Principles of administration and monitoring of specific treatment of burns in pediatric patients

Abstract

Introduction. Burns in children are serious tissue damage with necrosis of skin, adipose tissue, muscles, tendons, nerves, blood vessels, bones, disturbances of homeostasis, with the development of acute multiorganic failure syndrome and septic complications. These circumstances require the development of measures for the prophylaxis and treatment of pathological disorders developed locally and in the organs’ system due to thermal trauma. Depending on the depth degree, we distinguish burns of I, II, III, IV degrees. The distribution of burns according to heat transfer mechanism and aggression type is: 72.8% - hot liquids; 14.2% - flame; 8.7% - incandescent objects; 3.6% - electrical; 0.7% - chemical, solar. According to the statistics of the Republican Clinic of Burns and Plastic Surgery, burns make up 5-6% of all acute pediatric traumas. Breakdown of burns by age: 0-3 years 48.6%; 3-7 years 22.4%; 7-15 years 29.0%. According to world statistics, burns constitute a very important issue due to their high frequency in the pediatric population of about 3.4-36%. Aim of the study. To elucidate the particularities of the development of burns in children and some correct contemporary principles in the administration and monitoring of specific treatment. Materials and methods. Analysis of data from the Clinic of Burns and Plastic Surgery during 2007-2017. Results. In the last 10 years, 5715 children with burns (0-3 years - 50.6%, 4-7 years - 24.4%, 8- 18 years - 25%) were treated in the Clinic of Burns and {Plastic} Surgery. Of which: 2844 (55.2%) – with superficial burns, 2871 (44.8%) – with deep burns and 645 children were hospitalized with combustion shock. Contemporary treatment of burns and post-combustion sequelae consists of: necrophasciotomies, amputations, joint amputations, early necrectomies, free skin plastics, plastics with pedicle flaps, plastics with remotely migrated flaps, tissue expansion, but also of drug application. Currently, early surgical treatment of deep burns has become an axiom because the combustion disease consequences depend directly on the skin restoration term. Conclusions. Acquired experience indicates that initiation of intensive treatment at the initial stage (appropriate thermal shock therapy, septic complications prevention, early surgical restoration of damaged skin) allows achieving positive results in aforementioned surgical pathology.