Effects of early eschar excision en masse at one operation for prevention and treatment of organ dysfunction in severely burned patients

We sought to determine whether early eschar excision en masse (EEE) at one operation would be effective in the prevention and treatment of postburn or gan dysfunction (OD) and multiple organ dysfunction syndrome (MODS), A tota l of 60 patients, with total body surface burned area over 35% and a third degree burn area over 20% were studied and divided into two groups, the EEE group (35 cases) and the group treated with repeated escharectomies by sta ges (repeated escharectomy group, 25 cases). Other than the different opera tions undertaken, the patients in both groups received identical convention al treatment. Before, during, and after operation the hemodynamic and blood gas indices, plasma levels of endotoxin and tumor necrosis factor (TNF), a nd the injurious effects of burn patients' sera on endothelial cells in vit ro were determined in patients of the EEE group. The incidence of OD and MO DS was decreased significantly (11.4%) in patients of the EEE group, and th e cure rate increased greatly (85.7%), The cardiac output dropped to 77.8% of ifs preoperative level at the end of escharectomy but began to rise at 2 hours and returned to its baseline levels at 24 hours after operation, pla sma levels of endotoxin and TNF and levels of lactic dehydrogenase and 6-ke to-prostaglandin F-1 alpha in the endothelial cell culture media were all r educed profoundly. The cultured endothelial cells maintained their original morphology. The findings substantiate the hypothesis that eschar excision en masse at one operation is feasible and effective in preventing and treat ing early postburn OD and MODS, mainly by alleviating systemic inflammatory response syndrome and endothelial cell injury.