OPTIMIZATION OF PREOPERATIVE CARE OF PATIENTS WITH POST-BURN CONTRACTURES OF THE LOWER EXTREMITIES AFTER PREVIOUS SURGICAL INTERVENTIONS

Authors

N.Kh. Shamsov1 R.A. Rakhmatova2 S.Sh. Musoev1 U.T. Gulmuradov3
Job:

1 Republican Scientific Center for Cardiovascular Surgery 2 Republican Scientific and Clinical Center for Pediatrics and Pediatric Surgery 3 Department of Cardiovascular, Endovascular, and Plastic Surgery named after Professor T.G. Gulmuradov, State Educational Institution “Institute o
DOI:
10.65197/3106-4035-2025-1-4-27-40

Annotation

Resume.

*

Goal.

To develop and evaluate the effectiveness of a comprehensive approach to preoperative management of patients with late sequelae of lower extremity burns (LEBs), in particular, after previous unsuccessful surgical interventions, with an emphasis on optimizing the choice of anesthetic management to improve the quality of recovery.

Material and methods.

A singlecenter retrospective and prospective comparative analysis of treatment outcomes was conducted in 73 patients with OPNK. Two groups were formed depending on the anesthesia method used: Group 1 (n=47) – endotracheal anesthesia (ETA), and Group 2 (n=26) – alternative anesthesia methods (AMA), including spinal and conduction techniques. The main endpoints were: the quality of postoperative recovery according to the QoR15 scale, pain intensity according to the visual analogue scale (VAS), the incidence of postoperative nausea and vomiting (PONV), the need for opioid analgesics, the speed of rehabilitation, and the incidence of complications.

Results.

The use of AMA compared with ETN was associated with a statistically significantly higher quality of recovery according to the QoR15 scale (median 130 vs. 110 points; p<0.001), a 2.5fold decrease in the need for opioid analgesics (p<0.001), a decrease in the incidence of PONV (3.8% vs. 29.8%; p<0.01) and a reduction in the postoperative hospital stay by 3.2 days (p=0.002). The advantages of AMA were especially pronounced in patients with a history of repeated interventions. In the prospective group, where the proportion of AMA was increased, the overall incidence of postoperative complications decreased from 28.9% to 11.4% (p<0.05). 

Conclusion.

Selecting alternative anesthesia methods (spinal, regional) is a key component in optimizing the perioperative care of patients with POLYANTHROAT ANCHOR, especially after previous unsuccessful surgeries. This approach significantly improves the quality of early postoperative recovery, accelerates rehabilitation, and creates favorable conditions for achieving the best surgical outcomes. 

Keywords

post-burn contractures reconstructive surgery regional anesthesia quality of recovery reoperations perioperative management.

Full text

The article is in PDF format

List of literature

  1. 1. World Health Organization. Burns. Fact sheet. Updated March 2024. [Electronic resource]. URL: https://www.who.int/news-room/fact-sheets/detail/burns (дата обращения: 13.04.2026).
  2. 2. Маликов М.Х., Давлатов А.А., Джононов Д.Д., Хайдаров М.М., Махмадкулова Н.А., Карим-Заде Г.Д. Коррекция тяжёлых рубцовых контрактур и деформаций нижних конечностей. Вестник Авиценны. 2023; 25(2): 260-270. https://doi.org/10.25005/2074-0581-2023-25-2-260-270.
  3. 3. Афоничев К.А., Филиппова В.С., Цветаев Е.В., Крюков Е.Ю. Хирургическое лечение детей с последствиями ожогов. Ортопедия, травматология и восстановительная хирургия детского возраста. 2017; 5(1): 36-44. https://doi.org/10.17816/PTORS5136-44.
  4. 4. Панов А.В., Миронов П.И., Хафизов Р.Р., Агзамова Э.Р. Особенности ведения детей с обширными ожогами. Вестник современной клинической медицины. 2019; 12(4): 34-39. https://doi.org/10.20969/VSKM.2019.12(4).34-39.
  5. 5. Богданов С.Б., Апагуни А.Э., Пивоваров С.А. Особенности лечения пациентов с послеожоговыми рубцовыми деформациями, перенесших множественные оперативные вмешательства. Анналы пластической, реконструктивной и эстетической хирургии. 2018; 2: 33-40.
  6. 6. Patel K.F., Rodríguez-Mercedes S.L., Grant G.G., Rencken C.A., Kinney E.M., Austen A., Ryan C.M. Physical, psychological, and social outcomes in pediatric burn survivors ages 5 to 18 years: a systematic review. J. Burn Care Res. 2022; 43(2): 343-352. https://doi.org/10.1093/jbcr/irab162.
  7. 7. Шаймонов А.Х. Клеточные технологии в ведении больных с послеожоговыми рубцами различной локализации. Здравоохранение Таджикистана. 2025; 1: 95-100.
  8. 8. Ljungqvist O., Scott M., Fearon K.C. Enhanced Recovery After Surgery: A Review. JAMA Surg. 2017; 152(3): 292-298. https://doi.org/10.1001/jamasurg.2016.4952.
  9. 9. Stark P.A., Myles P.S., Burke J.A. Development and psychometric evaluation of a postoperative quality of recovery score: the QoR-15. Anesthesiology. 2013; 118(6): 1332-1340. https://doi.org/10.1097/ALN.0b013e318289b14b.
  10. 10. Шаймонов А.Х., Шамсов Н.Х., Исмоилов М.М. Применение новых технологий оценки качества обезболивания в хирургии отдалённых последствий ожогов. Евразийский научно-медицинский журнал «Сино». 2025; 6(1-2): 110-112.
  11. 11. Шаймонов А.Х., Шамсов Н.Х., Саидов М.С. Оптимизация хирургического лечения больных с отдалёнными последствиями ожогов нижних конечностей. Евразийский научно-медицинский журнал «Сино». 2025; 6(1-2): 113-116.
  12. 12. Ходжамурадов Г.М., Шаймонов А.Х., Исмоилов М.М., Саидов М.С. Реконструктивно-пластическая хирургия отдаленных последствий ожогов нижних конечностей. Вестник СурГУ. Медицина. 2024; 17(1): 67-72.
  13. 13. Шаймонов А.Х., Раджабов М.Ф., Саидов М.С., Шамсов Н.Х. Анестезиологическая тактика при ведении пациентов с многочисленными повторными операциями по поводу последствий ожогов. Пластическая хирургия и восстановительная медицина. 2025; 1(1): 39-50. https://doi.org/10.65197/3106-4035-2025-1-1-39-50.
  14. 14. Prasad M.K., Jain P., Varshney R.K., Khare A., Jheetay G.S. Tumescent local anesthesia as an alternative to general anesthesia in release of post-burn neck contracture and skin graft harvesting: A comparative study. Anaesthesia, Pain & Intensive Care. 2021; 25(1): 35-41.
  15. 15. Karakol P., Bozkurt M. Recent strategic approach in postburn extremity scars and contractures. Journal of Plastic Surgery and Hand Surgery. 2021; 55(3): 153-161.
  16. 16. Yin Z., Zhang X.H., He Y.Y., Cai D., Zhou X., Li Y.T., Chen X.X. Combination therapy of pulsed dye laser and ablative fractional carbon dioxide laser for the treatment of pediatric postburn scar: a systematic review. Lasers in Medical Science. 2025; 40(1): 77. https://doi.org/10.1016/j.cps.2017.08.001.
  17. 17. Hosseini M.S., Nouri M., Zarrabi M., Fatemi M.J., Shpichka A., Timashev P., Vosough M. Platelet-rich plasma in regenerative medicine: possible applications in management of burns and post-burn scars: a review. Cell Journal (Yakhteh). 2023; 25(5): 281. https://doi.org/10.22074/CELLJ.2023.558213.1093.
  18. 18. Best M.W., Egro F.M., Alfaras-Melainis K. Role of the Anesthesiologist in Burn Management. Current Anesthesiology Reports. 2025; 15(1): 26.
  19. 19. Шаймонов А.Х., Раджабов М.Ф., Саидов М.С., Шамсов Н.Х. Анестезиологическая тактика при ведении пациентов с многочисленными повторными операциями по поводу последствий ожогов. Пластическая хирургия и восстановительная медицина. 2025; 1(1): 39-50. https://doi.org/10.65197/3106-4035-2025-1-1-39-50.
Information
Language

English

License

CC BY 4.0

Category

RECONSTRUCTIVE SURGERYRY

FINANCING

There was no financial suppor

CONFLICT OF INTEREST

The authors declare no conflict of interest.

INFORMATION ABOUT THE AUTHORS:

*Shamsov Nodir Khizmatulloevich – researcher at the endosurgery department of the Republican Scientific Center for Cardiovascular Surgery, Dushanbe, Tajikistan. 

E-mail: omarion@list.ru 

https://orcid.org/0000-0002-5811-003X 

Rakhmatova Rukhshona Akramovna – Doctor of Medical Sciences, Associate Professor, Leading Researcher at the Republican Scientific and Clinical Center for Pediatrics and Pediatric Surgery, Dushanbe, Tajikistan. 

E-mail: ruhsh6868@mail.ru 

https://orcid.org/0000-0003-1333-5427 

Musoev Sorbon Sheralievich – Candidate of Medical Sciences, Head of the Treatment and Diagnostic Department of the Republican Scientific Center for Cardiovascular Surgery, Dushanbe, Tajikistan. 

https://orcid.org/0000-0002-7178-5250 

E-mail: smusoev00@mail.ru 

Gulmuradov Ulugbek Tashpulatovich – Candidate of Medical Sciences, Head of the Department of Cardiovascular, Endovascular and Plastic Surgery named after professor T.G. Gulmuradov of the State Educational Institution «Institute of Postgraduate Education in Healthcare of the Republic of Tajikistan», Dushanbe, Tajikistan. 

E-mail: gulmurod777@mail.ru 

https://orcid.org/0009-0007-7799-8488 

*Correspondence address.