The resistance of bacteria to antibiotics is a major problem for anti-bacterial therapy. This problem may be solved by using bacteriophages—viruses that can attack and destroy bacteria, including antibiotic-resistant ones. In this article, the authors compared the efficacy of topical bacteriophage therapy and systemic antibiotic therapy in the treatment of wound infections caused by ESKAPE pathogens in patients with limited (less than 5% of the body surface) full-thickness burns. Patients in the study group (n = 30) were treated with PVA-based hydrogel dressings saturated ex tempore with a bacteriophage suspension characterized by its lytic activity against the bacteria colonizing the wound. Patients in the control group (n = 30) were treated using etiotropic systemic antibiotic therapy, and the wounds were covered with gauze bandages soaked in an aqueous solution of povidone-iodine. An assessment of the decrease in the level of bacterial contamination of the recipient wounds in both groups was conducted after 7 days, and after that, free skin grafting was performed. On day 14 after free skin grafting, patients in both groups underwent incisional biopsy. The study group demonstrated an increase in the indices of proliferative activity (Ki-67), and angiogenesis (CD-31, VEGF) in the area of engraftment of the split-thickness skin grafts. The results indicate that PVA-based hydrogel wound dressings can be used as bacteriophage carriers for local antimicrobial therapy ahead of free skin grafting.

Introduction. Burns of various etiologies are on the 3-4 place in frequency among all injuries, they are associated with a high percentage of complications, disability and mortality. Currently, a single algorithm for objective verification of the depth of skin damage has not been developed. Numerous diagnostic technologies used to solve this problem require systemic analysis.The aim of study was to analyze current literature data on technologies for instrumental diagnostics of the depth of thermal damage to the skin.Materials and methods. A search for literary sources in databases was conducted using eLIBRARY.RU, PubMed, Cyberleninka databases. The period of publications was limited to 2011-2020.Results. The method of objective "gold standard" verification of thermal damage to the skin remains a biopsy followed by morphological examination, but the method's traumaticity does not allow it to be used for monitoring the course of the process in dynamics, for multi-focal studies. Among non-invasive methods, dermatoscopy and video microscopy are noted, but the small imaging area and the need for direct contact of the device with the skin surface limit the use of these methods. Laser Doppler flowmetry and imaging are fairly accurate non-contact methods that allow assessing the condition of a burn wound in real time. The method is not applicable to wounds with blisters, insufficient sanitation. Laser speckle contrast imaging is used to evaluate blood flow and is based on the analysis of speckle structure fluctuations. The method allows determining the degree of burn damage depending on changes in the blood flow. However, the method is difficult to apply with a vessel diameter sized 40 microns. The method is sensitive to movement and internal factors. Infrared and Raman spectroscopy are technique for evaluating vibrational patterns in a particular spectrum, these can be used to identify a molecule or determine its structure. Simultaneous use of spatial frequency visualization and speckle imaging demonstrated a high level of correlation with the results of histological research, which makes the use of these methods promising. Ultrasound also provides a proper correlation with histological data, but it is an imperfect method due to inaccuracies in determining the thickness of the epidermis, dermis, and scar condition. Optical coherence tomography (OCT) is a non-invasive optical method that allows obtaining high-resolution images of skin architecture in real time. The high level of compliance of the visualized structures, in particular, layers, appendages and vessels of the skin, with histological findings, gave this method a name "optical biopsy". Anatomical congruence of normal and damaged skin was established in an experiment between histology and OCT.Conclusion. Early assessment of the depth of thermal damage to the skin is crucial for choosing a personalized treatment strategy for the burned. None of the modern diagnostic methods is universal. Multimodal approaches to diagnostics are the most effective.

Currently, the problem of antibiotic resistance of the most pathogenic microorganisms is very relevant, and therefore it is necessary to search for new ways to eliminate pathogens of the infectious process in chronic soft tissue wounds. The article presents generalized data from published scientific studies that substantiate the clinical potential of using bacteriophages for the rehabilitation of chronic soft tissue wounds. The results of domestic and foreign studies confirm the safety and effectiveness of the use of bacteriophages in the treatment of chronic soft tissue wounds. The main problems limiting the spread of phage therapy are the high specificity of phages and the technical complexity of their immobilization in the area of clinical interest. Further research is needed and promising in the field of phage therapy in order to improve the results of treatment of chronic soft tissue wounds.

This study uses a recently proposed phase-sensitive optical coherence elastography (OCE) method to visualize diffusion and associated skin dehydration by reconstructing osmotically induced strains and assessing topical solution penetration in ex vivo human shin, rat dorsal, and porcine perioral skin, as well as in vivo human forearm skin, for the first time. Aqueous glycerol, ethanol, and tartrazine solutions at various concentrations were investigated. Initial penetration kinetics were characterized over the first 150 s by monitoring penetration-associated osmotic-strains. OCE revealed that, during the initial penetration phase, porcine skin is markedly more permeable than human skin, despite its greater mechanical robustness, whereas rat skin exhibits comparable permeability to human skin. OCE imaging further showed that the stratum corneum (SC), a superficial layer only several tens of micrometers thick, provides the primary skin barrier, and that partial SC removal markedly increases permeability. Enhanced skin stabilization enabled preliminary in vivo measurements by suppressing motion artifacts caused by cardiac pulsation and respiration, and the results were consistent with ex vivo findings. These results indicate that, for the hydrophilic/polar substances tested, rat skin is a more representative model of human skin permeability than porcine skin, highlighting the potential of OCE for real-time monitoring of skin penetration and associated dehydration.