Diagnostic algorithm for determining the risk of developing pathological types of scar tissue in patients with burn injury

Relevance. The problem of the development of pathological scar tissue in combustiology is still relevant. It is necessary to determine a pathogenetically sound approach to the treatment of a burn wound that reduces the likelihood of the development of pathological scar tissue.
Intention: To study the histological structure of the tissues from which skin scars are formed, to develop a diagnostic algorithm for predicting the development of pathological scars.
Methodology. Tissue biopsies taken intraoperatively in the center and along the periphery of burn wounds before free autodermoplasty (FADP) were examined in 56 patients with burn injuries. In the selection zone, microcirculation parameters were determined by laser Doppler flowmetry (LDF) at the stage of treatment of burn wounds and during the formation of scar tissue. Clinical observation of patients was carried out for a year. Relationships between histology of tissues from which the scar would subsequently form, their perfusion indices before FADP and types of scar tissue were assessed over a year.
Results and Discussion. It was revealed that pathological scar tissue develops from granulation tissue and fibrous-altered dermis. The possibility of predicting the formation of the type of scar tissue by determining perfusion (M) is shown: above 10 perfusion units (PE), pathological scar tissue arises from granulation tissue; less than 4 PE, a high risk of developing pathological scar tissue from fibrous-altered dermis. With perfusion (4≤M≤10) in the zone of burn defects, the dermis, elements of subcutaneous fat, fibrous layer of granulation tissue are histologically determined, and the risk of developing pathological scar tissue is minimal.
Conclusion. Taking into account the revealed patterns, principles for predicting the formation of pathological scar tissue were justified based on perfusion parameters in various parts of the burn wound and histology at the early stages of treatment. Based on the results, an algorithm for diagnosing various types of scar tissue has been developed

1. Bajtinger V.F., Pajtyan K.G. Morfofunkcional’nye osobennosti patologicheskih kozhnyh rubcov: sostojanie voprosa [Morph ologic and functional charac teri stics of pa thologic skin scar s: state of the art]. Voprosy rekonstruktivnoj i plasticheskoj hirurgii [Issues of reconstructive and plastic surgery]. 2013; 1(44):28–33. (In Russ.)

2. Guller A.E., Shekhter A.B. Klinicheskij tip i gistologicheskaja struktura kozhnyh rubcov kak prognosticheskie faktory ishoda lechenija [Clinical type and histological structure of cutaneous scars as predictive factors of therapeutic outcome]. Annaly plasticheskoj, rekonstruktivnoj i jesteticheskoj hirurgii [Annals of plastic, reconstructive and aesthetic surgery]. 2007; (4):19–31. (In Russ.)

3. Zikiryahodzhaev D.Z., Orifov B.M., Huseinov Z.H. Osobennosti raka kozhi, razvivshegosja iz rubcov [Peculiarities of skin cancer a rising from scars]. Doklady Akademii nauk Respubliki Tadzhikistan [Reports of the Academy of Sciences of the Republic of Tajikistan]. 2013; 56(9):756–761. (In Russ.)

4. Kovalyova L.N. Kliniko-morfologicheskie paralleli u pacientov s rubcovoj patologiej kozhi [Clinical and morphological parallels in patients with skin scar disorders]. Dermatovenerologija. Kosmetologija. Seksopatologija [Dermatology. Cosmetology. Sexopathology]. 2016; 1(4):108–117. (In Russ.)

5. Krupatkin A.I., Sidorov V.V. Lazernaja doplerovskaja floumetrija mikrocirkuljacii krovi [Laser Doppler flowmetry of blood microcirculation]. Moscow. 2005. 40 p. (In Russ.)

6. Filippova O.V., Afonichev K.A., Krasnogorskij I.N. Kliniko-morfologicheskie osobennosti sosudistogo rusla gipertroficheskoj rubcovoj tkani v raznye sroki ee formirovanija [Clinical and morphological characteristics of the vascular bed of hypertrophic scar tissue in different periods of its formation]. Ortopedija, travmatologija i vosstanovitel’naja hirurgija detskogo vozrasta [Pediatric Traumatology, Orthopaedics and Reconstructive Surgery]. 2017; 5(3):25–35. DOI: 10.17816/PTORS5325-36. (In Russ.)

7. Gold M.H., McGuire M., Mustoe T.A. [et al.]. International Advisory Panel on Scar Managements. Up-dated international clinical recommendations on scar management: part 2-algorithms for scar prevention and treatment. Dermatol. Surg. 2014; 40(8):825–831. DOI: 10.1111/dsu.0000000000000050.

8. Liu Q, Wang X, Jia Y. Increased blood flow in keloids and adjacent skin revealed by laser speckle contrast imaging. Lasers Surg. Med. 2016; 48(4):360–364. DOI: 10.1002/lsm22470.