The experience of using “ChitoPran” wound coating for treating a patient with combined injury

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Abstract

Background. Resolution of problems related to burn injuries remains relevant and extremely complex in the modern medicine. Biological wound coatings are actively used in the treatment of patients with burn injury. Researchers at the Scientific Research Institute at the Ochapovsky Regional Clinical Hospital No. 1 have been using the biological wound coating “ChitoPran” since 2017. This coating creates a dry environment in the wound for borderline depth burns and after autoplasty, which contributes to the acceleration of epithelization. For deeper burns after necrectomy, the “ChitoPran” accelerates the growth of granulation tissues.

Clinical case. This article presents the clinical case of the successful treatment of a 17-year-old burn patient with a combined injury. The patient presented with a blunt abdominal injury on the background of a deep burn of the anterior abdominal wall. The patient underwent a median laparotomy on the first day and an early necrectomy with primary cutaneous autoplasty with the “ChitoPran” closing of the wounds on a day later.

Discussion. The use of the “ChitoPran” wound coating in combination with skin autoplasty for the early surgical treatment of burns contributes to the acceleration of epithelization of wounds in comparison with stage-based surgical treatment. This coating is hence comparable in terms of cellular epithelization with the use of fibroblasts.

Conclusions. Creating optimal conditions for epithelization in the wound can prevent the development of purulent complications (such as the failure of skin sutures of the anterior abdominal wall). The use of “ChitoPran” wound coating showed improved outcomes in the treatment of patients with burn injuries through accelerated restoration of the skin and reduced suppuration in the wound.

Full Text

Till date, the treatment of patients with thermal injury has remained an urgent and complicated problem of modern medicine [1]. The current standard of treatment for patients with deep burn lesions is early excision (removal) of necrotic tissue, followed by immediate or delayed skin grafting [2–4]. Wound closure with a full-thickness autodermal graft, which reduces the formation of rough scars, is considered to be optimal in terms of functional and cosmetic results [5, 6].

In the case of delayed skin grafting after surgical debridement, the temporary closure of the resulting wound is required. For temporary wound closure, the use of biological wound coatings is most appropriate [7]. However, due to the absence of these coatings, the widespread introduction of this treatment method is impossible [8–10]. In the Russian Federation, biological wound coatings such as Supratel (Polymedics Innovations Inc, Germany), Xenoderm (AB Medical, Russia), Ji Derm (Ji-Group, Russia), and “ChitoPran” (Biotechpharm, Russia) are used.

In the Burn Center of the Scientific Research Institute at Ochapovsky Regional Clinical Hospital No. 1 of the Ministry of Health of Krasnodar Territory, the biological wound coating “ChitoPran” has been used since 2017, which includes chitosan, ciprofloxacin, and trypsin. Chitosan is a polymer of natural origin and is obtained from a renewable natural raw material chitin, which is found in the shells of crustaceans (shrimp or crabs) and in mushrooms or algae. Chitosan has unique properties such as biocompatibility and biodegradability. It is also a complex-forming agent, an immune stimulant, and has a bacteriostatic and hemostatic effect [11–13]. However, despite the advances in the field of wound coatings, new methods of wound closure are being developed [14–18].

Clinical case

Patient D (age: 17 years), after a road traffic accident, was admitted to the burn department on July 10, 2018, with a diagnosis of combined injury: II–III degree thermal burn (by flame) at the head, neck, trunk, upper, and lower extremities in 31% of body surface and blunt abdominal trauma. Upon admission, on day 2 after the injury, a deep burn at the neck, trunk, and limbs with the formation of a scab was revealed (Fig. 1).

 

Fig. 1. Blunt abdominal trauma and burns on day 2 after combined injury due to a road traffic accident

 

The next day, after stabilization and preparation of the patient for surgery, tangential debridement up to 18% of the body surface was performed with a necrotome close to the laparotomy sutures. The wound bottom was represented by viable lower layers of the dermis (Fig. 2).

 

Fig. 2. Tangential surgical debridement up to 18% of the body surface (performed by a necrotome close to the laparotomy sutures)

 

Autografts (0.3-mm thick) were taken from both thighs. The treated wounds were covered with perforated autografts, with a perforation index of 1:4 (Fig. 3).

 

Fig. 3. After primary autografting with 1:4 perforation

 

To create the optimal conditions for retention of graft and accelerate the timing of cell epithelialization, the autografting zones were covered with a biological wound coating “ChitoPran” (Fig. 4). After 7 days, autografting signs of active epithelialization were noted under the “ChitoPran” (Fig. 5).

 

Fig. 4. Autografting sites covered with “ChitoPran”

 

Fig. 5. Wound after 1 week of epithelialization under “ChitoPran”

 

All bandages were removed after 18 days. The burn wound was epithelized due to the dry environment. The laparotomy suture of the burn was strong (Fig. 6).

 

Fig. 6. Epithelized wound after 2.5 weeks

 

Discussion

During staged surgical treatment, the wound healing process occurs in a burn wound, which includes all phases of the development of inflammation, suppuration, and sequestration of the scab. Therefore, surgical treatment on the abdominal organs is associated with the occurrence of purulent complications. Early surgical treatment accelerates recovery of the skin compared with stage one by 1.5–2 times [19]. The clinical case considered revealed that when using the “ChitoPran” wound coating together with early surgical treatment of burns, epithelialization of cells occurs on days 7–8, which is 4–5 days earlier in comparison with epithelialization under wet-to-dry dressings. In the wound, conditions are created for cell epithelialization after grafting with a high perforation index or with depth-borderline burns after excision of necrotic tissues. “ChitoPran” adheres to the wound on drying and epithelialization proceeds under favorable conditions. After 2–4 days, the bandages did not adhere to “ChitoPran” on drying, which facilitated the work of the medical personnel and did not cause any further injury to the wound.

In the clinical case described, the laparotomy wound healed by primary intention. In the area of deep burns, due to the favorable conditions, complete epithelialization without purulent complications was also observed.

Conclusion

The presented clinical case of the use of biological wound coating demonstrates a positive result of early surgical treatment. The use of “ChitoPran” for closing the wound surface reduced the wound healing time by 4–5 days and prevented purulent complications. The development of new biological coatings will help improve the quality of treatment for patients with thermal injury.

Additional information

Source of funding. This work was supported by the complex research work “Development of new approaches to cell therapy for the regeneration of injured tissues and organs” of the Scientific Research Institute at the Regional Clinical Hospital No. 1.

Conflict of interests. The authors declare no conflict of interest.

Ethical statement. The consent of the patient (or his representative) for processing and publication of personal data was obtained.

Author contributions

S.B. Bogdanov, A.V. Karakulev, and A.V. Polyakov performed surgical treatment, prepared the introduction, and conducted the clinical part of the work.

I.V. Gilevich, K.I. Melkonyan, and A.S. Sotnichenko took part in the analysis and design of the article.

All authors made significant contributions to the research and preparation of the article and read and approved the final version before its publication.

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About the authors

Sergey B. Bogdanov

Scientific Research Institute — Ochapovsky Regional Clinic Hospital of Krasnodar Region Public Health Ministry; Kuban State Medical University

Author for correspondence.
Email: bogdanovsb@mail.ru
ORCID iD: 0000-0001-9573-4776

MD, PhD, D.Sc., Head of the Burn Department; Professor of the Department of Orthopedics, Traumatology and VPH

Russian Federation, Krasnodar

Anton V. Karakulev

Scientific Research Institute — Ochapovsky Regional Clinic Hospital of Krasnodar Region Public Health Ministry; Kuban State Medical University

Email: karakulev797@gmail.com
ORCID iD: 0000-0002-5477-5755

MD, Orthopedic and Trauma Surgeon of the Burn Department; post-graduate student of the Department of Orthopedics, Traumatology and VPH

Russian Federation, Krasnodar

Irina V. Gilevich

Scientific Research Institute — Ochapovsky Regional Clinic Hospital of Krasnodar Region Public Health Ministry; Kuban State Medical University

Email: giliV@list.ru
ORCID iD: 0000-0002-9766-1811

Head of the Laboratory

Russian Federation, Krasnodar

Karina I. Melkonyan

Kuban State Medical University

Email: kimelkonian@gmail.com
ORCID iD: 0000-0003-2451-6813

MD, PhD, Head of the Central Research Center, Associate Professor of the Department of Fundamental and Clinical Biochemistry

Russian Federation, Krasnodar

Andrey V. Polyakov

Scientific Research Institute — Ochapovsky Regional Clinic Hospital of Krasnodar Region Public Health Ministry; Kuban State Medical University

Email: 350000@mail.ru
ORCID iD: 0000-0003-1065-1352

MD, PhD, Associate Professor; Assistant Professor of General surgery

Russian Federation, Krasnodar

Alexander S. Sotnichenko

Kuban State Medical University

Email: alex24.88@mail.ru
ORCID iD: 0000-0001-7322-0459

MD, PhD, Head of the Central Research Center, Laboratory of Basic Research in the Field of Regenerative Medicine, Assistant Professor of the Department of Pathological Anatomy

Russian Federation, Krasnodar

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Supplementary files

Supplementary Files
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1. Fig. 1. Blunt abdominal trauma and burns on day 2 after combined injury due to a road traffic accident

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2. Fig. 2. Tangential surgical debridement up to 18% of the body surface (performed by a necrotome close to the laparotomy sutures)

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3. Fig. 3. After primary autografting with 1:4 perforation

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4. Fig. 4. Autografting sites covered with “ChitoPran”

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5. Fig. 5. Wound after 1 week of epithelialization under “ChitoPran”

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6. Fig. 6. Epithelized wound after 2.5 weeks

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Copyright (c) 2020 Bogdanov S.B., Karakulev A.V., Gilevich I.V., Melkonyan K.I., Polyakov A.V., Sotnichenko A.S.

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

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