APPLICATION OF IMPROVED AUTODERMOPLASTY TECHNIQUE IN GRANULATING WOUNDS TREATMENT.

Abstract

This prospective study was conducted at the Department of Surgery of the Pavlodar branch of the NCJSC "SMU" (Non-profit joint-stock company "Medical University of Semey" based on the city hospital No. 1, surgical hospital of Pavlodar, Kazakhstan.

Purpose: The purpose of research is to evaluate the results of improved autodermoplasty technique for granulating wounds of different origin.

Study design: Non-randomized controlled clinical trial Material and methods: The study included a total of 100 patients with granulating purulent wounds of various origins aged 20 to 70 years. In the period from 2022-2024. The average age was 41.03±1.14 years. In the main group, 50 patients with granulating wounds were treated using an improved technique of free split autodermoplasty. The study also included a comparison group, represented by 50 patients who underwent traditional local treatment of wounds after autodermotransplantation using wet-drying gauze dressings impregnated with antiseptic agents. To include patients in the study groups regarding the state of the wound surface before autodermoplasty, the following criteria were selected: wounds of various origins with active granulation and the presence of signs of marginal epithelialization after complete cleansing of the wound surface from purulent-necrotic tissues. The wound surface areas ranged from 50 to 200 cm2. Accordingly, the criteria for excluding patients from the study regarding the state of the wound surface were patients with flaccid granulation of wounds, the presence of purulent-necrotic tissues, and the absence of marginal epithelialization. Informed consent was obtained from all patients to participate in the study.

Results: Surgical diseases with the occurrence of purulent wounds accounted for 25%, of which after the treatment of phlegmon - 10 (40%) cases, abscesses - 6 (24%), suppuration of postoperative wounds - 9 (36%) cases. Burn wounds of the IIIb degree occurred in 45%, wounds of traumatic origin 18% and frostbite of the III degree in 12%. The bottom of the wounds was represented by muscles and subcutaneous fat tissue. The engraftment rate of autodermal grafts relative to the initial area of the transplanted skin flap for surgical, burn and traumatic wounds in the main group of patients was 97.15±0.28%, 95.35±0.28% and 96.89±0.37%, respectively, which corresponded to the criterion of complete engraftment. For frostbite wounds, it was 81.2±1.14%, which was assessed as partial engraftment. In the comparison group, in surgical, burn and traumatic wounds, the degree of engraftment of autodermal grafts relative to the initial area of the transplanted skin flap was characterized as partial engraftment (78.75±0.41%, 76.0±0.28%, 80.0±0.9%, respectively), and as non-engraftment - in wounds due to frostbite (50.0±0.58%). After autodermoplasty of granulating wounds in 100 patients, wound complications were observed in 14 (14%) patients. Of these, there were 2 (4%) cases in the main group of patients and 12 (24%) in the comparison group (χ2=6.728; p=0.01).