The benefits of early surgical treatment of deep cervical burns in children

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Abstract

Background. The frequency of deep cervical burns in children is four times higher than that of deep face burns. Currently, there is no consensus on the methods for surgical treatment of deep burns in cervical areas; meshed skin autografts continue to be used.

Aim. To evaluate the benefits of early surgical treatment of deep сervical burns in children between the third and fifth days from the moment of injury.

Materials and methods. Case-control study. Surgical treatment was performed in 81 children with deep cervical burns. The main group with early surgical treatment included 46 children and underwent surgical treatment at 3.37 ± 0.14 days from the moment of injury; the control group received autograft during stage treatment for 35 children at 27.17 ± 0.18 days. The treatment results were evaluated by the following indicators: the number of dressing changes, the period of skin restoration, and the area of graft success. In the long term, functional and cosmetic treatment results were evaluated.

Results. In the study and control groups, 7.93 ± 0.45 and 18.75 ± 0.61 dressings were required to complete the treatment, respectively (p < 0.001). The skin restoration periods were 16.54 ± 0.68 and 36.94 ± 0.89 days, respectively (p < 0.001). The graft success areas were 99.50% ± 0.13% in the main group and 93.91% ± 2.68% in the control (p < 0.001). During the staged surgical treatment, one patient showed a loss of 90% of the graft, which required regrafting. Other complications in the treatment process have not been noted. When assessing long-term cosmetic results using the Vancouver Scar Scale, the average score was 4.0 ± 0.26 points in the main group and 7 ± 0.28 points in the control (p < 0.001). The presence of post-burn cicatricial contracture in the main group was noted in 12 (26%) people and the absence in 34 (74%) children. In the control group, 20 (57%) patients required surgical removal of post-burn deformity, and 15 (43%) children did not need further surgical interventions.

Conclusions. Early surgical treatment of deep cervical burns in children on the third and fifth days from injury allows not only to accelerate the process of restoration of the skin but also to directly affect the cosmetic and functional results in a better way.

About the authors

Pavel A. Gnipov

Saint Petersburg Children State Hospital No. 1

Author for correspondence.
Email: elect86@mail.com
ORCID iD: 0000-0002-1906-9943

MD, Orthopedic and Trauma Surgeon of Burn Department

Russian Federation, 198205, Saint-Petersburg, Avanguardnaya street 14

Alexey G. Baindurashvili

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: turner01@mail.ru
ORCID iD: 0000-0001-8123-6944
SPIN-code: 2153-9050

MD, PhD, D.Sc., Professor, Member of RAS, Honored Doctor of the Russian Federation, Director

Russian Federation, 64, Parkovaya str., Saint-Petersburg, Pushkin, 196603

Marina A. Brazol

Saint Petersburg Children State Hospital No. 1; H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: mbrazol@mail.ru
ORCID iD: 0000-0002-2678-5729

MD, PhD, Deputy Chief for Surgery, Head of the Burn Department; Senior Researcher of the Department of Trauma Sequalae and Rheumatoid Arthritis 

Russian Federation, 198205, Saint-Petersburg, Avanguardnaya street 14; 64, Parkovaya str., Saint-Petersburg, Pushkin, 196603

Ekaterina V. Mitrofanova

Saint Petersburg Children State Hospital No. 1; H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: elect86@mail.com
ORCID iD: 0000-0001-5959-5086

MD, Orthopedic and Trauma Surgeon of the Burn Department; Researcher of the Department of Trauma Sequalae and Rheumatoid Arthritis 

Russian Federation, 198205, Saint-Petersburg, Avanguardnaya street 14; 64, Parkovaya str., Saint-Petersburg, Pushkin, 196603

Maxim R. Melnikov

Saint Petersburg Children State Hospital No. 1

Email: elect86@mail.com
ORCID iD: 0000-0002-2173-5693

MD, Orthopedic and Trauma Surgeon of Burn Department

Russian Federation, 198205, Saint-Petersburg, Avanguardnaya street 14

Gleb A. Mashevskiy

Saint Petersburg Electrotechnical University LETI

Email: aniket@list.ru
ORCID iD: 0000-0001-9380-9543

PhD, Associate Professor. Department of Biotechnical Systems

Russian Federation, 5, Professor Popov street, Saint-Petersburg, 197376

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2. Fig. 7. Cosmetic result after treatment of a deep burn in the submandibular triangle of the neck: a - boy G., 5 years old, after early surgical treatment (hyperpigmentation of the graft, no growth of scar tissue); b - girl A., 4 years old, after the staged treatment of a deep burn (proliferation of hypertrophic scar along the periphery of the graft)

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3. Fig. 8. Cosmetic result after treatment of a deep burn of the right lateral surface of the neck: a - boy Sh., 10 years old, after early surgical treatment (transplant hyperpigmentation, no scar tissue growth); b - boy G., 13 years old, after the staged treatment of a deep burn (proliferation of a hypertrophic scar along the periphery of the transplant, a pulling scar in the region of the angle of the lower jaw)

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4. Fig. 1. Pediatric patient K., 1 year 2 months. (a) Diagnosis of thermal burn degrees II–IIIa and b of the face and right side of the neck 3 days after the burn. The wound is represented by a dry motley scab. (b) View of the wound after tangential necrectomy: the wound bed is represented by a deep bleeding layer of the dermis. (c) Burn wound after autodermoplasty: the graft is fixed to the edges of the wound defect with separate nodular sutures with a monofilament thread. (d) Day 3 after early surgical treatment: the graft is pink and tight to the wound. A single small hematoma is determined, which will be emptied. (e) Day 9 after early surgical treatment: the graft retention area is 100%. The sutures have been removed. Restoration of the skin is completed. (f) Month 6 after the early surgical treatment: there is no graft retraction. There is no cicatricial deformity or contracture

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5. Fig. 2. Pediatric patient D., 15 years old. Diagnosis of thermal burn degrees II–IIIa and b of the face and neck (a) day 2 after the burn. (b) Day 9 after the injury, the appearance of the wound after dressings with silver sulfadiazine. (c) Day 15 after the injury, the wound is actively cleaned of necrotic tissues along with the use of hydrocolloid dressings and debridement with a Debrisoft® sponge. (d) Day 18 after the injury, the wound is completely cleared of necrotic tissue. (e) Day 24 after the injury, the wound is ready for autodermoplasty. (f) Treatment of the granulating wound with a metal debrider. (g) The graft distribution on the wound. (h) Day 9 after autodermoplasty, the graft retention area is 100%. (i) Month 6 after autodermoplasty, the graft retraction, hypertrophic scar growth along the periphery, and the contracture formation were noted

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6. Fig. 3. Boy A., 2 years old, wearing a compression half mask

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7. Fig. 4. Boxed graphs of the values of the number of dressings for early and staged surgical treatments. In the vast majority of cases, early surgical treatment required a smaller number of dressings (on average, eight dressings less)

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8. Fig. 5. Boxed graphs of the values of the area of graft retention in early and staged surgical treatments. The area of graft retention was larger in case of early surgical treatment (on average, 5% more)

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9. Fig. 6. Boxed graphs of the values of the skin restoration period in early and staged surgical treatments. With early surgical treatment, the skin restored much faster than with staged treatment (on average, 20 days faster)

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10. Fig. 7. The cosmetic result after treatment of a deep burn in the submaxillary space of the neck. (a) Boy G., 5 years old, after early surgical treatment (hyperpigmentation of the graft and no growth of scar tissue). (b) Girl A., 4 years old, after the staged treatment of a deep burn (proliferation of hypertrophic scar along the periphery from the graft)

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11. Fig. 8. The cosmetic result after treatment of a deep burn of the right lateral surface of the neck. (a) Boy Sh., 10 years old, after early surgical treatment (graft hyperpigmentation and no scar tissue growth). (b) Boy G., 13 years old, after the staged treatment of a deep burn (proliferation of a hypertrophic scar along the periphery from the graft and a traction scar in the region of the gonial angle)

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Copyright (c) 2020 Gnipov P.A., Baindurashvili A.G., Brazol M.A., Mitrofanova E.V., Melnikov M.R., Mashevskiy G.A.

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This work is licensed under a Creative Commons Attribution 4.0 International License.
 


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