Alekseev Andrey, Bobrovnikov Alex Bobrovnikovander, Krutikov Michail, Bogdanov Vitaly

1. 1
EVALUATION OF LOCAL EFFECTS OF PHYSICAL
METHODS ON BURN WOUNDS
Alekseev A.A., Bobrovnikov A.E., Krutikov M.G., Bogdanov V.V.
Department of thermal injuries, wounds and wound infection,
Russian Medical Academy of Postgraduate education,
Burn center, A.V.Vishnevsky Institute of Surgery, Moscow, Russian Federation
Aim:
To evaluate efficiency of local effects of physical methods (VAC-therapy,
ultrasound and hydrosurgical debridement) for treatment of burn wounds
(table 1).
Table 1
MECHANISMS OF PHYSICAL METHODS ON WOUNDS
Physical methods`
Mechanical
cleansing
of wounds
Effect on
microcirculation
Bactericidal
effect
Introduction
of medicines
into wound
Ultrasound
debridement
+ + + +
VAC-therapy + + +
Hydrosurgical
debridement
+ +
Methods:
Clinical and laboratory evaluation of physical methods: VAC-therapy,
ultrasound and hydrosurgical debridement for preparation of deep burns
for skin grafting was conducted in 128 patients (main group) treated in
2008-2012 years with extensive burns more 20% of body surface.
Retrospective analysis of 80 archival case histories (from 2003 to 2008
years) of patients with analogical burn injuries, without above mentioned
physical methods, was also conducted.
All patients with deep burns had surgical necrectomies and skin
graftings.

2. 2
Results:
Results of treatment showed good efficiency for VAC-therapy and
ultrasound debridement after necrectomy of deep wounds.
Fig. 1. Apparatus for ultrasound
debridement
Apparatus for ultrasound
debridement allows to treat
granulating wounds by antiseptic
flow (acoustic environment) (Fig. 1)
Ultrasound debridement provided
intensive removal of pus, fibrin,
eschar, necrotic dermis and
pathologic hypertrophic
granulations. (Fig. 2 and 3).
Fig. 2. Conducting ultrasonic debridement
of burn wounds.
Fig. 3. Burn wounds: (1) before ultrasound debridement, (2) at operation, (3) after
ultrasound debridement

3. 3
Fig. 4. Apparatus for VAC-therapy with
single use materials
Dressings with moist environment
and VAC—therapy with modern
equipment (Fig. 4) increase
treatment opportunities for
burned patients, including
wounds with redundant
discharge, especially in 1 stage of
wound healing, and wound
infection.
VAC-therapy, especially in deep
wounds with uneven relief
decreased tissue edema,
accelerated removal of necrosis
foci, stimulated formation of
granulation, bottom of wounds rose
and edges smoothed, edges
healing appeared (Fig. 5 и 6). Fig. 6. System of low pressure
«Pulsavac Plus» for irrigation and cleansing
of granulating wounds
Fig. 5. VAC-therapy for deep wounds after electrical burn

4. 4
Hydrosurgical debridement was efficient for removal of granulations.
Fig. 7. Apparatus for hydrosurgical
debridement with single use handle
Apparatus uses high-speed fluid
flow technology, allows to remove
and aspirate damaged and scar
affected tissues (Fig. 7).
Quick and radical hydrosurgical debridement decreased time of
operations and increased efficiency of skin grafting, compared with
standard tangential excision by electric dermatom especially in
problematic areas (neck, interdigital space, etc.) (Fig. 8).
Fig. 8. Hydrosurgical debridement of burn wounds

5. 5
Comparison of local treatment with and without
local physical methods
Application of physical methods with local effects on burn wounds
allowed 2 times to decrease microbial contamination (Fig. 9), decrease 4
days preparation time for skin grafting, improve condition of recipient
wounds, decrease by 50 % grafts lysis , 5 days to decrease length of
hospitalization compared with patients did not treated by physical
methods (table 2).
Fig. 9. Microbial contamination of wounds in investigated groups.
Table 2
Data
Preparation for skin grafting
Group with local physical
methods
Group without local
physical methods
Patients of groups 128 80
Day of skin grafting after
hospitalization 16,3±0,7 19,6±0,7
Partial lysis of skin grafts (%) 10% 20%
Time of hospitalization (days) 35,8±1,2 41,1±1,2
Conclusions:
Main method of treatment for deep burns is surgical debridement and
early skin grafting. Application of modern physical methods effecting on
burn wounds may improve results of treatment.