EXTENSIVE WOUND EXCISION IN THE ACUTE SHOCK STAGE IN PATIENTS WITH MAJOR BURNS

In order to reduce excessive;plasma lass, to alleviate the effects of devitalized tissues on the body, and to shorten the time in hospital, we attempted to perform extensive escharectomy during the shock period in extensively burned patients. Group A consisted of 21 patients, age d 9-45 years, with a mean total burn area of 63.2 +/- 18.1 per cent TB SA, and full-thickness injury involving 35.9 +/- 19.6 per cent TBSA. T he First escharectomy was performed at 24.1 +/- 13.9 h postburn. The e xcision area averaged 32.3 +/- 6.7 per cent TBSA (range 24-96 per cent ). In 15 patients a Swan-Ganz catheter was introduced to monitor haemo dynamic changes. II teas found that RAP, PAI), PAWP, ABP, HR, CO and C I were all stable during and after the operation. Group B consisted of 29 patients, and escharectomy was begun 4-5 days postburn. The mean h ealing lime of the patients in group A was 33.1 days, which was shoute r than that in group B (40.1 days). The period of haemoconcentration w as shorter in group A and the amount of blood required during the firs t 2 weeks was almost 700 mi less in group A. There were fewer visceral complications in group A and smaller amounts of antibiotics were requ ired in this group. The authors believe that escharectomy during the s hock stage is feasible.