Early burn wound excision significantly reduces blood loss.
The hypothesis that near-total early excision of large burns in children can be performed safely with a reduction in blood loss was tested. Of 1662 acutely burned patients admitted to this institution between 1982 and 1989, 594 underwent near-total excision of cutaneous flame or scald burn injuries in a single procedure. Operations took less than 3 hours and there were no operative deaths. Blood losses in burns of more than 30% total body surface area (TBSA) were significantly less at 0.40 +/- 0.06 mL/cm2 and 0.49 +/- 0.49 mL/cm2 excised when surgery was performed within the first 24 hours or after the 16th day after burn, respectively, when compared to 0.75 +/- 0.02 mL/cm2 for those excised between 2 and 16 days after burn (p less than 0.05). Blood loss for burns of less than 30% TBSA was of 1.19 +/- 0.13 mL/cm2. Early excision did not increase mortality rate when compared to later excision times. We suggest that near-total excision of large burns within the first 24 hours reduces blood requirements and morbidity without adversely altering hemodynamic stability or increasing mortality risks.
Desai
M H
MH
Shriners Burns Institute-Galveston, TX 77550.
Herndon
D N
DN
Broemeling
L
L
Barrow
R E
RE
Nichols
R J
RJ
Rutan
R L
RL
D001803:Blood Transfusion; D002056:Burns / Q000401:mortality / Q000601:surgery*; D002648:Child; D005440:Fluid Therapy; D006400:Hematocrit; D006470:Hemorrhage / Q000517:prevention & control*; D006488:Hemostasis, Surgical; D006801:Humans; D007430:Intraoperative Care; D008991:Monitoring, Physiologic; D013997:Time Factors