Evaluation of skin graft take following post-burn raw area in normovolaemic anaemia

Abstract

Background:Traditional wisdom is that wound healing is directly related to haemoglobin level in the blood; therefore blood transfusion is given in anaemic patients to raise the haemoglobin level for better wound healing.Methods:Evaluation of wound healing in the form of split thickness skin graft take was done in 35 normovolaemic anaemic patients (haemoglobin level of < 10 gm/ dl) and compared with control group (patients with haemoglobin level of 10 or > 10 gm/ dl).Results:There was no statistically significant difference in mean graft take between the two groups.Conclusion:It is not mandatory to keep haemoglobin level at or >10 g/dL or PCV value at or >30% for skin graft take, as mild to moderate anaemia per se does not cause any deleterious effect on wound healing; provided perfusion is maintained by adequate circulatory volume. Prophylactic transfusion to increase the oxygen carrying capacity of the blood for the purpose of wound healing is not indicated in asymptomatic normovolemic anaemic patients (with haemoglobin levels greater than 6g/dL) without significant cardiovascular or pulmonary disease.

Burn wound healing and treatment: review and advancements

“…Other anabolic agents, such as oxandrolone, have been shown to increase lean body mass recovery, decrease length of stay, and improve overall outcomes, including wound healing [ 97 – 100 ]. Additionally, while conventional theory suggests that hemoglobin levels must be maintained above 10 g/dl to promote wound healing [ 101 ], preliminary evidence suggests that mild to moderate anemia has no effect on graft success if perfusion is maintained with proper circulatory volume [ 102 ]. The results of a multicenter, randomized, controlled trial (ClinicalTrials.gov NCT01079247) comparing blood transfusion with lower volumes (target hemoglobin of 7 to 8 g/dl) and conventional volumes (target hemoglobin >10 g/dl) for a large cohort of patients are expected soon and will allow for more definitive clinical guidelines on blood transfusion volumes.…”

Relationship between Split-thickness Skin Graft and Hemoglobin Level in Burn Patients

“…The decision to transfuse blood either before or after surgery should be considered if the patient's Hb level is less than 10 g/dL. 4 Blood transfusion is an integral aspect of major burn management. 5 From our viewpoint, we recommend performing the transfusion in the first 12 hours after surgery.…”