title: Experience and efficacy of surgery for retaining viable subcutaneous tissue in extensive full-thickness burns.
abstract: OBJECTIVE
  For adult patients with extensive full-thickness burns (EFTB), a fascial excision is mostly used but it causes a very significant deformity. This study aims to summarize experience and efficacy of surgery for retaining viable subcutaneous tissue in EFTB.
  
  
  METHODS
  Clinical data were reviewed for 31 consecutive adult patients with full-thickness burn (FTB) over 70% total body surface area (TBSA) and undergoing first tangential excision and skin grafting on subcutaneous tissue wound (TESGSTW) within 7 days post burn at our burn center between 2002 and 2013.
  
  
  RESULTS
  Average age, total burn area, and FTB area of 31 patients were 32.4 ± 12.8 years, 89.0 ± 6.2% and 80.4 ± 7.6% TBSA, respectively. Of these, 80.6% combined with inhalation injury and 71.0% supervened early shock. Eighteen patients who survived (58.1%) totally underwent 121 times of surgery, of which TESGSTW and autologous skin grafting were 41 and 88 times, respectively. Their average time and area of first tangential excision was 4.1 ± 0.6 days post burn and 33.8 ± 7.6% TBSA, respectively, and accumulated tangential excision area was 58.4 ± 10.8% TBSA. In 39 times of TESGSTW within 14 days post burn, cryopreserved alloskin or fresh young pigskin was applied on 84.6%, and average time and take rate of autologous skin grafting instead of grafted alloskin or xenoskin was 14.6 ± 0.7 days and 89.5 ± 1.4%, respectively. Scalp was the main donor site for autologous skin, especially microskin grafting. Systemic wound healing time roughly was 67.3 ± 1.9 days post burn, meanwhile, viable subcutaneous tissue was retained. Healed wounds were plump, and their extensibility and sensitivity were better by follow-up.
  
  
  CONCLUSIONS
  The surgical treatment in EFTB is practicable and effective.
authors.affiliation: Department of Burns, Jinan Central Hospital Affiliated to Shandong University, 105 Jiefang Road, Jinan, Shandong 250013, PR China. Electronic address: sgd.zxyy@163.com.
authors.forename: Guodong
authors.initials: G
authors.lastname: Song
authors.affiliation: Department of Burns, Jinan Central Hospital Affiliated to Shandong University, 105 Jiefang Road, Jinan, Shandong 250013, PR China. Electronic address: jiajun727@163.com.
authors.forename: Jun
authors.initials: J
authors.lastname: Jia
authors.affiliation: Department of Burns, Jinan Central Hospital Affiliated to Shandong University, 105 Jiefang Road, Jinan, Shandong 250013, PR China. Electronic address: yindongma@126.com.
authors.forename: Yindong
authors.initials: Y
authors.lastname: Ma
authors.affiliation: Department of Burns, Jinan Central Hospital Affiliated to Shandong University, 105 Jiefang Road, Jinan, Shandong 250013, PR China. Electronic address: shiwen2015@126.com.
authors.forename: Wen
authors.initials: W
authors.lastname: Shi
authors.affiliation: Department of Burns, Jinan Central Hospital Affiliated to Shandong University, 105 Jiefang Road, Jinan, Shandong 250013, PR China. Electronic address: wangfang108719@163.com.
authors.forename: Fang
authors.initials: F
authors.lastname: Wang
authors.affiliation: Department of Burns, Jinan Central Hospital Affiliated to Shandong University, 105 Jiefang Road, Jinan, Shandong 250013, PR China. Electronic address: peilongli1987@163.com.
authors.forename: Peilong
authors.initials: P
authors.lastname: Li
authors.affiliation: Department of Burns, Jinan Central Hospital Affiliated to Shandong University, 105 Jiefang Road, Jinan, Shandong 250013, PR China. Electronic address: gc2000_80@163.com.
authors.forename: Cong
authors.initials: C
authors.lastname: Gao
authors.affiliation: Department of Burns, Jinan Central Hospital Affiliated to Shandong University, 105 Jiefang Road, Jinan, Shandong 250013, PR China. Electronic address: zuohaibin1012@126.com.
authors.forename: Haibin
authors.initials: H
authors.lastname: Zuo
authors.affiliation: Department of Burns, Jinan Central Hospital Affiliated to Shandong University, 105 Jiefang Road, Jinan, Shandong 250013, PR China. Electronic address: fanchunjiess@163.com.
authors.forename: Chunjie
authors.initials: C
authors.lastname: Fan
authors.affiliation: Department of Burns, Jinan Central Hospital Affiliated to Shandong University, 105 Jiefang Road, Jinan, Shandong 250013, PR China. Electronic address: naijunxin123@163.com.
authors.forename: Naijun
authors.initials: N
authors.lastname: Xin
authors.affiliation: Department of Burns, Jinan Central Hospital Affiliated to Shandong University, 105 Jiefang Road, Jinan, Shandong 250013, PR China. Electronic address: qiuhew@hotmail.com.
authors.forename: Qiuhe
authors.initials: Q
authors.lastname: Wu
authors.affiliation: Department of Burns, Jinan Central Hospital Affiliated to Shandong University, 105 Jiefang Road, Jinan, Shandong 250013, PR China. Electronic address: sy-cgy@163.com.
authors.forename: Yang
authors.initials: Y
authors.lastname: Shao
mesh_terms: D000293:Adolescent; D000328:Adult; D001830:Body Surface Area; D002053:Burn Units; D002056:Burns / Q000601:surgery*; D003646:Debridement / Q000379:methods*; D000071938:Fasciotomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059351:Organ Sparing Treatments / Q000379:methods; D012189:Retrospective Studies; D016038:Skin Transplantation / Q000379:methods*; D040521:Subcutaneous Tissue / Q000601:surgery*; D016896:Treatment Outcome; D014945:Wound Healing; D055815:Young Adult
keywords: Burns; Skin grafting; Subcutaneous tissue; Tangential excision; Treatment outcome