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[Efficacies of treating large area third-degree burns by tangential excision and skin grafting for subcutaneous tissue wounds].

OBJECTIVE
To explore the efficacies of treating patients with large area third-degree burns by tangential excision and skin grafting for subcutaneous tissue wounds.


METHODS
From January 2002 to December 2013, the medical records were retrospectively reviewed for 31 consecutive adult patients with a third-degree burn area exceeding 70% and undergoing tangential excision and skin grafting on subcutaneous tissue wound (TESGSTW) for the first time within 7 days postburn at Burn Center, Affiliated Jinan Central Hospital, Shandong University. For 31 patients, wounds with relative integrity eschar underwent TESGSTW by stages. Tourniquet was not used in some extremities. The relevant clinical data including patient condition on admission, causes of death, blood loss of tangential excision wound, surgical procedures and efficacies in cured group were analyzed.


RESULTS
Average age, burn total area and third-degree burn area of 31 patients were (32.4 ± 12.8) years, (89.0 ± 6.2)% and (80.4 ± 7.6)% respectively. There were inhalation injury (n = 25, 80.6%) and early-stage shock before hospitalization (n = 22, 71.0%). Among 18 cured ones (58.1%), 2 patients had a third-degree burn area ≥ 90%. And 13 patients (41.9%) died and 10 of them died at 4 to 19 days postburn. Burn area was a risk factor of burn mortality. Sepsis and multiple organ dysfunction syndrome (MODS) were major mortality causes. Four patients died from early-stage sepsis. Within 14 days postburn, average blood loss volume per 1% tangential excision area in non-tourniquet group was slightly higher than that in the tourniquet group, but the difference was insignificant. For 18 cured patients, TESGSTW were performed 41 times. For 14 patients (77.8%), TESGSTW was performed twice. The average time of the first tangential excision was (4.1 ± 0.6) days postburn, the time interval between the first two tangential excisions was (6.4 ± 2.0) days, the first tangential excision area (33.8 ± 7.6)% and accumulated tangential excision area (58.4 ± 10.8)%. Among 39 operations within 14 days postburn, refrigerated allogeneic or fresh porcine skin grafts were involved 33 times (84.6%). The wounds were fresh and bleeding after peeling 5 to 7 days postoperation. The time of allogeneic (xenogeneic) skin removal or rejection, recipient bed debridement and auto-skin grafting was (18.0 ± 4.8) days postoperation. And the auto-skin survival rate was (89.5 ± 9.5)%. Wound infection occurred 5 times in 4 patients. During a follow-up period of 6-108 months after TESGSTW, healed wound surface was plump and contraction relatively mild and non-prone to ulceration. And both extensibility and sensitivity were good.


CONCLUSIONS
TESGSTW is safe for treating patients with large area third-degree burns. And its short and long-term outcomes are favorable.