[Early excision and grafting in the burned child. Apropos of 49 cases studied retrospectively 1986-1987].
Early excision and grafting (EEG) is a commonly-used surgical technique which limits the risk of infection and improves healing. However, when used on children, their particular anatomic and physiological specificities must be taken into account. The authors present a retrospective investigation concerning 49 EEG performed on 45 patients from five months to nineteen years old, presenting a burnt skin surface of between 1% and 70%. This short operation (1 h 30) gives rise to an important and early haemorrhage induced by blood losses which are impossible both to stop and to evaluate. This explains the frequency and the severity of the peroperative complications (one cardiocirculatory deficiency, eleven low blood pressure/tachycardias) related to an underestimated blood loss. The post-operative period is characterized by hemodynamic, infectious and hypothermic complications. As regards operative results, they can be considered to be good or excellent in 80% of the cases both from a functional and an anaesthetic point of view. In order to decrease the important operative morbidity related to EEG in the case of children, the authors stress the necessity or taking certain precautions: During the operative period --Antibiotic prophylaxis against cutaneous bacteria when the excision is important and BSS greater than 20%; --ordering sufficient quantities of blood and plasma taking into account the estimated amount of blood losses during the per and post-operative period, and also with regard to the patient's weight and the excised (AE): During the operation --prevention of hypothermia by the permanent use of an infrared radiator, warming up the solutions before perfusion, using of a heating mattress...); --provision of two large diameter venous passages; --initiation of the transfusion before the first incision.(ABSTRACT TRUNCATED AT 250 WORDS)
Boussard
N
N
Département d'Anesthésie-Réanimation, CHU de Nancy-Brabois, Vandoeuvre-les-Nancy.
Gayet
C
C
Rose
E
E
Prevot
J
J
D000293:Adolescent; D002056:Burns / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D005260:Female; D005440:Fluid Therapy; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy; D006801:Humans; D007223:Infant; D008297:Male; D011182:Postoperative Care; D012189:Retrospective Studies; D016038:Skin Transplantation; D014182:Transplantation, Autologous
Excision greffe précoce chez l'enfant brûlé. A propos de 49 cas, étude rétrospective 1986-1987.