1. Introduction

At present, it is important to rely on high technologies in the treatment and diagnosis of diseases, the use of modern equipment, early detection of diseases, low cost and short days of patient recovery [1].

But it can be noted that the problems of some pathologies have not lost their relevance. Cases of deep burns of the palms and fingers, post-burn complications (contractures, keloid scars, pigmentary changes, impaired aesthetics of the palm and fingers) account for 35% of burn injuries. Among children, this figure is higher [2].

55% of burns in young children occur mainly on the palm and fingers. These burn injuries are mainly caused by the use of household heating equipment, hot water containers (thermoses), as well as the use of sandals to heat the house during the winter months in mountainous areas, including sandals that cause deep burns to the feet, hands, head and face [3].

30% burns of the feet, 30% of the palms and fingers, 35-40% of the head and face due to falling on sandals. Sandalwood burns are always characterized by deep skin burns. This means that the coals from sandalwood fire have a high temperature of 400 to 800 degrees [4].

In the elderly, in many cases, burns of the palms and fingers are observed, mainly from open flames and hot bodies [5].

The treatment of deep burns of the palms and fingers remains one of the urgent problems of modern combustiology. The healing process of a burn injury is long, deforming contractures of the palm and fingers occur in 25-50% of cases [6,7].

The healing period of deep burns of the palms and fingers is 1-1.5 months. During this period, a thick black scab appears on the wound, and during the inflammatory period, the wound is purulent. The effectiveness of the humid-air environment in deep burn wounds lies in the fact that it is important to maintain the permeability of the vessels that feed the skin at the bottom of the wound [8,9,10].

During the cleaning of the wound, granulations appear in the wound after necrotomy, necrotomy in surgical practice. After that, a free skin graft (autodermoplasty) is performed surgically. Humidity of the air is explained by the fact that the separation of necrotic tissues is painless, and bleeding from the wound during surgery is not observed [11].

2. Objective

To evaluate the effectiveness of the "humid-air environment" in the treatment of deep burns of the palms and fingers and early skin autodermoplasty.

3. Materials and Methods

In 2020-2022, 125 patients who were treated with deep burns of the hands and fingers were divided into 2 groups and the results of treatment were studied in the Combustology department of the Samarkand branch of the Republican Scientific Center for Emergency Medicine. In the treatment of 68 (54.4%) patients of the main group, a “moist-air environment” was used, a schematic representation of which is shown in Fig. 1.

Figure 1. Schematic representation of the humid-air (greenhouse) environment

57 (46.6%) patients in the control group were treated with traditional methods of treatment. The age of patients ranges from 7 months to 73 years, the average age is 23±3.0 years.

28 (21.4%) victims received burns with a hot object. 58 people (46.4%) received burns from open fire, 39 people (31.2%) received treatment for deep burns with boiling water. The area of deep burns affected is from 5% to 12%.

In our study, patients with IIIB-IV degree burn injuries of the palms and fingers were divided into 2 groups, taking into account the area of the burn and the time spent in the hospital.

68 patients of the main group underwent primary wound treatment and anesthesia with an aerosol containing a mixture of doxidine and lidocaine. Necrotic tissues were removed, a 1% dermazine ointment was applied to the damaged area, and an aseptic bandage with a 1% betadine solution was applied. A hermetic bandage with a sterile polyethylene bag 0.3-0.4 mm thick was applied over the bandage (Fig. 2). These procedures continued for 13-14 days. The amount of serous fluid collected in the bag was measured daily, and the resulting fluid was subjected to biochemical analysis. By the 8-10th day, the discharge from the wound decreased, thick fibrin on the wound slowly exfoliated, bleeding from the wound and pain were not observed (Fig. 3). In order to prevent the development of a purulent process, the wounds were applied to the wound in combination with levamicol-oflomelide-dermazine ointment containing antibiotics, an aseptic dressing with betadine was applied to the upper layer, and a sterile dressing was applied. on the palmar and finger areas in a sterile condition. During the treatment, patients practically did not experience pain. There were no restrictions on the movements of the fingers in the wrist joint due to the "humid-air environment", on the 15-17th day granulations appeared in the wound. A free skin grafting operation was performed (Fig. 4-5).

Figure 2. Creating a "moist air environment"

Figure 3. Exposure to the "humid-air environment" on the first day after the burn injury

Figure 4. Jarohat granulation_14th day

Figure 5. Free skin grafting (autodermoplasty)

The thickness of the skin from the obtained donor site was 0.3-0.4 mm, and in order to preserve the aesthetic state of the hand and palm area, as well as to prevent contractures in the future, skin grafting was performed longitudinally from the obtained free skin perforation mat (Fig. 6-8).

Figure 6. Free skin grafting (autodermoplasty) inner surface of the palm

Figure 7. Free skin grafting (autodermoplasty) on the outer surface of the palm

Figure 8. After surgery 3rd day

In the control group, 57 patients were admitted to the hospital with deep burns of the palms and fingers and were treated according to generally accepted standards of treatment. After establishing the diagnosis of IIIB-IV degree burns on the palms and fingers, the patients underwent anesthesia and pre-treatment of the wound, an aseptic dressing with betadine was applied with levamicol-dioxizoldermazine ointment, which was changed every 3-3 hours. 4 days, salicylic 10%-20 was applied to eliminate necrosis. Conservative necrotomy was performed with % ointment.

Trypsin and hemotrypsin enzymes were used to prepare the wound for autodermoplasty in order to clean the wound from purulent fibrins. In patients of the control group, during the period of bandage replacement, severe pain and bleeding from the wound were noted, and granulations appeared on the 23-24th day. After that, plastic surgery was performed. Perforated pieces of skin 0.3-0.4 mm thick were applied to the granular wounds of the upper and lower surfaces of the palm. The need to perforate the donor skin meant that small foci of necrosis and granulation were not fully visible.

Soft lancets were used in all patients since the palm and finger areas are areas of movement.

In all patients of the main group, bacteriological examination was subjected to discharge collected in plastic bags. Bacteriological analysis was performed on swabs taken from the wounds of patients in the control group. Accordingly, treated patients in both groups received the same antibiotic treatment. In many cases, susceptibility to broad-spectrum antibiotics has been found. Depending on the results, cephalosporin antibiotics of the II-III generation were used.

4. Results

In the main group, a "humid-air environment" was created by wearing an aseptic dressing with betadine on the wounds of the palms and fingers of the treated patients from the first hour. After a certain time, a dark yellowish exudative fluid began to stand out. During the day, 500-1000 ml of fluid was released from the wound in elderly patients. Dry necrosis in the wound was prevented in the “moist-air environment”, and tissue blood supply was prevented by deepening the wound. At the same time, patients practically did not complain about pain in the wound.

The bandage on the wound was opened once a day. The dressing change was painless due to the "moist atmosphere" and the dressing was easily separated from the wound. On the 2nd day thick yellowish fibrins appeared on the wound. Fibrins adhered to the dressing and separated with each dressing change. Painless excision of necrotic skin tissues was performed with light movements at each dressing change. The fluid released from the wound decreased by 10-15% per day, became darker and thicker. Biochemical analysis of the obtained liquid exudate content of total protein decreased from 55 g/l to 25-30 g/l after 6-7 days. In addition, potassium-sodium-chlorine electrolytes were found in the liquid.

Electrolytes showed 3-4 times less than in the blood test. Thus, the "moist-air environment" applied to the treated patients of the main group caused the appearance of granulations in the wound on the 10-15th day, contributed to the cleansing of the wound in a short time, and in patients of the main group, skin grafting was performed on the 16-17th day. This amounted to treatment days of patients of the main group 22.5±1.5 days. Patients in the control group were treated for 32.5±3.4 days.

Figure 9. 18-day status before discharge

Figure 10. Result 1 month after surgery

After restoring the integrity of the skin of the treated patients of both groups for 3-4 months, gypsum hard lancets or soft lancets were applied to the palms and fingers, the bandages were removed once a day and massaged with a 5% -10% camphor oil solution and therapeutic exercises. Treatment with physical culture continued for 30-40 minutes. This was aimed at early prevention of contractures of the palms and fingers.

After skin grafting, only 8 (8.9%) patients of the main group (two years later) had contractures of I-II degrees on the palms and fingers. It turned out that this was due to the fact that patients did not follow these recommendations. Therefore, a repeated plastic surgery of the skin was carried out.

In the control group, 36 (63.2%) patients treated with traditional methods had contractures of the palms and fingers of II-III degree (flexion-extension) (Fig. 11-12).

Figure 11. Contracture II degree in a treated patient in the control group

Figure 12. III degree contracture in a treated patient in the control group

Complications were observed in patients of the control group after 10-12 months of conservative treatment with electrophoresis, softening and cicatricial absorbable preparations, 36 (63.2%) underwent repeated skin plastic surgery.

Table 1. Results of treatment of deep burns of palms and fingers

As a result of the analysis, it was found that, compared with the traditional method of treatment used in the control group, patients who received the "humid-air environment" in the main group had unfavorable conditions for the survival and reproduction of microorganisms in the burn zone. wounds, tissue drying was prevented, vascular permeability was preserved, and during regeneration we observed that the process accelerated.

5. Conclusions

The results of these studies and analysis show that the use of "humid-air environment" is highly effective in the treatment of deep burns of the palms and fingers, and this method of treatment not only allows for early surgical skin grafting, but also reduces its duration, but also accelerates wound healing, has a positive effect on reducing complications after the procedure. It also causes a decrease in pain and negative emotions during daily dressing and treatment of wounds, which occupies a special place in the practice of treating burn patients.

Conflict of Interest

The authors declare no conflicts of interest or special funding for the current study.