound, it almost completely subsides.

In the area of ​​3rd degree damage, blisters practically do not appear, appearing only at the edges of the wound, where damage is usually smaller - 2nd or even 1st degree. If, during the healing of wounds of 1st and 2nd degrees, scars remain barely noticeable, then a 3rd degree burn is characterized by the appearance of hard scars. This will be especially noticeable on the hands. Scars appear because damaged dead tissue is replaced with new ones.

All of the above is also typical for a 3B degree burn, but with it deeper tissue damage occurs with the formation of a scab at the site of the lesion. The duration of treatment for such burns often exceeds a month, and in the first 10-12 days after the injury, dead tissue is rejected, and only after this does the actual healing of the wound begin.

With a fourth-degree burn, not only the skin, but also the muscles and tendons underneath it die and char, and in particularly difficult cases, even bone tissue. A 4th degree burn means automatic hospitalization, since damaged tissue melts under the influence of high temperature. Therefore, their rejection and replacement with healthy tissue occurs very slowly - rejection can last several weeks. After healing, rough, ugly scars remain in the damaged areas, and scar contractures remain on the neck and joints.

First aid for burns

For a speedy recovery, timely and correct first aid to the victim immediately after a burn is very important. The nature of such assistance depends on the type of damage. In case of thermal injuries, which happen most often in everyday life, you first need to isolate the victim from damaging factors: protect from open fire, hide from sun rays, extinguish, and if possible, remove burning clothing, etc.

If the burn damage to the body is no more than 2nd degree, then you need to quickly rinse the damaged area with cold (15-18º) water to cool the damaged tissue. This procedure should be performed for 15-20 minutes, and then cover the damaged area with a clean cloth soaked in cold water.

If the victim has received a severe burn (3rd degree), then it is impossible to wash the wound with cold water; in such cases, it is necessary to cover the wound with a clean, damp cloth and immediately call an ambulance. If your hands or feet are burned, you should immediately remove all bracelets, rings and other items from them. Then you need to isolate the contact between your fingers by placing wet, clean cloths between them. And in any case, it would not be superfluous to give the victim a pain reliever containing paracetamol or ibuprofen.

In case of electrical burns, you must first isolate the victim from the source of the injury, while strictly observing personal safety rules. After this, cover the damaged areas with a bandage and seek help from an ambulance, since this type of lesion is the most insidious of all, since minor visual damage to the skin can seriously damage internal organs.

For different types of chemical burns, first aid can vary significantly. If damaged by acids (except for sulfuric acid), the wound should be washed in ordinary cold water for 15-20 minutes. If affected by sulfuric acid, the burn should be washed with soapy water or treated with a 3% soda solution. If the source of damage was alkali, the wound should be thoroughly washed with water and then treated with a 2% solution of citric or acetic acid.

Regardless of the type of burn received, there is general rules providing assistance.

If the injury is not too serious (grade 1-2), then you should try to calm the victim as much as possible. In this case, it’s a good idea to give him warm (but not scalding) tea.

If the victim has lost consciousness, then you need to try to give his body the most comfortable position, while it is very important to ensure the most free access of fresh air, for which you must unfasten the constricting clothes, and, if necessary, turn your head to the side to free the airways.

When providing first aid to a burn victim, it is important not only to know how to do it correctly, but also to know what you should never do:

• tear off clothing stuck to the wound;
• treat the burn with iodine or hydrogen peroxide;
• lubricate damaged areas with oil, creams or sprinkle with powders;
• puncture blisters and squeeze out their contents;
• apply ice, cotton wool to the burned areas, bandage them or cover them with a band-aid.

Treating burn injuries at home

Today, Panthenol or sea buckthorn oil is most often used to treat small burn wounds. “Panthenol” can be purchased without a prescription at any pharmacy. It is available in the form of an ointment, spray or cream. Its basis is active substance dexpanthenol, which has remarkable healing, regenerating properties and anti-inflammatory effects.

Treatment with Panthenol gives the most effective results when applied to a fresh wound. After providing first aid, the wound should be treated with an antiseptic, and then a thin layer of Panthenol should be applied to the damaged area. During the day, you can use this remedy every 6 hours, and more often if necessary.

Sea buckthorn oil has unique healing and restorative properties, and it significantly reduces painful sensations from a burn. Treat wounds with soaked sterile sea ​​buckthorn oil gauze pads, which are placed directly on the treated wound and bandaged with a sterile bandage.

If no complications arise during the healing process, the dressing is changed every 72 hours. But the condition of the wound must be monitored daily, and if signs of suppuration are detected, the bandage must be changed. The bandage is finally removed after 8-10 days.

Treatment at home is justified for minor household burns of 1-2 degrees. Under favorable circumstances, with the permission and under the supervision of a doctor, it is possible to treat third-degree superficial burns at home. In all other cases, treatment should be carried out in hospitals of specialized institutions.

In any case, even if you receive an extensive 2nd degree burn, it is better to consult a doctor as soon as possible, since a person who receives such wounds inevitably experiences severe pain shock and may even fall into a coma.

Each of us has suffered burns in our lives. The area of ​​burns varies, but the sensations are always the same: as if a hot coal is being applied to the affected area. And no water, ice or cold compress can't overcome this feeling.

And from a medical point of view, a burn is tissue damage caused by high temperature or highly active chemicals, such as acids, alkalis, and heavy metal salts. The severity of the condition is determined by the depth of damage and the area of ​​damaged tissue. There are special forms of burns received from radiation or electric shock.

Classification

The classification of burns is based on the depth and type of damage, but there is a division according to clinical manifestations, medical tactics or type of injury.

Burns are classified according to depth:

1. The first degree is characterized by damage to only the top layer of skin. Externally, this manifests itself as redness, slight swelling and painful sensations. Symptoms disappear after three to four days, and the affected area of ​​the epithelium is replaced by a new one.
2. Damage to the epidermis down to the basal layer indicates a 2nd degree burn. Bubbles with cloudy contents appear on the surface of the skin. Healing lasts up to two weeks.
3. When thermal damage occurs, not only the epidermis, but also the dermis.
   - Grade A: the dermis at the bottom of the wound is partially intact, but immediately after the injury it looks like a black scab, sometimes blisters appear that can merge with each other. No pain is felt at the burn site due to damage to the receptors. Independent regeneration is possible only if there is no secondary infection.
   - Grade B: complete destruction of the epidermis, dermis and hypodermis.
4. The fourth degree is charring of the skin, fat layer, muscles and even bones.

Classification of burns by type of damage:

1. Exposure to high temperatures:
   - Fire - the affected area is large, but the depth is relatively small. Primary treatment is complicated by the fact that it is difficult to clean the wound from foreign bodies (threads from clothing, pieces of melted buttons or zippers).
   - Liquid - the burn is small but deep (up to the third A-degree).
   - Hot steam - a significant extent of the burn, but the depth rarely reaches the second degree. Often affects the respiratory tract.
   - Hot objects - the wound follows the outline of the object and can have significant depth.
2. Chemical substances:
   - Acids cause coagulative necrosis, and a scab of coagulated proteins appears at the site of the lesion. This prevents the substance from penetrating into the underlying tissue. The stronger the acid, the closer to the surface of the skin the affected area is located.
   - Alkalies form liquefaction necrosis, it softens the tissues and the caustic substance penetrates deeply, a 2nd degree burn is possible.
   - Salts of heavy metals resemble acid burns in appearance. They are only 1st degree.
3. Electrical burns occur after contact with technical or atmospheric electricity and, as a rule, occur only at the point of entry and exit of the discharge.
4. Radiation burns can occur after exposure to ionizing or light radiation. They are shallow, and their impact is associated with damage to organs and systems, and not directly to soft tissues.
5. Combined burns involve multiple damaging factors, such as gas and flame.
6. Combined injuries can be those where, in addition to a burn, there are also other types of injuries, such as fractures.

Forecast

Anyone who has ever received burns (the area of ​​the burns was larger than a five-ruble coin) knows that the prognosis of the development of the disease is an important detail in making a diagnosis. Often, trauma patients are victims of accidents, natural disasters, or work-related emergencies. Therefore, people are brought to the emergency room in whole groups. And that’s when the ability to predict changes in the patient’s future condition will come in handy during triage. The most severe and complex cases should be treated by doctors first, because sometimes hours and minutes count. Typically, the prognosis is based on the area of ​​the damaged surface and the depth of the lesion, as well as associated injuries.

In order to accurately determine the forecast, conditional indices are used (for example, the Frank index). To do this, for each percentage of the affected area, from one to four points are assigned. This depends on the degree and location of the burn, as well as the area of ​​the burn in the upper respiratory tract. If there is no breathing problem, then the burn to the head and neck receives 15 points, and if there is, then all 30. And then all the scores are calculated. There is a scale:

Less than 30 points - the prognosis is favorable;
- from thirty to sixty - conditionally favorable;
- up to ninety - doubtful;
- more than ninety - unfavorable.

Damage area

In medicine, there are several ways to calculate the area of ​​the affected surface. Determining the area and degree of the burn is possible if we take as a rule that the surface of different parts of the body occupies nine percent of the total area of ​​the skin, according to this, the head along with the neck, chest, abdomen, each arm, thighs, legs and feet each occupy 9%, and the posterior surface of the body is twice as large (18%). Only one percent each suffered injuries to the perineum and genitals, but these injuries are considered quite severe.

There are other rules for determining the area of ​​burns, for example using the palm of your hand. It is known that the area of ​​the human palm occupies from one to one and a half percent of the entire surface of the body. This allows us to conditionally determine the size of the damaged area and assume the severity of the condition. The percentage of burns on the body is a relative value. They depend on the subjective assessment of the doctor.

Clinic

There are several symptoms that burns can cause. The area of ​​burns in this case does not play a special role, since they are extensive but shallow. Over time, the forms of clinical manifestations may change into each other during the healing process:

1. Erythema, or redness, is accompanied by reddening of the skin. Occurs with any degree of burns.
2. A vesicle is a bubble filled with cloudy liquid. It may be mixed with blood. Appears due to detachment of the top layer of skin.
3. A bulla is several vesicles that have merged into one bubble more than one and a half centimeters in diameter.
4. Erosion is a burn surface on which there is no epidermis. It bleeds or secretes ichor. Occurs during the removal of blisters or bullae, necrotic tissue.
5. An ulcer is a deeper erosion affecting the dermis, hypodermis and muscles. The value depends on the area of ​​previous necrosis.
6. Coagulative necrosis is dry, dead tissue that is black or dark brown in color. Easily removed surgically.
7. Liquation necrosis is wet rotting tissue that can spread both deep into the body and to the sides, capturing healthy tissue.

Burn disease

This is a systemic response of the body to a burn injury. This condition can occur both with superficial injuries, if the body is burned 30% or more, and with deep burns, occupying no more than ten percent. The weaker a person’s health, the stronger this manifestation. Pathophysiologists distinguish four stages in the development of burn disease:

1. Burn shock. It lasts the first two days, for severe damage - three days. It occurs due to improper redistribution of fluid in the shock organs (heart, lungs, brain, kidneys).
2. Acute burn toxemia develops before infection occurs and lasts from a week to nine days. Pathophysiologically similar to long-term crush syndrome, that is, tissue breakdown products enter the systemic bloodstream and poison the body.
3. Burn septicotoxemia appears after infection. It can last up to several months until all bacteria are eliminated from the wound surface.
4. Recovery begins after the burn wounds are covered with granulation tissue or epithelium.

Endogenous intoxication, infection and sepsis

A body burn is accompanied by body poisoning with protein denaturation products. The liver and kidneys are almost unable to cope with the increased load when the pressure in the systemic circulation decreases. In addition, after an injury, a person’s immune system is in a state of high alert, but prolonged poisoning of the body disrupts the defense mechanisms, and secondary immunodeficiency is formed. This leads to the fact that the wound surface is colonized by putrefactive microflora.

Triage of burn victims

Local treatment

There are two known methods of treating burns - closed and open. They can be used either separately or together. To prevent the wound from becoming infected, it is actively dried so that dry necrosis appears. This is what the open method is based on. Substances, such as alcohol solutions of halogens, which can coagulate proteins, are applied to the wound surface. In addition, physical therapy techniques such as infrared radiation may be used.

Closed treatment involves the presence of dressings to prevent the entry of bacteria, and drainages ensure the outflow of fluid. Under the bandage, medications are applied that promote wound granulation, improve fluid outflow and have antiseptic properties. Most often, this method uses broad-spectrum antibiotics, which have a complex effect.

RCHR (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Clinical protocols Ministry of Health of the Republic of Kazakhstan - 2016

Thermal burn 50-59% of the body surface (T31.5), Thermal burn 60-69% of the body surface (T31.6), Thermal burn 70-79% of the body surface (T31.7), Thermal burn 80-89% of the body surface (T31.8), Thermal burn of 90% or more of the body surface (T31.9)

Combustiology

general information

Short description

Approved
Joint Commission on Quality medical services
Ministry of Health and Social Development of the Republic of Kazakhstan
dated June 28, 2016 Protocol No. 6

Burns - damage to body tissues resulting from exposure to high temperatures, various chemicals, electric current and ionizing radiation.

Superficial and borderline burns (II- IIIAArt.)- damage, with preservation of the dermal or papillary layer, with the possibility of independent restoration of the skin.

Deep burns- full-thickness skin lesions. Self-healing is not possible. To restore the skin, surgical intervention is necessary - skin grafting, necrectomy.

Burn disease - This pathological condition, developing as a consequence of extensive and deep burns, accompanied by peculiar dysfunctions of the central nervous system, metabolic processes, activity of the cardiovascular, respiratory, genitourinary, hematopoietic systems, damage to the gastrointestinal tract, liver, development of DIC syndrome, endocrine disorders, etc.

datedevelopmentprotocol: 2016

Protocol users: combustiologists, traumatologists, surgeons, anesthesiologists-resuscitators, general practitioners, ambulance and emergency doctors.

Level of evidence scale:
Table 1

A	A high-quality meta-analysis, systematic review of RCTs, or large RCTs with a very low probability (++) of bias, the results of which can be generalized to an appropriate population.
IN	High-quality (++) systematic review of cohort or case-control studies, or High-quality (++) cohort or case-control studies with very low risk of bias, or RCTs with low (+) risk of bias, the results of which can be generalized to an appropriate population .
WITH	Cohort or case-control study or controlled trial without randomization with low risk of bias (+). The results of which can be generalized to the relevant population or RCTs with very low or low risk of bias (++ or +), the results of which cannot be directly generalized to the relevant population.
D	Case series or uncontrolled study or expert opinion.

Classification

Classification of burns into 4 degrees(adopted at the XXXVII All-Union Congress of Surgeons in 1960):

· I degree - redness of the skin with clear contours, sometimes on an edematous basis, the epidermis is not affected. Disappears after a few hours or 1-2 days.

· II degree - the presence of thin-walled bubbles with transparent liquid contents. Heavy exudation persists for 2 - 4 days. Independent epithelization occurs after 7-14 days.

· III-A degree - the presence of thick-walled blisters with jelly-like plasmatic contents, partially opened. The exposed bottom of the wound is moist, pink, with areas of white and red color - the papillary layer of the skin itself, often covered with a thin, whitish-gray, soft scab, petechial hemorrhages, pain sensitivity is preserved, vascular reaction is often absent. Self-epithelialization occurs after 3-5 weeks.

· III-B degree - damage to the entire thickness of the skin with the formation of coagulation (dry) or liquefaction (wet) necrosis. In dry necrosis, the scab is dense, dry, dark red or brown-yellow, with a narrow zone of hyperemia and slight perifocal edema. With wet necrosis, the dead skin is swollen and has a doughy consistency, the remaining thick-walled blisters may contain hemorrhagic exudate, the bottom of the wound is variegated, from white to dark red, ashy or yellowish, and there is widespread perifocal edema. There is no vascular or pain reaction.

IV degree - accompanied by necrosis not only of the skin, but also of formations located below subcutaneous tissue- muscles, tendons, bones. The formation of a thick, dry or wet, whitish, yellowish-brown or black scab with a pasty consistency is characteristic. Under it and in the circumference, tissue swelling is pronounced, the muscles have the appearance of “boiled meat”.

Classification of the degree (depth) of a burn according to ICD-10

Correlation of the classification of burn degrees according to ICD-10 with the classification of the XXVII Congress of Surgeons of the USSR in 1960.
table 2

Characteristic	Classification of the XXVII Congress of Surgeons of the USSR	Classification according to ICD-10	Burn depth
Skin hyperemia	1st degree	1st degree	Superficial burn
Bubble Formation	II degree
skin necrosis	III-A degree	II degree
Complete skin necrosis	III-B degree	III degree	Deep burn
Necrosis of the skin and underlying tissues	IV degree

Classification of burn disease (BD)

· Burn shock (BS) - lasts up to 12-72 hours depending on the severity of the injury, premorbid background, duration of the prehospital stage, and therapy.

· Acute burn toxemia (ABT) - occurs from 2-3 to 7-14 days from the moment of injury.

· Septicotoxemia - lasts from the moment the scab suppurates until the skin is completely restored.

· Convalescence - begins after complete restoration of the skin and continues for several years.
OB current.

· There are three degrees of the course of the OB period: mild, severe and extremely severe (as in burn shock). Accordingly, OOT and septicotoxemia, depending on the area of ​​the burn, are divided into mild, severe and extremely severe.

Diagnostics (outpatient clinic)

OUTPATIENT DIAGNOSTICS

Diagnostic criteria

Complaints:
· For burning pain in the area exposed to thermal agents or chemicals.

Anamnesis:
· Exposure to high temperatures, acids, alkalis.

Physical examination:
· Evaluation in progress general condition; external respiration(respiratory rate, assessment of freedom of breathing, airway patency); pulse rate is determined and measured arterial pressure.

Local status:
· The appearance of the wounds, the presence of detachment of the epidermis, areas of de-epithelialization, scab (the nature of the scab is described - wet, dry), how long ago the wound originated, localization, area are assessed.

Laboratory tests: no.
Instrumental studies: no.

Diagnostic algorithm:
· History - circumstances and location of burns.
· Visual inspection.
· Determination of respiratory rate, heart rate (HR), blood pressure (BP).
Determination of difficulty breathing or hoarseness of voice

Diagnostics (ambulance)

DIAGNOSTICS AT THE EMERGENCY CARE STAGE

Diagnostic measures:
· Collection of complaints and medical history;
· physical examination (measurement of blood pressure, temperature, pulse count, respiratory rate count) with assessment of general somatic status;
· inspection of the affected area with assessment of the area and depth of the burn;
· presence or absence of signs of thermal inhalation injury: Hoarseness, hyperemia of the mucous membranes of the oropharynx, soot formation of the mucous membranes of the nasal passages, oral cavity, respiratory sufficiency.

Diagnostics (hospital)

DIAGNOSTICS AT THE INPATIENT LEVEL

Diagnostic criteria at the hospital level

Complaints:
· burning and pain in the area of ​​burn wounds, chills, fever;

Anamnesis:
· History of exposure to high temperatures, acids, alkalis. It is necessary to find out the type and duration of action of the damaging agent, the time and circumstances of the injury, concomitant diseases, and an allergic history.

Physical examination:
· An assessment of the general condition is carried out; external respiration (respiratory rate, assessment of damage and freedom of breathing, airway patency), auscultation of the lungs; pulse rate, auscultation are determined, blood pressure is measured. Looking around oral cavity. The type of mucous membrane, the presence of soot in the respiratory tract, oral cavity, and the presence of a burn to the mucous membrane are described.

Laboratory research
Taking blood for laboratory research are carried out in the intensive care unit or in the intensive care ward of the emergency department.
General analysis blood, determination of glucose, capillary blood clotting time, blood group and Rh factor, blood potassium/sodium, total protein, creatinine, residual nitrogen, urea, coagulogram (prothrombin time, fibrinogen, thrombin time, fibrinolytic activity of plasma, aPTT, INR), acid-basic acid, hematocrit, microreaction, general urinalysis, feces for worm eggs.

Instrumental studies(UD A):
· ECG - to assess the condition of cardio-vascular system and examination before surgery (EL A);
radiography chest- for the diagnosis of toxic pneumonia and thermal inhalation injuries (UD A);
· Bronchoscopy - for thermal inhalation lesions (UD A);
· Ultrasound of the abdominal cavity and kidneys, pleural cavity - for assessment toxic damage internal organs and detection of underlying diseases (UD A);
· FGDS - for the diagnosis of burn stress Curling ulcers, as well as for placement of a transpyloric probe for gastrointestinal paresis (UD A);

Other research methods
· According to indications in the presence of concomitant diseases and injuries. Blood for HIV, hepatitis B, C (for recipients of drugs and blood components). Bacterial culture from a wound for microflora and sensitivity to antibiotics, bacterial culture of blood for sterility.

Diagnostic algorithm:, UD A (scheme)

· History - circumstances and location of burns - first aid provided, availability of tetanus vaccinations.
· Life history and presence of somatic diseases.
· Visual inspection.
· Determination of difficulty breathing or hoarseness, respiratory rate, auscultation of the lungs.
· Determination of pulse, blood pressure, heart rate, auscultation.
· Examination of the oral cavity, tongue, assessment of the condition of the mucous membrane, palpation of the abdomen.
· Determination of the depth and area of ​​burns.
· Interpretation laboratory tests
· Interpretation of instrumental examination results

List of main diagnostic measures:

1. General blood test, determination of glucose, capillary blood clotting time, blood group and Rh factor, blood potassium/sodium, total protein, creatinine, urea, coagulogram (prothrombin time, fibrinogen, thrombin time, APTT, INR), acid-base balance, hematocrit, general urine test, feces for worm eggs, ECG

2. Determination of the depth and area of ​​the burn.

3. Diagnosis of respiratory tract damage

4. Diagnosis of burn shock

List of additional diagnostic measures, (UD A) :
· Bacterial culture from wounds - according to indications or when changing antibacterial therapy (UD A);
· Chest X-ray according to indications - for the diagnosis of toxic pneumonia and thermal inhalation injuries (UD A);
· FBS - for thermal inhalation injuries (UD A);
· FGDS - for the diagnosis of burn stress Curling ulcers, as well as for placement of a transpyloric probe for gastrointestinal paresis (UD A).

Determination of burn area
The most acceptable and quite accurate are simple methods for determining the size of the burned surface using the method proposed by A. Wallace (1951) - the so-called rule of nines, as well as the rule of the palm, the area of ​​which is equal to 1-1.1% of the body surface.

“Rule of nines” (method proposed by A.Wallace, 1951)
Based on the fact that the area of ​​each anatomical region as a percentage is a multiple of 9:
- head and neck - 9%
- front and back surfaces of the body - 18% each
- each upper limb- 9% each
- each lower limb - 18%
- perineum and genitals - 1%.

"Rule of the Palm" (J. Yrazer, 1997)
As a result of anthropometric studies, J. Yrazer et al. concluded that the area of ​​the palm of an adult is 0.78% of the total surface area of ​​the body.
The number of palms placed on the surface of the burn determines the percentage of the affected area, which is especially convenient for limited burns to several areas of the body. These methods are easy to remember and can be used in any environment.

To measure the area of ​​burns in children, a special table has been proposed, which takes into account the ratios of body parts, which vary depending on the age of the child (Table 4).

Area as a percentage of the total body surface area of ​​the surface of anatomical regions depending on age
Table 4

Anatomical region	Newborns	1 year	5 years	10 years	15 years	Adult patients
Head	19	17	13	11	9	7
Neck	2	2	2	2	2	2
Anterior surface of the body	13	13	13	13	13	13
Posterior surface of the body	13	13	13	13	13	13
Buttock	2,5	2,5	2,5	2,5	2,5	2,5
Crotch	1	1	1	1	1	1
Hip	5,5	6,5	8	8,5	9	9,5
Shin	5	5	5,5	6	6,5	7
Foot	3,5	3,5	3,5	3,5	3,5	3,5
Shoulder	2,5	2,5	2,5	2,5	2,5	2,5
Forearm	3	3	3	3	3	3
Brush	2,5	2,5	2,5	2,5	2,5	2,5

Diagnostics of OS
All patients with a total area of ​​burns of more than 50%, deep burns of more than 20% are admitted to the clinic with severe or extremely severe OS (Table 5)

Severity of burn shock in adults
Table 5

OR refers to the hypovolemic type of hemodynamic disorders. Burn shock is characterized by:
1. Persistent hemoconcentration caused by the loss of the liquid part of the circulating blood volume (“white bleeding”).
2. Plasma loss occurs continuously throughout the entire period of burn shock (from 12 to 72 hours).
3. Pronounced nociceptive impulses.
4. In most cases, a hyperdynamic type of hemodynamics is manifested.
5. Permeability increases significantly in the first 24 hours vascular wall, through which large molecules (albumin) are able to pass, which leads to interstitial edema of the paranecrosis zone, “healthy” tissues and aggravates hypovolemia.
6. Cell destruction (including up to 50% of all red blood cells) is accompanied by hyperkalemia.

At easy degree of OR (burn area less than 20%) patients experience severe pain and burning in places of burns. There may be excitement in the first minutes and hours. Tachycardia up to 90. Blood pressure is normal or slightly increased. There is no shortness of breath. Diuresis is not reduced. If treatment is delayed by 6-8 hours or is not carried out, oliguria and moderate hemoconcentration may be observed.

At severe OR (20-50% b.t.) lethargy and adynamia rapidly increase with preserved consciousness. Tachycardia is more pronounced (up to 110), blood pressure is stable only with infusion therapy and the administration of cardiotonics. Patients feel thirsty and experience dyspeptic symptoms (nausea, vomiting, hiccups, bloating). Paresis of the gastrointestinal tract and acute dilatation of the stomach are often observed. Urination decreases. Diuresis is ensured only by the use of medications. Hemoconcentration is pronounced - the hematocrit reaches 65. From the first hours after the injury, moderate metabolic acidosis with respiratory compensation is determined. Patients are cold and their body temperature is below normal. Shock may last 36-48 hours or more.

At 3rd (extremely severe) degree of OS (burn more than 50% of the body) the condition is extremely serious. 1-3 hours after the injury, consciousness becomes confused, lethargy and stupor occur. The pulse is threadlike, blood pressure drops to 80 mm Hg. Art. and lower (against the background of infusion therapy, administration of cardiotonic, hormonal and other drugs). Shortness of breath, shallow breathing. Vomiting is often observed, which can be repeated, and the color of “coffee grounds”. Severe gastrointestinal paresis. Urine in the first portions shows signs of micro- and macrohematuria, then dark brown with sediment. Anuria sets in quickly. Hemoconcentration is detected after 2-3 hours, the hematocrit rises to 70 or more. Hyperkalemia and decompensated mixed acidosis increase. Body temperature drops below 36°. Shock can last up to 3 days. and more, especially with a burn of the respiratory tract (RD).

Diagnosis of thermal inhalation injury (TIT).

Diagnostic criteria for TIT according to frequency of occurrence:
· Fiberglass bronchoscopy (FBS) data - in 100% of cases;
· History (closed room, burnt clothes, loss of consciousness during a fire) - in 95% of cases;
· Burns of the face, neck, mouth - 97%;
· Burning of hair in the nasal passages - in 73.3%;
· Cough with soot in sputum - in 22.6%;
· Dysphonia (hoarseness of voice) - in 16.8%;
· Stridor (noisy breathing), bronchospasm, tachypnea - in 6.9% of cases.

Provision and indications for diagnostic FBS upon admission to hospital(category of evidence A), Level of Evidence A
Table 6

Indications	Security
Anamnestic data of TIT	Under local anesthesia, except in cases of intolerance to local anesthetics, expressed alcohol intoxication, psychomotor agitation, status asthmaticus and aspiration syndrome
Dysphonia
Soot in the oropharynx or sputum
Consciousness< 9 баллов по шкале Глазго	With tracheal intubation
Stridor, shortness of breath
Deep burns on the face and neck
PaO2/FiO2< 250

Severity of TIT according to FBS data(Institute of Surgery named after A.V. Vishnevsky, 2010):
1. Hyperemia and slight swelling of the mucous membrane, emphasis or blurred vascular pattern, pronounced tracheal rings, mucous secretion (in small quantities).
2. Severe hyperemia and swelling of the mucous membrane, erosion, single ulcers, fibrin deposits, soot, mucous, mucopurulent or purulent secretion (the tracheal rings and main bronchi are not visible due to swelling of the mucous membrane).
3. Severe hyperemia and swelling of the mucous membrane, friability and bleeding, multiple erosions and ulcers with a significant amount of fibrin, soot, mucous, mucopurulent or purulent secretion, areas of pallor and yellowness of the mucosa.
4. Total damage to the tracheobronchial tree, pale yellow mucosa, absence of a vascular pattern, dense soot deposits fused to the underlying tissues, early (1-2 days) desquamation is possible.

Diagnostic measures in the ICU (PICU), (UD A)
Table 7

Event	Patient category
	1st day after injury	2nd day after injury	3rd day after injury	4th and subsequent days
Collection of complaints	All patients	All patients	All patients	All patients
History taking	All patients	-	-	-
Assessing the area and extent of the burn	All patients	All patients	-	-
Consciousness assessment using the Glasgow scale	All patients	All patients	All patients	All patients
Assessment of skin moisture and turgor	All patients	All patients	All patients	All patients
Body thermometry	All patients	All patients	All patients	All patients
RR, HR, BP	All patients	All patients	All patients	All patients
CVP	All patients	All patients	All patients	All patients
SpO2	All patients	All patients	All patients	All patients
Diuresis	All patients	All patients	All patients	All patients
ECG	All patients	According to indications	According to indications	According to indications
X-ray OGK graphics	All patients	Patients with TIT, SOPL	Patients with TIT, ARDS	Patients with ARDS
Diagnostic FBS	According to the table 3	-	-	-
Diagnostic FGDS	-	-	Patients with gastrointestinal tract	Patients with gastrointestinal tract
General blood analysis	All patients	-	All patients	All patients
Hb, Ht of blood every 8 hours	All patients	All patients	Patients with gastrointestinal tract	Patients with gastrointestinal tract
General urine analysis	All patients	-	All patients	All patients
Specific gravity of urine every 8 hours	All patients	All patients	-	-
ALT, AST blood	All patients	-	Patients with sepsis	Patients with sepsis
Total blood bilirubin	All patients	-	Patients with sepsis	Patients with sepsis
Blood albumin	All patients	All patients	All patients	All patients
Blood glucose	All patients	-	Patients with sepsis	Patients with sepsis
Blood urea	All patients	-	Patients with sepsis	Patients with sepsis
Blood creatinine	All patients	-	Patients with sepsis	Patients with sepsis
Blood electrolytes	-	-	Patients with sepsis	Patients with sepsis
APTT, INR, blood fibrinogen	-	All patients	Patients with sepsis	Patients with sepsis
Blood gas composition	Patients with TIT	Patients with TIT	Patients with severe TIT	Patients with severe TIT
Urine myoglobin	When muscle tissue is damaged	-	-
Blood carboxyhemoglobin	Patients with fire and loss of consciousness ≤ 13 points on the Glasgow scale	-	-	-
Alcohol in blood and urine	Patients with loss of consciousness ≤ 13 points on the Glasgow scale; with signs of alcohol intoxication	-	-	-

Treatment tactics

The following are subject to treatment in the ICU:

· patients with OS;
· patients with a burn area of ​​more than 20% of the body surface with severe acute burn toxemia;
· victims of STIT until the signs of respiratory failure are completely relieved;
· patients with electrical trauma until cardiac damage is excluded;
· patients with symptoms of sepsis, gastrointestinal bleeding, psychosis, burn exhaustion, impaired consciousness;
· patients with signs of multiple organ failure.

Patients in satisfactory condition with a superficial burn, in whom mild OS completed in the first 8-12 hours, absent high fever and leukocytosis, gastrointestinal motility is not affected and diuresis is not less than 1/ml/kg/hour and do not require further intensive therapy.

Therapeutic measures in the ICU
Table 8

Intensive therapy	Patient category
	1st day after injury	2nd day after injury		3rd day after injury	4th and subsequent days
Promedol 2% - 1 ml every 4 hours IV (in children 0.1-0.2 mg/kg/hour IV) - option I	All patients (one or more options)	All patients (one option)		Patients with pain syndrome(one of the options)	Patients with severe pain syndrome (one of the options)
Tramadol 5% - 2 ml every 6 hours IV (in children after 1 year, 2 mg/kg every 6 hours IV) - option II
Ketorolac 1 ml every 8 hours (except for children under 15 years old) IM for up to 5 days - option III
Metamizole sodium 50% - 2 ml every 12 hours IV, IM (for children analgin 50% 0.2 ml/10 kg every 8 hours IV, IM) - IV option				All patients	All patients
Decompression strip necrotomies	Patients with deep circular burns of the neck, chest, abdomen, and limbs			-
Prednisolone 3 mg/kg/day IV	Patients with mild OS	-		-	-
Prednisolone 5 mg/kg/day IV	Patients with severe OS	Patients with severe OS		-	-
Prednisolone 7 mg/kg/day IV	Patients with extremely severe OS	Patients with extremely severe OS		-	-
Prednisolone 10 mg/kg/day IV	Patients with TIT	Patients with TIT		-	-
Ascorbic acid 5% - 20 ml every 6 hours intravenously	All patients	Except for patients with mild OS		-	-
Furosemide 0.5-1 mg/kg IV every 8-12 hours while maintaining the rate of IV infusion	Patients with diuresis< 1 мл/кг/час	Patients with diuresis< 1 мл/кг/час		Patients with diuresis< 1 мл/кг/час	Patients with diuresis< 1 мл/кг/час
Heparin 1000 units/hour IV (in children - 100-150 units/kg/day subcutaneously) without heparin inhalations	Except for patients with mild OS	Except for patients with mild OS		-	-
Enoxaparin 0.3 ml (or Nadroparin 0.4 ml, Cibor 0.2 ml), except for children under 18 years old, 1 time per day s.c.	-	-		Patients with sepsis	Patients with sepsis
Insulin (Rapid) every 6 hours s.c.		Patients with blood sugar ≥ 10 mmol/l		Patients with blood sugar ≥ 10 mmol/l	Patients with blood sugar ≥ 10 mmol/l
Omeprazole 40 mg (in children 0.5 mg/kg) 1 time at night intravenously	Except for patients with mild OS	Except for patients with mild OS		All patients	All patients
Omeprazole 40 mg (in children 0.5 mg/kg) every 12 hours intravenously	-	-		Patients with gastrointestinal tract	Patients with gastrointestinal tract
			(in adults, category of evidence A)
Sterofundin Iso (Ringer, Disol, Sodium chloride 0.9%)	According to the table 9	According to the table 9		-	-
Sterofundin G-5 (Ringer, Disol, Sodium chloride 0.9%)	-	According to the table 9		-	-
HES	According to the table 9	According to the table 9		-	-
Albumin 20%	-	According to the table 9		According to the table 9	Patients with albumin ≤ 30 g/L (total protein ≤ 60 g/L)
Normofundin G-5 (maximum up to 40 ml/kg/day)	-	-		According to the table 9	All patients
Reamberin 400-800 ml (in children 10 ml/kg) per day for up to 11 days	-	-		-	All patients
III generation cephalosporins IV, IM	-	All patients		All patients	All patients
Ciprofloxacin 100 ml every 12 hours (except for children)	-	-		Patients with sepsis	Patients with sepsis
Amikacin 7.5 mg/kg every 12 hours (including children) IV, IM	-	-
PSS 3000 units.	-	-		-	According to Appendix 12 to the Order of the Ministry of Health of the Russian Federation No. 174 of May 17, 1999.
PSCH	-	-		-
SA	-	-		-
DTP	-	-		-
Invasive ventilation	Patients with loss of consciousness< 9 баллов по шкале Глазго (категория доказательности А); глубоким ожогом >40% (category of evidence A); deep burn on the face and progressive swelling of soft tissues (category of evidence B); severe TIT with laryngeal involvement and risk of obstruction (evidence category A); heavy TIT with combustion products (category of evidence B); ARDS
Adrenaline 0.1% every 2 hours of inhalation for up to 7 days	Patients with TIT	Patients with TIT		Patients with severe TIT	Patients with severe TIT
ACC 3-5 ml every 4 hours inhalation up to 7 days	Patients with TIT	Patients with TIT		Patients with severe TIT	Patients with severe TIT
	(category of evidence B)
Heparin 5000 units. for 3 ml saline solution every 4 hours (2 hours after ACC) inhalation for up to 7 days	Patients with TIT	Patients with TIT		Patients with severe TIT	Patients with severe TIT
	(category of evidence B)
Sanitation FBS every 12 hours	Patients with TIT from combustion products			Patients with severe TIT from combustion products	-
Surfactant BL 6 mg/kg every 12 hours endobronchially or inhaled for up to 3 days	Patients with severe TIT	Patients with severe TIT		Patients with ARDS	Patients with ARDS
Regidron into the probe	According to the table 9	-		-	-
Enteral protein mixture into the tube in a volume of up to 45 kcal/kg/day (category of evidence A) through an infusion pump	800 gr	According to the table 9		According to the table 9	Patients who are unable or unwilling to eat
3-component bag for parenteral nutrition in a volume of up to 35 kcal/kg/day through an infusion pump	-	-		Patients who cannot tolerate enteral mixture	Patients who are unable or unwilling to eat and cannot tolerate enteral formula
Immunovenin 25-50 ml (in children 3-4 ml/kg, but not more than 25 ml) 1 time in 2 days up to 3-10 days	-	-		Patients with severe sepsis	Patients with severe sepsis
Glutamine enterally 0.6 g/kg/day or IV 0.4 g/kg/day	-	All patients (category of evidence A)
Red blood cell mass	In case of chronic anemia and hemoglobin below 70 g/l, indications for transfusion of erythrocyte-containing blood components are clinically pronounced signs of anemic syndrome (general weakness, headache, tachycardia at rest, shortness of breath at rest, dizziness, episodes of syncope), which cannot be eliminated within a short time as a result of pathogenetic therapy. The hemoglobin level is not the main criterion determining the presence of indications. Indications for transfusion of erythrocyte-containing blood components in patients can be determined not only by the level of hemoglobin in the blood, but also taking into account the delivery and consumption of oxygen. Transfusion of red blood cell-containing components may be indicated when hemoglobin decreases below 110 g/l, PaO2 is normal and oxygen tension in the mixed blood decreases. venous blood(PvO2) below 35 mmHg, that is, an increase in oxygen extraction above 60%. The wording of the indication is “reduced oxygen delivery during anemia, Hb ____g/l, PaO2 ____mmHg, PvO2_____mmHg. Art." If, at any hemoglobin level, venous blood oxygenation indicators remain within normal limits, then transfusion is not indicated. (Order of the Minister of Health of the Republic of Kazakhstan dated July 26, 2012 No. 501)
SZP	Indications for transfusion of FFP are: 1) hemorrhagic syndrome with laboratory confirmed deficiency of factors coagulation hemostasis. Laboratory signs of deficiency of coagulation hemostasis factors can be determined by any of the following indicators: prothrombin index (PTI) less than 80%; prothrombin time (PT) more than 15 seconds; international normalized ratio (INR) more than 1.5; fibrinogen less than 1.5 g/l; active partial thrombin time (APTT) more than 45 seconds (without previous heparin therapy). .(Order of the Minister of Health of the Republic of Kazakhstan dated July 26, 2012 No. 501)

Summary table of rehydration during the OS period
Table 9

Days since injury		1st day			2nd day	3rd day
		8 ocloc'k	16 hours		24 hours	24 hours
Volume, ml Compound		2 ml x kg x % burn*	2 ml x kg x % burn*	2 ml x kg x % burn*		35-45 ml/kg (IV + peros + via tube)
Sterofundin isotonic. Sterofundin G-5 (on the 2nd day)		100% volume	Remaining volume	remaining volume		-
HES		-	10 - 20 - 30 ml/kg	10 - 15 ml/kg		-
Albumin 20% (ml)		-	-	0.25 ml x kg x % burn		with blood albumin ≤ 30 g/l
Normofundin G-5		-	-	-		no more than 40 ml/kg
Parenteral nutrition		-	-	-		according to indications
Via probe	Regidron	50-100 ml/hour	100-200 ml/hour	-		-
	Enteral protein nutrition (EP)	800g	-	50 ml/hour x 20 hours		75 ml/hour x 20 hours
Diet	Mild OS	drink	ATS	ATS		ATS
	Severe OS	Regidron	Regidron	EP or VBD		EP or VBD
	Extremely severe OS	Regidron	Regidron	EP		EP

* - if the burn area is more than 50%, the calculation is carried out at 50%
** - it is possible to count fluid administered enterally
*** - It is acceptable to take the blood albumin level as ½ of the total blood protein content. The volume of albumin solution is calculated using the formula:
Albumin 10% (ml) = (35 - blood albumin, g/l) x BCC, l x 10
where bcc, l = FMT, kg: 13

Indications for transfer to the burn department from the ICU.
Transfer of victims to the burn department is permitted:
1. after the OS period, as a rule, on the 3-4th day from the moment of injury in the absence of persistent violations of the life support function.
2. during the period of OOT, septicotoxemia in the absence or compensation of respiratory disorders, cardiac activity, central nervous system, parenchymal organs, restoration of gastrointestinal function.

Non-drug treatment, UD A ;
· Table 11, mode 1, 2. Installation nasogastric tube, catheterization of the bladder, catheterization of the central vein.
Table 10

Equipment/hardware	Indications	Number of days
Enteral protein nutrition (nutritional support)	Extensive burns, inability to independently replenish losses	5 - 30 days
Staying on a fluidizing burn bed (type Redactron or “SAT”)	Extensive burns back surface body	7 - 80
Placing the patient in rooms with laminar heated air flow up to 30-33*C, air ionizing unit, anti-decubitus mattresses, covering the patient with a heat-insulating blanket.	Extensive burns to the torso	7 - 40 days
Argon multifunctional scalpel.		During surgical interventions
ILBI	Extensive burns, intoxication
UFOK	Extensive burns, intoxication	Period of toxemia and septicotoxemia
Ozone therapy	Extensive burns, intoxication	Period of toxemia and septicotoxemia

Infusion therapy. IT for burns is carried out if there are clinical indications - pronounced loss of fluid through the wound surface, high performance hematocrit, in order to normalize microcirculation. The duration depends on the severity of the condition and can be several months. Use saline solution saline solutions, glucose solution, amino acid solution, synthetic colloids, blood components and products, fat emulsions, multicomponent preparations for enteral nutrition.

Antibacterial therapy. For extensive burns, antibacterial therapy is prescribed from the moment of admission. Semi-synthetic penicillins, cephalosporins of I - IV generations, aminoglycosides, fluoroquinolones, carbopenems are used according to indications.
Disaggregants: p about indications: macetylsalicylic acid, pentoxifylline, low molecular weight heparins, etc. in age-specific dosages.

Local treatment of wounds., (UD A).
The goal of local treatment is to cleanse the burn wound from necrotic scab, prepare the wound for autodermoplasty, and create optimal conditions for epithelization of superficial and borderline burns.

A drug for local treatment of superficial burns should help create favorable conditions for the implementation of the reparative capabilities of the epithelium: it should have bacteriostatic or bactericidal properties, should not have irritating or painful effects, allergic and other properties, should not stick to the wound surface, and maintain a moist environment. The drug must retain all these qualities for a long time.

For local treatment, use dressings with antiseptic solutions, ointments and gels on a water-soluble and fatty base (octenidine
dihydrochloride, silver sulfadiazine, povidone-iodine, multicomponent ointments (levomekol, oflomelide), various coatings with antibiotics and antiseptics, hydrogel coatings, polyurethane foam dressings, dressings of natural, biological origin.

Dressings are carried out after 1 - 3 days. During dressings, you need to carefully remove only the top layers of the dressing after soaking with sterile water and antiseptic solutions. The layers of gauze adjacent to the wound are removed only in areas where there is purulent discharge. It is not advisable to completely change the dressing if it does not come off easily. Forcible removal of the lower layers of gauze violates the integrity of the newly emerged epithelium and interferes with the normal process of epithelization. In cases of a favorable course, the bandage applied after the initial dressing of the wound can remain on the wound until complete epithelialization and does not require changing.

It is effective to treat the wound surface with a shower of running sterile water using detergents. antiseptic solutions, cleansing of wound surfaces with devices of hydrosurgical systems, piezotherapy, ultrasonic sanitation of wounds ultrasonic devices. After washing, the wound is covered with bandages with ointments, polyurethane foam, and non-adhesive bandages with antiseptics.
If the possibility of early surgical necrectomy is limited, it is possible to perform chemical necrectomy using Salicylic ointment 20% or 40%, benzoic acid.

List of essential medicines, (UD A) (Table 11)
Table 11

Drug, release forms	Dosing		Duration of use	Probability %			Level of evidence
Local anesthetic drugs:
Local anesthetics (procaine, lidocaine)	According to release form		According to indications	100%			A
Anesthetics							A
Antibiotics
Cefuroxime	1.5 g IV, IM, according to instructions		According to indications, according to instructions				A
Cefazolin	1 - 2 g, according to instructions		According to indications, according to instructions	80%			A
Ceftriaxone	1-2 g according to instructions		According to indications, according to instructions	80%			A
Ceftazidime	1-2 g IM, IV, according to instructions		According to indications, according to instructions	80%			A
Cefepime	1-2 g, IM/IV according to instructions		According to indications, according to instructions				A
Amoxicillin/clavulanate	600 mg, IV according to instructions		According to indications, according to instructions	80%			A
Ampicillin/sulbactam	500-1000 mg, intramuscularly, intravenously, 4 times a day		According to indications, according to instructions	80%			A
Vancomycin	powder/lyophilisate for the preparation of solution for infusion 1000 mg, according to the instructions		According to indications, according to instructions	50%			A
Gentamicin	160 mg IV, IM, according to instructions		According to indications, according to instructions	80%			A
Ciprofloxacin, solution for intravenous infusions	200 mg 2 times IV, according to instructions		According to indications, according to instructions	50%			A
Levofloxacin	solution for infusion 500 mg/100 ml, according to instructions		According to indications, according to instructions	50%			A
Carbopenems	according to instructions		According to indications, according to instructions				A
Analgesics
Tramadol injection solution 100mg/2ml, 2 ml in ampoules 50 mg in capsules, tablets	50-100 mg. IV, through the mouth. maximum daily dose 400 mg.		According to indications, according to instructions		A
Metamizole sodium 50%	50% - 2.0 intramuscularly up to 3 times		According to indications, according to instructions	80%	A
Ketoprofen	according to instructions		According to indications, according to instructions		A
Other NSAIDs	according to instructions		According to indications, according to instructions		A
Narcotic analgesics(promedol, fentanyl, morphine)			According to indications, according to instructions	90%	A
Antiplatelet agents and anticoagulants
Heparin	2.5 - 5 t. units - 4 - 6 times a day		According to indications, according to instructions	30%		A
Nadroparin calcium, solution for injection	0.3, 0.4, 0.6 units s.c.		According to indications, according to instructions	30%		A
Enoxaparin, solution for injection in a syringe	0.4, 0.6 6 units s.c.		According to indications, according to instructions	30%		A
Pentoxifylline 5% - 5.0	intravenously, by mouth		According to indications, according to instructions	30%		A
Acetylsalicylic acid 0.5	through the mouth		According to indications, according to instructions	30%		A
		Medicines for local treatment
Povidone-iodine	Bottle 1 liter		According to indications, according to instructions	100%	A
Chlorhexedine	Bottle 500 ml		According to indications, according to instructions	100%	A
Hydrogen peroxide	Bottle 500 ml		According to indications, according to instructions	100%	A
Octenidine dihydrochloride 1%	Bottle 350 ml, 20 gr		According to indications, according to instructions	100%	A
Potassium permanganate	For cooking aqueous solution		According to indications, according to instructions	80%	A
Water-soluble and fat-based ointments (silver-containing, antibiotic and antiseptic containing, multi-component ointments)	Tubes, bottles, containers		According to indications, according to instructions	100%	A
Dressings
Gauze, gauze bandages	meters		According to indications, according to instructions	100%		A
Medical bandages	PC.		According to indications, according to instructions	100%		A
Elastic bandages	PC.		According to indications, according to instructions	100%		A
Wound coverings (hydrogel, film, hydrocolloid, etc.)	Plates		According to indications, according to instructions	80%		A
Xenogeneic wound dressings (pork skin, calf skin, preparations based on pericardium, peritoneum, intestines)	plates		According to indications, according to instructions	80%		A
Corpse human skin	plates		According to indications, according to instructions	50%		A
Skin cell suspensions cultured using biotechnological methods	bottles		According to indications, according to instructions	50%		A
Infusion drugs
Sodium chloride, solution for infusion 0.9% 400ml	Bottles 400 ml		According to indications, according to instructions	80%		A
Lactated Ringer's solution	Bottles 400 ml		According to indications, according to instructions	80%		A
Sodium chloride, potassium chloride, sodium acetate,	Bottles 400 ml		According to indications, according to instructions	80%		A
Sodium chloride, potassium chloride, sodium bicarbonate	Bottles 400 ml		According to indications, according to instructions	80%		A
Glucose 5.10%	Bottles 400 ml		According to indications, according to instructions	80%		A
Glucose 10%	Ampoules 10 ml		According to indications, according to instructions	80%	A
Glucose 40%	Bottles 400 ml		According to indications, according to instructions	80%	A
Dextran, 10% solution for infusion	400ml		According to indications, according to instructions	80%	A
	Other medications (according to indications)
B vitamins	ampoules		According to indications, according to instructions	50%	A
Vitamins of group C	ampoules		According to indications, according to instructions	50%	A
Vitamins of group A	ampoules		According to indications, according to instructions	50%	A
Tocopherols	capsules		According to indications. according to instructions	80%	A
H2 blockers and proton pump inhibitors	ampoules		According to indications, according to instructions	80%	A
Etamsylate, solution for injection in ampoule 12.5%	ampoules 2ml		According to indications, according to instructions	50%	A
Aminocaproic acid	Bottles		According to indications, according to instructions	50%	A
Diphenhydramine	Ampoules 1%-1ml		According to indications, according to instructions	50%	A
Prednisolone	Ampoules 30mg		According to indications, according to instructions	50%	A
Metoclopramide	Ampoules 0.5% -2ml		According to indications, according to instructions	50%	A
Human insulin	Bottles 10ml/1000 units		According to indications, according to instructions	90%	A
Aminophylline	Ampoules 2.5%-5ml		According to indications, according to instructions	50%	A
Ambroxol	15mg-2ml		According to indications, according to instructions	80%	A
Furosemide	Ampoules 2ml		According to indications, according to instructions	50%	A
Nystatin	Tablets		According to indications, according to instructions	50%	A
Ambroxol	Syrup 30mg/5ml 150ml		According to indications, according to instructions	80%	A
Nandrolone deconoate	Ampoules 1ml		According to indications	50%	A
Enteral protein nutrition (nutritive support) Sterile mixture in the ratio of proteins - 7.5 g, Fats-5.0g, carbohydrates-18.8g. Daily volume from 500ml to 1000ml.	800g bags		According to indications	100%	A
3-component bag for parenteral nutrition in a volume of up to 35 kcal/kg/day 70/180, 40/80 via infusion pump	Bags volume 1000, 1500ml		According to indications	50%	A

*OB occurs with damage to all organs and systems of the human body, and therefore requires the use of various groups of medications (for example, gastroprotectors, cerebroprotectors). The table above cannot cover the entire group of medications used in the treatment of burn disease. Therefore, the table shows the most commonly used medications.

Surgical intervention

1.Operation - Primary surgical treatment of a burn wound.
All patients undergo primary surgical treatment of the burn wound (PHOR).

Purpose of the operation - Cleansing wound surfaces and reducing the bacterial number in the wound.

Indications-Presence of burn wounds.

Contraindications.

PHOR technique: With swabs moistened with antiseptic solutions (povidone-iodine solution, nitrofuran, octenidine hydrochloride, chlorhexedine), the skin around the burn is cleaned of contamination, foreign bodies and exfoliated epidermis are removed from the burned surface, tense large blisters are incised and their contents are released. Wounds are treated with antiseptic solutions (povidone-iodine solution, octenidine dihydrochloride, nitrofuran, chlorhexedine). Bandages with antiseptic solutions, hydrogel, hydrocolloid biological and natural coatings are applied.

2. Necrotomy.

Purpose of the operation- dissection of scars for decompression and restoration of blood supply to the limb, excursion of the chest

Indications. Circular compression by a dense necrotic scab of the chest and limbs with signs of circulatory disorders.

Contraindications. In clinical cases of compression and the threat of limb necrosis, there is no contraindication.

After processing surgical field Three times with a povidone-iodine solution, a longitudinal dissection of the burn scab is carried out to healthy tissue. There may be 2 or more cuts. In this case, the edges of the incision should diverge and not interfere with the blood supply to the limb and the excursion of the chest.

2. Operation - Necrectomy

Necrectomy differs into the following types according to deadlines.
RCN - early surgical necrectomy 3-7 days.
PCN - late surgical necrectomy 8-14 days.
HOGR - surgical treatment of a granulating wound later than 15 days.

According to the depth of tissue removed.
Tangential.
Fascial.
Initially, the timing of the upcoming necrectomy, the type and volume of the upcoming surgical intervention are planned. The average time for necrectomy is 3-14 days.

According to the depth of tissue removed.
Tangential.
Fascial.
The operation is traumatic, costly, requires massive transfusion of components and blood products, the presence of allogeneic, xenogeneic, biological, synthetic wound coverings, highly qualified anesthesiologists, resuscitators, and combustiols.

Considering the pronounced tissue trauma during these operations and the massive blood loss during their implementation, reaching up to 300 ml from one percent of the removed skin, when planning a necrectomy of more than 5%, it is necessary to form a supply of single-group FFP and red blood cells. In order to reduce blood loss, it is necessary to use hemostatic agents, both local (aminocaproic acid) and general (trinixanoic acid, ethamsylate).

Purpose of the operation- Excision of a burn scab to clean the wound and prepare for skin transplantation, reducing infectious complications and intoxication.

Indications. The presence of necrotic scab on the surface of the wound.

Contraindications. Extremely serious condition of the patient, severe infection of burn wounds, massive burns complicated by damage to the respiratory organs, associated burn injury severe damage to the liver, kidneys, heart, central nervous system, diabetes mellitus in a decompensated form, the presence of bleeding from the gastrointestinal tract, a state of intoxication psychosis in the patient, persistent disruption of normal hemodynamics, blood clotting disorders.

Procedure/intervention technique:
Necrectomy is performed in an operating room under general anesthesia.
After 3 times processing of the operating fields r-m Povidone iodine is injected according to indications of subcutaneous fat tissue in order to smooth out the relief and reduce blood loss.
Using a necrotome: electrodermatomes, Gambdi knives, ultrasonic, radio wave, hydrosurgical desectors such as various manufacturers, and an argon multifunctional scalpel can be used as a necrotome.

Within the limits of viable tissue, necrectomy is performed. Subsequently, hemostasis is performed, both local (aminocaproic acid, hydrogen peroxide, electrocoagulation) and general (trinixanoic acid, FFP, coagulation factors).
Subsequently, after the formation of stable hemostasis during limited necrectomies on an area of ​​up to 3% and the patient’s stable condition, autodermoplasty is performed with free split autografts taken by a dermatome from donor sites.

When performing necrectomies on an area of ​​more than 3%, there is a high risk of non-radical removal of necrotic tissue; the wound surfaces are covered with wound coverings of a natural (allogeneic skin, xenogeneic coverings), biological or synthetic nature, in order to restore the lost barrier function of the skin.
After complete cleansing of the wound surface, skin restoration is performed using skin transplantation.

Operation - Surgical debridement granulating wound (GGR)

Target: excision of pathological granulations and improvement of engraftment of split skin grafts.

Indications.
1. Granulating burn wounds
2. Residual long-term non-healing wounds
3. Wounds with pathological granulations

Contraindications. The patient’s condition is extremely serious, persistent disruption of normal hemodynamics.

Procedure/intervention technique:
To carry out HOGR of extensive burns, a prerequisite is the presence of an electric dermatome, a Gumby knife. Granulation treatment with hydrosurgical devices is more effective and less traumatic.
The surgical field is treated with povidone-iodine solution, chlorhexedine, and other antiseptics. Excision of pathological granulations is performed. In case of heavy bleeding, the operation is accompanied by the administration of components and blood products. The operation can result in xenotransplantation, skin allotransplantation, transplantation of keratinocyte layers, wound coverings of 2 - 4 generations.

Operation - Autodermoplasty (ADP).
It is the main operation for deep burns. ADP can be carried out from 1 to 5-6 (or more) times until the lost skin is completely restored.

Purpose of the operation- eliminate or partially reduce the wound resulting from burns by transplanting free thin skin flaps cut from undamaged areas of the patient’s body.

Indications.
1. Extensive granulating burn wounds
2. Wounds after surgical necrectomy
3. Mosaic wounds, residual wounds on an area of ​​more than 4 x 4 cm 2 body surface
4. for extensive 3A degree burns after tangential necrectomy to accelerate epithelization of burn wounds.

Contraindications.

Procedure/intervention technique:
To carry out ADP of extensive burns, a prerequisite is the presence of an electric dermatome, a skin perforator. Manual methods of skin harvesting result in loss (“deterioration”) of the donor site, which complicates subsequent treatment.

Treatment of donor sites three times with alcohol 70%, 96%, povidone-iodine solution, chlorhexedine, octenidine dihydrochloride, skin antiseptics. Using an electrodermatome, a split skin flap with a thickness of 0.1 - 0.5 cm 2 is removed over an area of ​​up to 1500 - 1700 cm 2. A gauze bandage with an antiseptic solution or film, hydrocoloid, hydrogel wound coverings are applied to the donor site.
Split skin grafts (according to indications) are perforated with a perforation ratio of 1: 1, 5, 1:2, 1:3, 1:4, 1:6.

Perforated grafts are transferred to the burn wound. Fixation to the wound (if necessary) is carried out with a stapler, sutures, and fibrin glue. In case of severe condition of the patient, to increase the area of ​​wound closure, combined autoallodermoplasty, autoxenodermoplasty (mesh in mesh, transplantation in sections, etc.), transplantation with laboratory-grown skin cells - fibroblasts, keratinocytes, mesenchymal stem cells - is performed.
The wound closes gauze bandage with an antiseptic solution, ointment on a fatty or water-soluble base, synthetic wound coverings.

Operation - Transplantation of xenogeneic skin and tissue.

Purpose of the operation

Indications.

Contraindications. The patient's condition is extremely serious, severe infection of burn wounds, persistent disruption of normal hemodynamics.

Procedure/intervention technique:
Treatment of the surgical field with an antiseptic solution (povidone-iodine, 70% alcohol, chlorhexedine). Wounds are washed with antiseptic solutions. Solid or perforated sheets of xenogeneic skin (tissue) are transplanted onto the surface of the wounds. In a combined transplantation of split autoskin and xenogeneic skin (tissue), xenogeneic tissue is applied on top of perforated autoskin with a high perforation coefficient (mesh within a mesh). The wound is covered with a gauze bandage with ointment or antiseptic solution.

Operation - Allogeneic skin transplantation.

Purpose of the operation- Temporary closure of the wound in order to reduce losses from the wound surface, protect against microorganisms, and create optimal conditions for regeneration.

Indications.
1. deep burns (3B-4 degrees) over an area of ​​more than 15-20% of the body surface when immediate skin autotransplantation is impossible due to heavy bleeding during necrectomy. When cutting skin grafts, the total area of ​​the wounds increases while the wounds at the site of the cut autografts are epithelialized and the transplanted grafts engraft;
2. shortage of donor skin resources;
3. impossibility of simultaneous autotransplantation of skin due to the severity of the patient’s condition;
4. as a temporary coating between stages of autoskin transplantation;
5. during the preparation of granulating wounds with deep burns for autologous skin transplantation in patients with severe concomitant diseases, with sluggish wound process with changing CT scans at each dressing change;
6. for extensive 3A degree burns after tangential necrectomy to accelerate epithelization of burn wounds.
7. for extensive borderline burns in order to reduce losses through the burn wound, reduce pain, prevent microbial contamination

Contraindications. The patient's condition is extremely serious, severe infection of burn wounds, persistent disruption of normal hemodynamics.

Procedure/intervention technique:
Treatment of the surgical field with an antiseptic solution (povidone-iodine, 70% alcohol, chlorhexedine). Wounds are washed with antiseptic solutions. Solid or perforated sheets of allogeneic skin are transplanted onto the surface of wounds. In a combined transplantation of split autoskin and allogeneic (cadaveric) skin, cadaveric skin is applied over perforated autoskin with a high perforation coefficient (mesh within a mesh). The wound is covered with a gauze bandage with ointment or antiseptic solution.

Other treatments
Transplantation of cultured fibroblasts, transplantation of cultured keratinocytes, combined transplantation of cultured skin cells and autoskin.

Indications for consultation with specialists
Table 12

Indications for transfer to the intensive care unit:

1. Deterioration of the patient’s condition with the appearance of respiratory, cardiovascular, hepatic and renal failure.
2. Complications of burn disease - bleeding, sepsis, multiple organ failure
3. Serious condition after extensive skin autoplasty

Indicators of treatment effectiveness
· Cleansing the wound from necrotic tissue, clinical readiness of the wound to accept a skin graft, percentage of engraftment of skin grafts, length of hospital treatment. restoration of working capacity;
· restoration of motor function and sensitivity of the affected segment of the skin;
· epithelization of wounds;
· length of hospital treatment. restoration of working capacity;

Further management.
After the patient is discharged from the hospital, he is subject to observation and treatment in a clinic by a surgeon, traumatologist, or therapist.

Differential diagnosis

With a known history and the fact of extensive burns, a differential diagnosis is not made.

Treatment abroad