Early Burn Wound Excision Significantly Reduces Blood Loss

Desai, M. H.; Herndon, David N.; Broemeling, Lyle D.; Barrow, Robert E.; Nichols, Ray J.; Rutan, Randi L.

doi:10.1097/00000658-199006000-00015

Cited by 178 publications

(63 citation statements)

References 32 publications

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“…Early excision of burn wounds has been shown, by our institution and others, to directly benefit patients through reducing blood loss at operation, 28 decreasing overall hospital stay, 29 and limiting serious infectious complications, 30,31 but has not previously been shown to alter the metabolic response. 32 The association between burn-induced hypermetabolism and muscle wasting has been controversial.…”

Section: Discussionmentioning

confidence: 85%

Determinants of Skeletal Muscle Catabolism After Severe Burn

et al. 2000

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ObjectiveTo determine which patient factors affect the degree of catabolism after severe burn. Summary Background DataCatabolism is associated with severe burn and leads to erosion of lean mass, impaired wound healing, and delayed rehabilitation. MethodsFrom 1996 to 1999, 151 stable-isotope protein kinetic studies were performed in 102 pediatric and 21 adult subjects burned over 20 -99.5% of their total body surface area (TBSA). Patient demographics, burn characteristics, and hospital course variables were correlated with the net balance of skeletal muscle protein synthesis and breakdown across the leg. Data were analyzed sequentially and cumulatively through univariate and cross-sectional multiple regression. ResultsIncreasing age, weight, and delay in definitive surgical treatment predict increased catabolism (P Ͻ .05). Body surface area burned increased catabolism until 40% TBSA was reached; catabolism did not consistently increase thereafter. Resting energy expenditure and sepsis were also strong predictors of net protein catabolism. Among factors that did not significantly correlate were burn type, pneumonia, wound contamination, and time after burn. From these results, the authors also infer that gross muscle mass correlates independently with protein wasting after burn. ConclusionsHeavier, more muscular subjects, and subjects whose definitive surgical treatment is delayed are at the greatest risk for excess catabolism after burn. Sepsis and excessive hypermetabolism are also associated with protein catabolism.The hypermetabolic response to severe burn trauma and sepsis is associated with increased energy expenditure and energy substrate release from protein and fat stores.

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Section: Discussionmentioning

confidence: 85%

Determinants of Skeletal Muscle Catabolism After Severe Burn

et al. 2000

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“…3,21 We believe that the use of this surgical approach in our patient population is primarily responsible for the low death rate in the patients who survived more than 30 days after the burn. Survival in the overall population with burns of more than 90% TBSA was also improved by this technique.…”

Section: Discussionmentioning

confidence: 97%

Cost-Efficacy of Cultured Epidermal Autografts in Massive Pediatric Burns

Barret¹,

Wolf²,

Desai³

et al. 2000

Annals of Surgery

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ObjectiveTo assess the efficacy of cultured epidermal autografts (CEA) for closure of burn wounds in pediatric burn patients with fullthickness burns of more than 90% total body surface area. Summary Background DataPaucity of donor sites in massive burns makes the use of expanded skin of paramount importance. CEA techniques have been used in burned patients with differing and controversial results. The true impact and the efficacy of such techniques in massive burns remain uncertain. MethodsPatients with full-thickness burns of more than 90% body surface area treated between May 1988 and May 1998 were studied. Patients grafted with CEA were compared with patients grafted with conventional meshed autografts. Rates of death and complications, length of hospital stay (LOS), hospital cost, acute readmissions for reconstruction, and quality of scars were studied as outcome measures. ResultsPatients treated with CEA had a better quality of burn scars but incurred a longer LOS and higher hospital costs. Both groups had comparable readmissions for open wounds, but patients treated with CEA required more reconstructive procedures during the first 2 years after the injury. The incidence of sepsis and pneumonia in both groups was comparable. ConclusionsConventional meshed autografts are superior to CEA for containing hospital cost, diminishing LOS, and decreasing the number of readmissions for reconstruction of contractures. However, the use of CEA provides better scar quality such that perhaps future research should focus on bioengineered dermal templates to promote take and diminish long-term fragility.Severe full-thickness burns covering more than 90% of the total body surface area (TBSA) continue to pose an immense challenge to even the most experienced burn teams. In the past few decades, the burn-related death rate has declined dramatically, and this can be attributed in part to early excision and closure of the burn wound. Currently, even children sustaining full-thickness burns of more than 90% TBSA have a better than 50% rate of survival. 1The approach to skin coverage in the massively burned patient depends on the type and extent of injury. Burns of less than 30% TBSA can be covered with autograft skin at one operation. In full-thickness burns of more than 30% TBSA, however, the autograft donor site is quickly exhausted, so that alternative skin coverage is necessary. This is particularly true in patients with massive burns, in whom a paucity of donor sites makes skin substitutes and the use of expanded skin of paramount importance. For years, these patients have been treated with traditional methods of widely expanded meshed autografts with an overlay of cadaveric allograft. 2,3 More recently, the use of cultured epidermal autografts (CEA) has been advocated for wound closure in massive burn injury. 4 Nevertheless, cost, longterm fragility, and the lack of an optimal dermal equivalent for CEA have restricted its routine use. 5,6 Recurrent open wounds, increased rates of burn scar contractures, and troublesome re...

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“…33,34 Recent studies by Herndon and associates have shown that burn wound excision reduced blood loss, reduced mortality, and improved wound healing. 21,35 If indeed the burn wound provides a potential source of inflammatory mediators, early removal of this damaged tissue would be expected to interrupt inflammatory cell signaling, to reduce proinflammatory cytokine synthesis, to improve downstream organ function, and to decrease susceptibility to subsequent infection. Studies described herein support that premise.…”

Section: Discussionmentioning

confidence: 99%

“…14 -17 However, cutaneous burns and loss of the dermal barrier renders the burn subject susceptible to bacterial invasion via the burn wound; in this regard, Barret and Herndon showed greater bacterial colonization of the burn wound bed and increased rates of infection with delayed burn wound excision. 18 Numerous other studies have described that early excision of the burn wound modulated systemic inflammatory cytokine responses to burn injury, 19 attenuated muscle catabolism, 20 decreased operative blood loss, 21 decreased length of hospitalization, and decreased the incidence of wound infection. 22 However, the effects of early burn wound excision on myocardial inflammation and dysfunction have not, to our knowledge, been studied.…”

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confidence: 99%