Search

Introduction Thermal injury to the palmar surface of the hand is usually complicated by flexion desmogenic contracture of the finger joints. This condition is more complicated with significant wound areas and depths of soft tissue destruction. Conventional surgical methods and soft tissue reconstructions may fail to provide full restoration of the hand function. The objective was to present the optimal treatment strategy for patients with scar flexion contractures of the fingers after thermal injury to the palmar surface of both hands using a pediatric case report. Material and methods A child aged 2 years and 4 months underwent surgical treatment to include excision of scars, skin grafting of both hands with a vascularized fasciocutaneous flap raised with the radial artery. Result The patient could regain all types of hand grip on both sides 12 years after surgical treatment. Both hands were aesthetically acceptable. Discussion Treatment of patients with thermal injury and substantial soft tissue damage is a complex disease process. Conservative treatment and surgical procedures using non-vascularized skin flaps are normally used for the condition. These approaches are associated with cicatricial and arthrogenic flexion contracture of the finger joints. The radical treatment includes thorough wound debridement and early flap coverage and wound closure using a flap with an axial-pattern blood supply, free flaps and reverse-flow flaps. The surgical approach helps to avoid flexion contracture of the fingers initiating early restoration of professional, social stereotypes and stereotypes in everyday life. Conclusion The clinical observation has shown the possibility of one-stage organ-preserving surgical treatment using flaps with an axial blood supply.

The problem of difficult airways remains relevant for many years. Complications associated with unpredictable difficult airways often lead to the lethal outcome or neurological problems. This article analyzes the causes of difficult airways in patients with burns of face and neck. Such patients face a higher risk to develop difficult airways and it is impossible to follow the traditional procedure for maintaining airway patency. The article expresses the opinion about the inability of modern methods for assessing airway patency to predict possible problems associated with tracheal intubation and ventilation of patients with burns of face and neck.

Aim. The aim of our work was to study characteristics and results of surgical treatment of patients with wounds and cicatricial deformities who underwent tube flaps grafting.Materials and methods. The analysis of the treatment of 15 patients aged 9 to 58 was made. All patients were treated in the Burn Unit of the Scientific Research Institute – S.V. Ochapovsky Regional Clinical Hospital №1 with thermal, electrical and mechanical injuries and their consequences in 2005-2017 years.Results. The average frequency of this method use was 1 time per year. Remoteness of the affected area from the site of tube flap preparation determined the number of migrations and the terms of treatment of patients. With the localization of the recipient zone on the upper extremities, migration of one of the supply legs was immediately combined with partial grafting, and the total number of migrations was two. The duration of treatment of patients from the moment of tube flap preparation to the completion of plastics averaged 134±36 days. In those cases when it was required to move a tube flap prepared on the trunk to the head or lower extremities, there were 3-4 migrations, and the treatment time was 312 to 644 days, on average 481±86 days. The total area of the replaced defect was from 40 to 220 cm2. Out of 15 operated patients, complications occurred in 3 (20%) cases when the tube flap was migrating. At the control examinations during the first year after grafting flap tissues were viable, adapted, without trophic disorders. In term from 1 to 6 years after grafting skin was elastic and well taken into the fold. There were insignificant differences in the pigmentation of displaced flaps from the surrounding tissue. Cicatricial deformities associated with the harvesting, transport of the flap and grafting, were not observed.Conclusion. Tube flap proposed more than one century ago is primarily of historical significance and is rather rare in modern clinical practice, but sometimes it is the optimal method for recovering lost or scarred skin.