Current aspects of medical care for children with extensive soft tissue injuries (Description of three clinical observations with an analysis of mistakes)

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Abstract

BACKGROUND: Injury is an epidemic of the 21st century. It is associated with the increasing high-speed transportation, natural and man-made emergencies, and local wars. All this leads to the appearance of patients with complex, multiple, and not rarely combined injuries. Traumatic skin detachment is the result of high-energy trauma. The treatment of this patient group presents certain difficulties due to the provisional peculiarities of medical care because of the severity of these patients’ condition of such patients and the underlying muscle tissue destruction.

CLINICAL CASES: This paper presents several clinical examples of successfully treated patients with traumatic skin detachments as a part of polytrauma. The timely correction of the improper treatment procedures enabled avoiding unfavorable results.

DISCUSSION: Treatment of victims with traumatic skin detachment who are in a relatively stable state and the absence of destruction of the underlying muscle tissues should be performed using traditional full layer free skin grafting, according to Krasovitov. In contrast, the treatment of victims with traumatic full-thickness skin detachment in an unstable (decompensated) state and the destruction of the underlying muscle tissues, it is necessary to perform it using the technology of staged full layer free skin grafting with the possible use of a biological coating based on chitosan.

CONCLUSION: The presented clinical examples reflect the importance of developing a unified method of treating injuries at all stages of organizing medical assistance to the victim.

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About the authors

Sergei B. Bogdanov

Scientific Research Institution — Regional Clinical Hospital No. 1 named by professor S.V. Ochapovsky; Kuban State Medical University

Author for correspondence.
Email: bogdanovsb@mail.ru
ORCID iD: 0000-0001-9573-4776
SPIN-code: 2465-5462

MD, PhD, D.Sc.

Russian Federation, 167 1st May str., Krasnodar, 350086; Krasnodar

Aleksandr N. Blazhenko

Scientific Research Institution — Regional Clinical Hospital No. 1 named by professor S.V. Ochapovsky; Kuban State Medical University

Email: vertebr58@mail.ru
ORCID iD: 0000-0002-9957-1422
SPIN-code: 5819-1988

MD, PhD, D.Sc., Associate Professor

Russian Federation, 167 1st May str., Krasnodar, 350086; Krasnodar

Sergei N. Kurinniy

Scientific Research Institution — Regional Clinical Hospital No. 1 named by professor S.V. Ochapovsky; Kuban State Medical University

Email: way_doc@mail.ru
ORCID iD: 0000-0002-8780-5308

PhD student

Russian Federation, 167 1st May str., Krasnodar, 350086; Krasnodar

Mikhail L. Mukhanov

Kuban State Medical University

Email: pputinn@yandex.ru
ORCID iD: 0000-0002-9061-6014
SPIN-code: 3684-9725

MD, PhD, Associate Professor

Russian Federation, Krasnodar

Andrey A. Boyko

Kuban State Medical University

Email: andreyboyko2511@yandex.ru
ORCID iD: 0000-0003-0796-4526
SPIN-code: 6932-9491

MD, clinical resident

Russian Federation, Krasnodar

Anton V. Karakulev

Scientific Research Institution — Regional Clinical Hospital No. 1 named by professor S.V. Ochapovsky; Kuban State Medical University

Email: karakulev797@gmail.com
ORCID iD: 0000-0002-5477-5755
SPIN-code: 9687-7717

MD, PhD student

Russian Federation, 167 1st May str., Krasnodar, 350086; Krasnodar

Valeriya A. Aladina

Scientific Research Institution — Regional Clinical Hospital No. 1 named by professor S.V. Ochapovsky; Kuban State Medical University

Email: lerka309@mail.ru
ORCID iD: 0000-0002-4580-6839
SPIN-code: 5218-7831

MD

Russian Federation, 167 1st May str., Krasnodar, 350086; Krasnodar

References

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  7. Bogdanov SB, Afaunova ON. Ispol’zovanie ranevyh pokrytij pri rannem hirurgicheskom lechenii pogranichnyh ozhogov konechnostej v funkcional’no aktivnyh oblastyah. Vrach-aspirant. 2016;79(6):4–9. (In Russ.)
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  9. Patent RF naizobretenie No. 2248757/27.03.05. Bogdanov SB, Kurinnyi NA. Sposob plastiki kozhnykh pokrovov konechnostei posle rannei nekrektomii. Available from: https://elibrary.ru/item.asp?id=37962093. (In Russ.)
  10. Patent RF naizobretenie No. 2618166/02.05.20. Bogdanov SB, Babichev RG. Sposob zabora kozhnogo autotransplantata. Available from: https://elibrary.ru/item.asp?id=38263544. (In Russ.)
  11. Patent RF naizobretenie No. 2665676/03.09.18. Bjul. No. 25. Blazhenko AN, Kurinnyj SN, Porhanov VA, Bogdanov SB, Muhanov ML. Sposob svobodnoj otsrochennoj plastiki kozhnym autotransplantatom pritravmaticheskih otslojkah kozhi [сited 2020 April 8]. Available from: https://patentinform.ru/inventions/reg-2665676.html

Supplementary files

Supplementary Files
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1. Fig. 1. Patient D., 12 years old, diagnosed with traumatic detachment of the left thigh skin up to 7% of the body area: (a) view of the wound after primary surgical treatment and application of apposition sutures; (b) view of the wound after repeated surgical treatment and suturing of the wound; (c) signs of moist necrosis; (d) signs of coagulation necrosis; (e) view of the wound with wound covering application; (f) view of the wound after granulation appearance; (g) grafting of wound; (h) end result of skin grafting

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2. Fig. 2. Patient L., 16 years old, diagnosed with a mine-explosive wound of the soft tissues of the left foot dorsum, traumatic detachment of the skin up to 0.5%, and multiple shrapnel wounds of the soft tissues of the lower extremities: (a) primary sutures were applied 1 h after the injury; (b) repeated surgical wound treatment and adipo-dermal flap excision; (c) foreign body removal

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3. Fig. 3. Patient P., 17 years old, was diagnosed with combined trauma of the chest, pelvis, and lower limb, left-sided pneumothorax, a condition after draining the left pleural cavity, open fracture of the pubic, ischial bones, and left acetabulum, traumatic avulsion of the lower limb at the left hip joint level, perineal wound, and a condition after primary surgical treatment. Colostomy was performed, and the severity of injuries on the National Institutes of Health Stroke Scale is 27 points: (a) the wound is sutured and drained; (b) the state of the wound after 17 h; the sutures were removed; (c) a vacuum bandage with a negative pressure of 125 mmHg was applied; (d) repeated surgical wound treatment on day 2, excision of necrotic muscles, and removal of fatty tissues; (e) repeated surgical wound treatment on day 5, excision of necrotic muscles, and removal of fatty tissues; (f) the closest result of treatment 1 month after injury, graft engraftment by 100%

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Copyright (c) 2021 Bogdanov S.B., Blazhenko A.N., Kurinniy S.N., Mukhanov M.L., Boyko A.A., Karakulev A.V., Aladina V.A.

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