Minimizing blood loss in burn surgery

Background: significant blood loss continues to plague early tangential exc ision of the burn wound. Although various techniques to reduce intraoperati ve blood loss have been described, there is an absence of uniformity and co nsistency in their application. Furthermore, it is unclear whether these te chniques compromise intraoperative tissue assessment and wound outcome, The purpose of this study was to evaluate the effects of a comprehensive intra operative blood conservation strategy on blood loss, transfusion requiremen ts, and wound outcome in burn surgery. Methods: An intraoperative blood conservation strategy (CONSV) that fnelude d donor site and burn wound adrenaline tumescence, donor site and excised w ound topical adrenaline, and limb tourniquets was prospectively evaluated a nd compared with a historical control group (HIST) where only topical adren aline and thrombin were applied to donor sites and excised wounds. Results: Estimated blood loss was reduced from 211 +/- 166 mt per percentag e body surface area excised and grafted in the HIST group to 123 +/- 106 mt in the CONSV group (p = 0.02), Similarly, the intraoperative transfusion r equirement in the HIST group was reduced from 3.3 +/- 3.1 units per case to 0.1 +/- 0.3 units per case in the CONSV group (p < 0.001), There was no co mpromise in wound outcome in the CONSV group, which had a mean skin graft t ake rate of 96 +/- 4.2%. Conclusion: The application of a strict and comprehensive intraoperative bl ood conservation strategy during burn excision and grafting resulted in a p rofound reduction in blood loss and transfusion requirements, without compr omising wound outcome.