Problems of surgical treatment of deep burns

Background. Patients with deep burns require surgical treatment, but the timing and scope of surgical interventions have not yet been defined. Objective. To analyze the world experience of surgical treatment of deep burns. Material and methods. The literature sources on the topic were searched for in the electronic databases: PubMed, Scopus, CrossRef for the period from 1947–2023. The work includes some early basic publications on the surgical treatment of deep burns; the current state of the problem has been analyzed in articles over the past 20 years. Conclusion. Data from foreign literature sources show that in low-income countries, the efficacy of early necrectomy has not been confirmed, which can be attributed to the lack of burn departments, donor blood, wound dressings. In developed countries of Europe, the USA, Japan, active surgical tactics are currently used and it is a rule to perform necrectomy on the first days of the patient's admission at the hospital. In numerous studies, the authors claim that the results of early necrectomy and skin grafting are better than those with delayed operations, but the data on mortality are ambiguous. The authors point out that high mortality is attributed to the elderly age of patients, a larger area of deep burns and the presence of inhalation injury. At the same time, none of the developed prognostic indices that include the above mentioned predictors of a fatal outcome of burn injury have been used for planning a surgical intervention.