Tangential excision of deep partial thickness burn wound during an early stage without tourniquet

Abstract

To explore the clinical efficacy of tangential excision of deep partial thickness burn wound without tourniquet during an early stage. A total of 32 patients with a large area of deep partial thickness burn wounds were operated within 24 h post-burn. The lamellar tangential excision was on the basis of stable index of resuscitation from shock without tourniquet. And the depth of tangential excision was achieved to the extent of uniform punctate hemorrhage on burn wounds. Xenogenic acellular dermal matrix was applied after hemostasis with diluted adrenaline. The intraoperative blood loss volumes, operative durations, pre- & post-operative temperatures, length of wound healing, the quality of wound healing and the contracture extent of scars of 1%TBSA (total body surface area) wound were recorded and compared with the published data. Thirty-one patients completed the whole clinical observation. The intraoperative blood loss volume of 1% TBSA wound was (8.8 ± 0.9) ml, the operative duration of 1%TBSA wound was (0.52 ± 0.06) min, the temperature at Day 5 was (37.7 ± 0.7)°C and it was significantly lower than that at 24 h [(38.6 ± 0.6)°C] (t = 0.42, P < 0.05), the length of wound healing was (25.2 ± 2.2) d. There were significantly statistical differences in terms of the operative durations, the temperature at Day 5 and the length of wound healing with the corresponding literature reports with intra-operative uses of tourniquets (all P < 0.05). The percentage of the quality of wound healing was 100% at Month 3. The development of scar proliferation were observed in varying degrees. Mild contracture of wounds appeared after 6 month post-burn. But all joints could move with ease and had no obvious dysfunction. Lamellate tangential excision of deep partial thickness burn wound during an early stage without tourniquet have advantages of smaller volumes of intraoperative blood loss, shorter operation duration and simpler procedures. Also the depth of tangential excision is easier to control so as to enhance the quality of wound healing.