Damage Control Tactics for Personalized Surgical Treatment of Patients with Deep Burns

Relevance The optimal timing of surgical treatment for deep burns has not been definitively established. Extensive interventions in unstable patients risk worsening their condition due to the “second strike” principle, while delaying surgery can lead to infectious complications. An individualized approach based on an integrated assessment of the prognosis of the injury outcome and the patient’s current condition is required.

Aim of the study To evaluate the effectiveness of an algorithm for selecting surgical treatment tactics based on an integrated assessment of the revised Frank Index, the probability of favorable outcome (PFO), and the SOFA score in patients with deep burns.

Material and methods This single-center retrospective-prospective cohort study included 320 patients with deep burns. A retrospective (n=213, treated in 2019–2022) and prospective (n=107, treated in 2023–2025) groups were formed. In the prospective group, treatment tactics were determined using the following algorithm: early surgical treatment was performed with PFO ≥50% and SOFA <4 points; with PFO <50% and a SOFA score ≥4, radical surgery was postponed.

Results Using the algorithm allowed us to differentiate surgical tactics. In patients with PFO ≥50%, the time to first necretomy was reduced from 12 (9; 16) to 10 (8; 13) days (p=0.001), and the time to first autologous skin grafting was reduced from 23 (16; 27) to 20 (17; 22) days (p<0.001). In patients with PFO <50%, the use of the algorithm resulted in a delay in the initial intervention (the necretomy time increased from 10 (6; 13) to 12 (10; 15) days, p=0.016) and a reduction in mortality from 40% to 6% (p=0.010).

Conclusion The algorithm implementing damage control principles in burn trauma is an effective tool for personalizing surgical tactics. Its use allows for shorter surgical timing in stable patients and lower mortality by justifiably delaying surgical intervention in critically ill patients.

1. Wolf SE, Cancio LC, Pruitt BA. Epidemiological, Demographic and Outcome Characteristics of Burns. In: Herndon DN. (ed.). Total Burn Care (Fifth Edition). Elsevier; 2018:14–27.e2. https://doi.org/10.1016/B978-0-323-47661-4.00003-4

2. Zinoviev EV, Soloshenko VV, Kourov AS, Shapovalov SG. On the issue of tangential necrectomy in burn surgery (literature review). Medicо-Biological and Socio-Psychological Problems of Safety in Emergency Situations. 2020;(3):24–35. (In Russ.) https://doi.org/10.25016/2541-7487-2020-0-3-24-35

3. Eftekhari H. Early wound excision in burned patients. Burns. 2024;50(1):283-284. https://doi.org/10.1016/j.burns.2023.09.023

4. Rennekampff HO, Tenenhaus M. Damage Control Surgery after Burn Injury: A Narrative Review. Eur Burn J. 2022;3(2):278–289. https://doi.org/10.3390/ebj3020024

5. De La Tejera G, Corona K, Efejuku T, Keys P, Joglar A, Villarreal E, et al. Early wound excision within three days decreases risks of wound infection and death in burned patients. Burns. 2023;49(8):1816–1822. https://doi.org/10.1016/j.burns.2023.06.003

6. Cavadore T, Goronflot T, Kanlagna A, Cavadore N, Perrot P, Lancien U. Early excision and sequelae of facial and cervical burns: A matched-cohort study of 110 patients. Burns. 2025;51(9):107678. https://doi.org/10.1016/j.burns.2025.107678

7. Zhirkova EA, Spiridonova TG, Sachkov AV, Medvedev AO, Eliseenkova EI, Borisov IG, et al. Comparing the Indices predictive of the thermal injury outcome. Transplantologiya. The Russian Journal of Transplantation. 2024;16(1):64–73. (In Russ.). https://doi.org/10.23873/2074-0506-2024-16-1-64-73

8. Zhirkova EA, Spiridonova TG, Sinyakova OG, Sachkov AV, Medvedev AO, Eliseenkova EI, et al. Method for Predicting the Outcome of Burn Injury Based on a Mathematical Model. Russian Sklifosovsky Journal Emergency Medical Care. 2025;14(1):61–68. (In Russ.). https://doi.org/10.23934/2223-9022-2025-14-1-61-68

9. Zhirkova EA, Spiridonova TG, Sachkov AV, Eliseenkova EI, Borisov IG, Medvedev AO, et al. Prognostic capabilities of the sofa score in patients with thermal injury. Russian Journal of Anesthesiology and Reanimatology. 2025;(1):36–43. (In Russ.). https://doi.org/10.17116/anaesthesiology202501136

10. Alekseev AA, Aref’ev IYu, Bobrovnikov AE, Bogdanov SB, Budkevich LI, Zhirkova EA, et al. Ozhogi termicheskie i khimicheskie. Ozhogi solnechnye. Ozhogi dykhatel’nykh putey: natsynal’ klinicheskie rekomendatsii. Moscow: MZ RF; Ob”edinenie kombustiologov “Mir bez ozhogov” Publ., 2024. (In Russ.)

11. Popov AYu, Petrovsky AN, Bondarenko YuS, Baryshev AG, Porkhanov VA. Damage control strategy in surgical treatment of patients with severe gastroduodenal bleeding. Pirogov Russian Journal of Surgery. 2022;(9):35–39. (In Russ.). https://doi.org/10.17116/hirurgia202209135

12. Vostroknutov IV, Grigoricheva LG, Egorov AF, Shaltagachev AV, Kuka IV. Delayed esophagojejunostomy as a damage control principle. Pirogov Russian Journal of Surgery. 2023;(10):129–132. (In Russ.). https://doi.org/10.17116/hirurgia2023101129

13. Nikolaev DV, Fomina MN, Diakova OV, Fomin VS. Damage control. The history and modern view on surgical tactics. Moscow Surgical Journal. 2023;(1):110–117. (In Russ.). https://doi.org/10.17238/2072-3180-2023-1-110-117

14. Spiridonova TG, Zhirkova EA, Sinyakova OG, Sachkov AV, Brygin PA, Eliseenkova EI, et al. Sposob prognozirovaniya blagopriyatnogo iskhoda u patsientov s termicheskoy travmoy dlya vybora taktiki lecheniya (varianty). Patent 2825062 13 S1 RF, decl. 11.10.2023, publ. 19.08.2024. Bull. No 23. (In Russ.) Available at: https://patentimages.storage.googleapis.com/7b/cc/c3/e6e84e0eebfe60/RU2825062C1.pdf [Accessed Mar 11, 2026]

15. Zhirkova EA, Spiridonova TG, Sachkov AV, Rebrova OYu, Petrikov SS. Revision of the Frank Index for Predicting Death in Thermal Injury. Russian Sklifosovsky Journal Emergency Medical Care. 2023;12(2):224–229. (In Russ.). https://doi.org/10.23934/2223-9022-2023-12-2-224-229

16. Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society, of Intensive Care Medicine. Intensive Care Med. 1996;22(7):707–710. https://doi.org/10.1007/BF01709751

17. Zhirkova EA, Sachkov AV, Spiridonova TG, Borovkova NV, Medvedev AO, Pidchenko NE, et al. Burns and donor site treatment using allogeneic type I collagen. Transplantologiya. The Russian Journal of Transplantation. 2022;14(4):432–443 https://doi.org/10.23873/2074-0506-2022-14-4-432-443

18. Cohen J.E. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. New York: Lawrence Erlbaum Associates Pabl.; 1988.

19. Kholmatova KK, Kharkova OA, Grjibovski AM. Cohort Studies in Medicine and Public Health. Human Ecology. 2016;(4):56–64. (In Russ.)

20. De La Tejera G, Corona K, Efejuku T, Keys P, Joglar A, Villarreal E, et al. Early wound excision within three days decreases risks of wound infection and death in burned patients. Burns. 2023;49(8):1816–1822. https://doi.org/10.1016/j.burns.2023.06.003

21. Wong L, Rajandram R, Allorto N. Systematic review of excision and grafting in burns: Comparing outcomes of early and late surgery in low and high-income countries. Burns. 2021;47(8):1705–1713. https://doi.org/10.1016/j.burns.2021.07.001

22. Miroshnychenko A, Kim K, Rochwerg B, Voineskos S. Comparison of early surgical intervention to delayed surgical intervention for treatment of thermal burns in adults: A systematic review and meta-analysis. Burns Open. 2021;5(2):67–77. https://doi.org/10.1016/j.burnso.2021.02.003

23. Hayashi K, Sasabuchi Y, Matsui H, Nakajima M, Otawara M, Ohbe H, et al. Does early excision or skin grafting of severe burns improve prognosis? A retrospective cohort study. Burns. 2023;49(3):554–561. https://doi.org/10.1016/j.burns.2023.01.013