A Study About Tangential Excision Within 24 Hours After Injury With Large Area Of Deep â…¡ Degree Burns Wounds IL-1 Release And Clinical Observation Of Wound Healing

Objective: The study was going to evaluating the security of tangential excision within 24h for the large area of deepⅡdegree burns, at the same time, proving that tangential excision within 24h could reduce inflammation and prevent the wound progressive damage, and promote the release level of IL-1 to the deepⅡdegree burn wounds, accelerate wound healing.Methods:7 patients with large area of deepⅡdegree burns were chosen for our study. Each burn wound of the selected patients was relatively uniform deepⅡdegree burn wound area as the experimental study area, and the experimental area was divided into three regions: the preoperation area, post- operation area and non-operation area. Tangential excision was performed within 24 hours postburn. For each patient, the samples from the pre-operation area were collected before the tangential excision, those from post-operation and non-operation area were gained on 3～5 days postoperation. The tissue specimens were examined by histopathologically HE staining and Masson staining, and the extent of wound inflammation responds was examined in the light microscope. The release level of IL-1 was experimented by immunohistochemical techniques. All the observation was changed to semi-quantitative data. It was necessary to recording vital signs and wound healing time of the patients. Statistical software used SPSS17.0 statistics package, semi-quantitative analysis of the data was analyzed by rank sum test, vital monitoring data using paired t test analysis, P<0.05 as statistically significant difference.Results:①in advance a positive and effective anti-shock fluid resuscitation, adequate volume of blood circulation, there were not the occurrence of compli- cations because of surgery, indicate it is safe that operating within 24h of tangential excision surgery on the large area of deepⅡdegree burns patients;②histopathological examination of the samples from burn wound tissue of seven patients showed experimental area were all deepⅡdegree burn wounds before the surgery, the skin locating the burn wounds was coagulation necrosis, and small amount of sweat glands was residual; the samples of non-operation area after 3~5d had changed from the coagulation necrosis to solution necrosis, the wound inflammation responds had significantly increased, tissue necrosis had extended,most of appendages of the skin had disappeared; but the samples of post-operation area were still appendages reserved, there was no obvious organization necrosis;③the outcome obtained from the expression of IL-1 semi-quantitative analysis showed that the release level of IL-1 in the partial tissue from the post-operation area has significantly increased than the non-operation area and the pre-operation area(P<0.05),the difference was statistically significant;④by tangential excision within 24h to deal with the wound the wound could be healed advanced 6~11d to traditional surgical treatment of wounds. Conclusion: depending on the active and effectual anti-shock, we can ensure that it is safe that operating tangential excision surgery within 24h to the large area of deepⅡdegree burns; it might beneficial to removal of necrotic tissue by tangential excision within 24h postburn, which could prevent form the progression of tissue degenerative injury, increase the release level of IL-1. Therefore the healing process of deepⅡdegree burn wound is accelerated.