Approaches to surgical treatment of deep burns of the hand burdened with subfascial hypertension syndrome

Abstract

The problem of treatment of subfascial hypertension syndrome in burn injury of the hand remains relevant due to lack of vigilance about its possible development. Purpose - to improve the results of treatment of deep burns of the hand by using the tactics of early surgery. Materials and methods. The clinical material consisted of 195 patients with burn lesions of the hand. The main group consisted of 83 victims, who used the tactics of active early surgery, followed by recovery and reconstruction. The comparison group consisted of 112 patients - in the treatment of which the tactics of gradual necrectomies were used after the formation of demarcation lines with the subsequent healing of wounds with the use of ointment dressings. Results. The data obtained showed that timely diagnosis, which consisted of the right treatment tactics, reduced the number of amputations and prevented the disability of victims with burns. This was achieved through timely and technically correct method of performing open decompression fasciotomies, which managed to reduce the subfascial pressure in each affected case, which prevented critical ischemia of muscle fibers and the development of Folkman’s contracture. It is extremely important to perform open fasciotomies in the syndrome of subfascial hypertension, because only in this way a complete decompression of tissues was achieved, and a timely verified diagnosis ensured a good treatment result. Early active surgical tactics for deep burns became a priority, compared to industry standards, which was expressed in an increase in the number of early surgical interventions (54.2% vs 23.2%; p<0.02), which reduced the proportion of wound infectious complications (4.8% vs 18.2; p<0.01), reduce the number of cicatricial contractures (14.5% vs 50.9%; р<0.02). Conclusions. Timely diagnosis of subfascial hypertension of the hand, active early surgical tactics, the proposed technique of decompression fasciotomies significantly improved the results of treatment, which manifested itself in the restoration of motor function of the hand. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors. Keywords: burns, hand’s burns, subfascial hypertension syndrome, open decompression fasciotomies, wounds.