Method for treating auricle burns

Abstract

FIELD: otolaryngology; plastic surgery.SUBSTANCE: used to treat burns of the auricle. The external auditory canal is closed with a gauze turunda soaked in an antiseptic. The affected auricle is placed in a pocket of a size corresponding to the immersion of the auricle, formed from a sterile polyurethane sponge divided into two sheets. Then everything is covered with a film bandage with sequential stitches previously laid along the bandage with sterile thread using a surgical needle around the circumference so that both ends of the thread are in adjacent holes on the outer side of the film behind the auricle. After this, the ends of the thread are pulled together until they stop, holding the film bandage in such a way that the auricle is located in the space of the resulting pouch. The threads are secured with a surgical knot and the bandage is left in this state until the next dressing change.EFFECT: optimization of the microclimate of the wound environment and reliable atraumatic sealing of the damaged area by creating an isolated biomechanical depot formed by encapsulating the auricle in a porous polyurethane matrix, followed by fixation with a purse-string suture under a sterile film membrane.1 cl, 1 dwg

Description

[0001] Technical field

[0002] The invention relates to medicine, namely to clinical combustiology, and can be used to treat burns of the auricle of II-IIIA degree.

[0003] One of the leading goals of burn surgery is to develop methods for skin healing with minimal aesthetic and functional loss. A certain staged development of such approaches is known and observed in the literature. One traditional method is the local treatment of burns using a closed method. The closed, or dressing, method of treating grades II-IIIA burns involves the use of wet-to-dry dressings with antiseptic and antibiotic solutions. The subsequent introduction of water-soluble ointments with pronounced antimicrobial, dehydrating, anti-inflammatory, necrolytic, and analgesic properties made them the treatment of choice for burn wounds, including borderline grade IIIA burns.However, it has been noted that gauze pads and bandages may adhere to the wound under both wet-to-dry and ointment dressings. Non-viable superficial layers of skin in grade IIIA and IIIB burns may dry out, form a scab, and adhere tightly to the underlying layers, preventing visual assessment of the wound and complicating the healing process. Patient movements are accompanied by tissue displacement relative to the dressing, causing pain and potentially injuring the wound. Another disadvantage is the potential for inflammation, swelling, and increased pain to develop under the dressing [1].

[0004] An important step in improving the effectiveness of burn wound treatment methods has been the use of wound dressings that maintain a moist environment during all phases of the healing process: inflammatory, granulation, and regenerative [2]. However, many studies have shown that their use also carries a significant risk of increased intoxication, an increase in the perinecrotic zone, wound infection, delayed healing, and the formation of coarse scar tissue, as well as a painful dressing process that complicates treatment and causes additional trauma to the wound area [3].

[0005] The above-mentioned shortcomings led to the development of the concept of treating burn wounds in their own liquid medium (SLM) [4, 5], the introduction of which into the practice of burn surgery has significantly increased the effectiveness of local burn treatment. SLM is a complex, multicomponent, biologically active system that ensures self-regulation of the mechanisms of the wound process by maintaining the viability of cells and tissues at the site of injury and their own regenerative and reparative potential. An important feature is that the formation of SLM is possible only in the presence of a film coating of the surface of burn wounds, and this is realized under a special moisture-retaining film dressing. One of the first to be proposed was the DDB-M film dressing [6]. It is a perforated polyethylene film with a dry mixture of medical talc and various antibiotics, antiseptics and antifungal drugs applied to the inner surface.The wound exudate accumulating under the film dressing, similar in composition to blood plasma and lymph, essentially constitutes the wound's own fluid environment, ensuring the active functioning of natural reparative mechanisms while providing reliable protection from external infection. Such dressings have been successfully used in the treatment of burns on various body surfaces, with proven reductions in inpatient and outpatient treatment periods and minimal cosmetic and functional disadvantages [7].

[0006] These data allow us to consider the use of film dressings as the closest analogue to the proposed method for treating auricular burns. One drawback is that the film dressing in the form described above cannot be placed on the auricle, which precludes its practical use in this area.

[0007] Essence of the invention

[0008] The objective of the proposed method is to improve the effectiveness of treating auricular burns resulting from thermal injury. It is based on the current clinical recommendations of the Russian Ministry of Health from 2024 [8], which include the use of film dressings. Furthermore, prior art solutions suggest treating burns in various parts of the body using film dressings [4, 5]. No such recommendations for treating auricular burns were found in the prior art, which can be explained by the impossibility of applying a film dressing to the auricle without special modification.

[0009] The distinctive properties of this new method are aimed at creating and maintaining a wound dressing in the auricle area for a long time by shaping and securely fixing the film dressing, creating a volume that maintains constant contact between the contents of the wound dressing and the medication, even when changing position. This ensures the fulfillment of the key conditions for successful burn treatment:

[0010] - moist state of the wound and maintaining a constant temperature on its surface;

[0011] - reliable protection of the wound from external infection;

[0012] - suppression of wound microflora, elimination of microbial bodies, remnants of necrotic tissue and necrolysis products;

[0013] - implementation of controlled outflow of exudate;

[0014] - painless easy separation from the wound surface when changing the dressing.

[0015] To ensure continuous contact of the absorbent material and medications with the burnt surface of the auricle, the proposed method utilizes a sterile polyurethane sponge used for vacuum instillation therapy [9]. The external auditory canal of the affected ear is then closed with a gauze pad soaked in an antiseptic. The auricle may be additionally coated with a medication appropriate to the condition. For the treatment of grade II-IIIA auricular burns, the sponge is divided under sterile conditions, for example, using scissors or a scalpel, into two partially separated sheets.The resulting pocket, the size of which corresponds to the maximum immersion of the auricle, pre-filled with medicinal products, is intended for placing the affected auricle in it in such a way that both sheets respectively adjoin the anterior and posterior surfaces of the auricle, covering the burn wound, ensuring constant contact of the medicinal products with the burn surface. A film dressing is used as a film dressing to organize an isolated volume and preserve the SGS, for example, a "Sterile film wound dressing (for example, produced under the brand name "Polipran", manufactured by OOO "New Film Technologies" or other analogues) with an area of ​​​​at least 150x150 mm, consisting of a copolymer based on vinyl acetate or polyvinyl acetate with medicinal applications or without applications, possessing sufficient softness and elasticity and protecting the wound from drying out and seeding with microbes, penetration of moisture and microbes from the outside

[10] .Using a surgical needle, place successive stitches 1.0-1.5 cm long along the surface of the film dressing in a circle 12-14 cm in diameter, so that at the end of the circle, both ends of the thread are in adjacent holes on the outer surface of the film dressing behind the auricle. The ends of the thread are then pulled together to their natural stop, holding the film dressing so that the auricle is within the resulting purse-string. The threads are secured with a surgical knot, and the dressing is left in this position until the next dressing change. This method allows the dressing to be applied to the auricle, followed by tightening and securing the threads, forming a "purse-string" that isolates the auricle and secures the medicated sponge to it. Excess film dressing and long ends of the threads can be trimmed.

[0016] The novelty of the technical solution of the proposed method lies in the creation of conditions for the formation of the SGS in the area of ​​the auricle and in ensuring constant contact of the wound surface with the contents of the SGS and with medicinal products during the periods between dressings, as well as in the possibility of visual control of the condition of the film dressing and the contents under it without removing it.

[0017] The technical result consists in increasing the effectiveness of treating auricle burns based on the criteria of the absence of pain during dressing changes, reducing the healing time of burn wounds with minimal aesthetic and functional losses.

[0018] Brief description of drawing figures

[0019] Fig. 1 shows how a sterile polyurethane sponge (1) is cut to form a pocket (2) between two petals.

[0020] Implementation of the invention

[0021] If there are no contraindications, the proposed method is implemented as follows. The external auditory canal is closed with a gauze pad soaked in antiseptic. A sterile polyurethane sponge is molded to the specific patient under sterile conditions. Its size is selected so that its partial division into two sheets ensures maximum insertion of the affected auricle into the resulting pocket. The pocket is then filled with medication (saturated with medication), after which the sponge is placed on the auricle. The auricle can be additionally coated with a medication appropriate for the condition.The ear is then covered with an antibacterial sterile film dressing (e.g., "Sterile Film Wound Dressing" marketed under the brand name "Polipran" and manufactured by New Film Technologies LLC) with an area of ​​at least 150 x 150 mm. The dressing should be positioned so that the auricle, with the sponge attached, is within the center of a circle delimited by successive stitches 1.0-1.5 cm long, previously laid along a circle 12-14 cm in diameter. The ends of the thread are then placed in adjacent holes on the outer surface of the film dressing and positioned behind the auricle. The ends of the thread are then pulled together to a natural stop, holding the film dressing so that the auricle is within the space of the resulting pouch, and the threads are secured with a surgical knot. The bandage is left in this state until the next dressing change, for example, for 2-3 days under visual control of the contents under the transparent film.

[0022] The implementation of the method is confirmed by an extract from the medical record. As an example, we provide the results of treatment of patient R. with the diagnosis: "Thermal flame burn of 32% of the body." The implementation of the method is confirmed by an extract from the medical record. According to patient R., born on September 15, 1995, he received a flame burn of II-IIIA degree to various parts of the body on May 7, 2025. First aid was provided at the scene of the injury, the patient was taken to the A.A. Vishnevsky Central Military Clinical Hospital in satisfactory condition. Upon examination, the skin outside the burn wounds is of normal color, clean. Locally: burns are localized in the head, including the right auricle, neck, extremities, with a total area of ​​32%. Burns to the right auricle were second-degree and consisted of blisters along the outer edge of the auricle containing opaque, bloody fluid, indicating the possibility of infection. Upon admission to the hospital on May 10, 2025,There were signs of an inflammatory reaction in the area of ​​the burn wounds of the auricle under a previously applied ointment gauze bandage, which indicated a high probability of an unfavorable development of the healing process and served as the basis for the use of the proposed method for treating burns of the auricle in its own liquid medium.

[0023] In the dressing room, an antibacterial, sterile film dressing was applied, which included the following steps:

[0024] 1. The external auditory canal was closed with a gauze pad soaked in antiseptic, and a layer of Levometil ointment was applied to the burn surface.

[0025] 2. The affected auricle was placed in a custom-molded pocket made of sterile polyurethane sponge, partially cut (dissected with a scalpel) into two petals proportionate to the auricle and pre-saturated with Levometil ointment.

[0026] 3. The auricle area was covered with a 15x15 cm Polyprane film dressing with sterile thread previously laid around a circumference of approximately 12 cm in diameter using a surgical needle with stitches approximately 1.5 cm long so that both ends of the thread were in adjacent holes on the outer side of the film behind the auricle.

[0027] 4. The ends of the suture were pulled to their natural point, holding the film dressing so that the auricle was positioned in the sub-film space like a purse-string, and the sutures were secured with a surgical knot. To improve patient comfort, the protruding edges of the film dressing were trimmed.

[0028] The dressing ensured the creation of a protective film around the auricle and constant contact of the wound surface with the contents of the protective film and the medications between dressing changes, as well as visual inspection of the condition of the dressing film and the contents underneath. After a total of 9 days of treatment, two similar dressings were applied every 3 days. As a result, the burn wounds healed without any scarring. There were no side effects or allergic reactions during the treatment. The following were the criteria for treatment effectiveness:

[0029] - painlessness of dressings;

[0030] - complete epithelialization of burn wounds;

[0031] - absence of rough scars;

[0032] - the healing period for second-degree burns occurred within 9 days from the moment the film-bandage was applied, which turned out to be significantly faster compared to the open method of treating such burns (up to 14-21 days).

[0033] Thus, the use of the claimed method has demonstrated its effectiveness in the treatment of burn injuries in the area of ​​the auricles in the SGS and made it possible to achieve a technical result in the form of increased treatment effectiveness according to the criteria of reducing the healing time of burn wounds, the absence of pain during dressings and the minimization of aesthetic and functional losses.

[0034] Sources of information

[0035] 1. Rudenko, T.G. Essays on combustiology: the fight against infection / T.G. Rudenko / / Chemistry and Life of the XXI century. - 2017. - No. 2. - P.: 30-33. - URL: https: / / hij.ru / read / 6403 / (date of access: 05 / 16 / 2025).

[0036] 2. Legonkova O.A. et al. Modern wound dressings: their properties and features / O.A. Legonkova, A.A. Alekseev / / Bulletin of Roszdravnadzor. - 2015. - No. 6. - P.: 66-68.

[0037] 3. Kashtanov A.D. et al. Review of modern materials used to cover wound surfaces / A.D. Kashtanov, Yu.L. Vasiliev, A.V. Bayrashevskaya / / Operative surgery and clinical anatomy (Pirogov Scientific Journal). - 2020. - Vol. 4. - No. 2. - P.: 49-56.

[0038] 4. Voynovsky EA et al. (eds.) System for treating burn wounds in their own liquid environment / E.A. Voynovsky, V.A. Menzul, T.G. Rudenko / / Ed. of the Journal: “On duty”: M. - 2015. - 271 p.

[0039] 5. Menzul V.V. et al. System of wound treatment in its own liquid medium for victims with burn and mine-blast injuries / V.A. Menzul, E.A. Voynovsky, I.E. Yusupov et al. / / In the collection of abstracts: “International scientific and practical conference”. - Sochi. - 2015. - P.: 173-175.

[0040] 6. Menzul V.A., Breitman R.Sh. Patent RU 2093126 C1. Dressing material DDB-M. 1996.

[0041] 7. Midlenko V.I. et al. Experience of treating victims with superficial and borderline burns with Menzul Dressing film dressings in combination with Levomekol ointment / V.I. Midlenko, V.A. Menzul, K.S. Kobelev / / Ulyanovsk Medical and Biological Journal. - No. 2. - 2016. - P.: 72-76.

[0042] 8. Clinical guidelines – Thermal and chemical burns. Sunburns. Respiratory tract burns – 2024-2025-2026 (August 31, 2024) – Approved by the Ministry of Health of the Russian Federation.

[0043] 9. VivanoMed Foam Kit, a sterile set of consumables for vacuum wound therapy. / / RU No. FSR 2011 / 09867 dated September 15, 2016.

[0044] 10. Wound dressing, film, sterile "Polyprane" according to TU 9393-010-52708501-2005, version 2. Wound dressing, film, antibacterial, sterile (with hydroxymethylquinoxaline dioxide) "Polyprane-DD". - FSR 2008 / 02201 dated 04.07.2022.

Claims

A method for treating burns of the auricle, including the application of drugs to the wound surface followed by the application of an antibacterial sterile film dressing, characterized in that the external auditory canal is closed with a gauze turunda impregnated with an antiseptic, and the affected auricle is placed in a pocket of a size corresponding to the immersion of the auricle, formed from a sterile polyurethane sponge divided into two sheets, after which everything together is covered with a film dressing of at least 15 × 15 cm in size with successive stitches 1-1.5 cm long previously laid along the dressing with sterile thread using a surgical needle along a circumference with a diameter of 12-14 cm so that both ends of the thread are in adjacent holes on the outer side of the film behind the auricle, after which the ends of the thread are pulled together until they stop, holding the film dressing so that the auricle is in space of the resulting pouch,secure the threads with a surgical knot and leave the bandage in this state until the next dressing change.

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