Rational Surgical Methods of Deep Burns Treatment in Older Patients

Abstract

ABSTRACT OBJECTIVES: We describe our experience with surgical treatment of elderly (aged >60 years) patients with deep burns. Available data have indicated that the best results can be achieved with a single-stage autologous skin grafting to close all wounds in one step for limited deep burns. For extensive burns, the best results are achieved with delayed autologous skin grafting performed in 1 to 2 stages. Use of early surgical intervention methods for deep burns in elderly patients substantially reduces the recovery time of skin integrity, the frequency of burn disease complications, and mortality. MATERIALS AND METHODS: We examined the results of comprehensive treatment of 69 patients seen in the combustiology department of the Samarkand City Medical Association from 2019 to 2023. Inclusion criteria included presence of deep burns of III-B to IV degree and age 60 years or older. All 69 patients had a Baux index exceeding 60 units. RESULTS: Elderly patients who received surgical debridement followed by autodermoplasty for treatment of deep burns had average skin recovery period after injury of 30.6 ± 2.0 days. Rate of autodermotransplant graft lysis among patients was 20.3%. Better outcomes were achieved with simultaneous autodermoplasty than with delayed autodermoplasty (11.8% vs 23.1%). The average postoperative mortality rate among patients with thermal injuries was 8.7%; mortality was 6.9% in patients with a Baux index of 60 to 80 but reached 11.1% in patients with more severe trauma. CONCLUSIONS: The application of surgical debridement methods in elderly patients significantly reduced the recovery time of skin surface, frequency of burn disease complications, and mortality rates. Simultaneous autodermoplasty with closure of all wounds in one stage is effective for limited deep burns. Delayed autodermoplasty performed in 1 to 2 stages can yield better outcomes for elderly patients with extensive burns.