Modern methods of treatment of children with post-burn curric contractures of the shoulder and elbow joints

The urgency of the problem. According to the WHO, every year, per 100,000 population, 294-384 people are affected by burns, i.e. 3.8%. In our republic, this figure is 2.3%. During the set d of cases after healing of a burn wound patients at the head, neck, body, upper and lower extremities develop scar deformation and contracture. According to the authors, contracture of the shoulder joint is 10-37%, the elbow joint

• -    7-28% of all contacts of large

joints [1,2,3,].

Cicatricial contractures of the shoulder and elbow joints by anatomical location are divided into: marginal, middle and total types. By type of dysfunction of the joints are divided into: I degree, II degree, III degree. In many cases, totally located scars lead to impaired          function          of the II and III degrees [4].

Children     with     post-burn contractures of the shoulder and elbow joints, there are psychoemotional e violations and gaps e development among rovestnikov. This, in turn, leads to a violation of the way of life, working capacity and when acquiring knowledge in educational institutions. Patients lose hope for cure [3].

Materials and research methods. Currently, the Department of Maxillofacial and Plastic Surgery Andijan regional children's multidisciplinary center spend Xia new modern methods of restorative plastic surgery post-burn rub tsovyh strain. From 2017 to 2019, more than 100 children with postburn scar contractures of the joints were operated on. Of these, we observed 62 patients with post-burn cicatricial contractures of the shoulder and elbow joints. The age of these patients varied from 2 to 16 years, girls were 24, boys - 38. Together with general clinical research methods, the patients underwent radiography of the shoulder and elbow joints, determination of the amount of oxygen in the tissues (PtcO 2 ).

Results and their discussion. We know, that the contracture of the shoulder and elbow joints, using traditional methods ( the Z -Plastic, plastic flap, free autodermoplasty, combined plastic ) operations.

We performed "Z" operations for post-burn flexion contractures of the shoulder (in 5 patients) and elbow (in 4 patients) joints. Have

In 3 patients, the wound healed with scarring after necrosis of the flap edges, due to impaired blood supply. This has resulted in relapse and disease.

In 3 patients with postburn contractures of the shoulder and elbow joints, carried out the operation with the help of a scrappy second plastic and. One (33.3%) patient had deformities in the joint area due to the excess thickness of the flap and aesthetic deficiencies in the donor area.

After the operation using free autodermoplasty, 11 patients with totally located post-burn contractures of the shoulder and elbow joints, in 3 (27.2%) patients, repeated contracture was observed due to skin wrinkling, which was taken with a dermatome.

By Combination

Card about wa nn nd plastic as     well, ie, plastic surgery with local tissues and free autodermoplasty in 13 patients with totally located post-burn contractures of the shoulder and elbow joints, in 3 (23%) patients gradual deformation of this area was observed.

All the above methods of surgery, being traditional methods, have several      disadvantages      (graft retraction, skin wrinkling, necrosis of a part of the flap, hyperpigmentation, etc.). Taking into account all these shortcomings, we proposed a new modern method of eliminating postburn cicatricial contractures of the shoulder and elbow joints by the method of free full-thickness skin autograft. This method was used to operate 26 patients with totally located post-burn       cicatricial       flexion contractures of the shoulder and elbow joints.

Operation            technique:

the medium and totally located pulling scars in the fossae of the shoulder and elbow joints are excised. Hemostasis. Produced a                             small joint redressatsiya. C. Creating Single wounds and closes polnosloynoy free wheel, which was taken from the groin with a scalpel, with all E layer s skin,        and purified by subcutaneous adipose tissue. A pressing furacillin bandage is applied to the wound. The donor wound is sutured using the “acute dermotension” method. The graft pressure bandage is removed on day 67. All patients, during and after the operation for 2-3 days, receive antibiotic therapy, and in the postoperative period, physiotherapy and balneotherapy are carried out.

Only in 1 patient, when the cicatricial contracture of the shoulder and elbow joints was eliminated by this method, there was a relapse of contracture due to lysis of the graft.

Conclusion. The results of the study show that 25 (96.15%) patients have functional restoration of joints, return to work and good results.