DELAYED SURGICAL NECRECTOMY OF BURN WOUND AFTER INITIAL SPECIAL DRESSING TREATMENT

A. STRITAR MD PhD, L. Emeršič MD, S. Stevovska MD, A. Arhar
Department of Plastic Surgery and Burns, University Medical Centre Ljubljana, Slovenia

Introduction
It sometimes proves difficult to define burn depth when treating mid-dermal burns, flash burns, scalds or chemical lesions. In these undefined cases it is possible to initially introduce special burn dressings with their own mechanical and pharmacodynamic characteristics. Wound dynamic is monitored when changing the dressings. Should wound healing stop, surgical procedure is required.

Materials and Methods
During the first three days burns of unspecified degree are treated using wet dressings, afterwards special dressings are applied. Wound dressing diminishes inflammation, infection and prevents deepening of the wound. It is in this manner that vital dermis and wound healing potential are preserved. Apart from healing by first intention, the granulation phase is prolonged in some areas of the wound preventing the process of epithelisation, which results in delayed wound healing. In those cases surgical therapy of slough as secondary necrectomy is indicated.

Results
Five patients that were initially treated with special dressings only were analysed. Surgical treatment of some of the unhealed areas was performed. The population comprises three children (10-15%TBSA) and two elderly patients (15-20%TBSA).

Conclusions and considerations
The case in point is an individual, selective, yet active approach. Regarding mid-dermal burns, demarcation of the burn wound is expected that would not gradually heal in its entirety were conservative therapy only to be applied. Indeed, delayed surgical necrectomy decreases the size of the surgical area and skin graft needed. This is especially important in certain populations, i.e. children and elderly patients. A thoughtful surgical management results in an optimal ratio between an operative and conservative approach of burn wound treatment.
Finally, multidisciplinary care is required, which includes microbiological diagnostics, targeted antibiotic therapy, glycaemic regulation, nutritive support and physical therapy up until complete rehabilitation.

4 - DELAYED SURGICAL NECRECTOMY OF BURN WOUND AFTER INITIAL SPECIAL DRESSING TREATMENT