A Two-stage Technique for Excision and Grafting of Burn Wounds

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Abstract
While the technique of early excision and grafting has many advantages in the treatment of thermal injuries, it is not without significant complications. Hemorrhage accompanying burn wound excision can be deceptively great, as can the metabolic stress of large surgical procedures performed in the postburn period. In an effort to minimize these complications, a 2-stage technique was developed for excision and grafting of burn wounds. This technique employs layered excision of eschar, followed by an overnight stabilization period for restoration of normal body temperature and blood volume. Continuous soaking of excised areas promotes hemostasis, and insures a viable base for autografting performed on the following day. During 1978-1979, 117 burn patients underwent 137 2-stage excision and grafting procedures. Mean graft size was 1988 cm2. Of the patients, 82% had all necessary grafting performed in a single 2-stage operation, including grafts as large as 5700 cm2. No graft loss occurred as a result of graft hematoma formation. Mean blood loss calculated for each 2-stage operation was 2627 cm3, 1/3 of which resulted from the harvesting of autografts. Temperature decrease during surgery was also great, with significant hypothermia occurring in 51% of procedures exceeding 2 h in length. Performing excision and grafting in 2 stages limits hemorrhage and heat loss from each individual surgery, thereby permitting the performance of larger procedures. Continued awareness of the magnitude of these complications remains an essential of successful excisional therapy.

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