Quantitative Estimation And Influential Factors Of Blood Loss During Tangential Excision And Skin Grafting In Extensive Deep Burns

ObjectiveDuring tangential excision and skin grafting (TESG) of burned wounds, lots of hemostasia approaches have been used but massive blood loss remains one of the most important complications of excision and skin grafting as well as one of the most important factors that affect intraoperative and postoperative homeostasis for extensive deep burns (EDB). It is still the important issue that perplex burn clinic and affect surgical safety in terms of how to accurately evaluate blood loss volume of burn surgery, timely and moderately transfuse blood. The objective of this study was to quantize and assess blood loss and transfusion during TESG for EDB patients, analyze and explore their influence factors. In order to provide some clinical reference for preoperative blood preparation, blood loss control, intraoperative and postoperative reasonable blood transfusionMethodsRigorous criteria of cases selection were set. Clinical data were retrospectively reviewed for all consecutive adult patients with EDB, undergoing early TESG and stable perioperative condition at Burn Center, Jinan Central Hospital Affiliated to Shandong University, from Jul 2008 to Jun 2014. Blood loss of 1% area excised per operation within postburn day 14 was calculated according to an existing blood loss volume calculated formula (Budny formula). The surgical blood loss volume, blood transfusion volume and haemoglobin level were quantitatively estimated, and influential factors, such as gender, age, weight, total burn area, deep partial-thickness burn area, full-thickness burn area, inhalation injury, postburn time of tangential excision, tangential excision area, whether or not using tourniquet, wound grafts, operation duration, on blood loss volume were compared and analyzed by using t-test, one-way analysis of variance, univariate and multiple regression analyses.Results(1) There totally were 96 patients with 110 times of TESG to be included in the study.83 of these were male and 13 were female. Their mean age was (34.5±12.2) years, total burn area was (71.5±16.7)% total body surface area (TBSA), of which full-thickness burn area was (46.7±22.0)% TBSA. Time of tangential excision was (5.8±2.9) days postburn, tangential excision including donor site area was (35.0±11.0) %TBSA, and the operation duration was (2.7±0.7) h. There were no severe postoperative complications and operative deaths in these patients.(2) Calculated blood loss and blood transfusion at operation and through the following 48h were (121.5±27.2) and (86.3±20.5) ml/1% area excised, respectively. Intraoperative, the first and second 24h postoperative blood transfusion were (53.8±13.9), (19.9±12.3) and (12.4±10.1) ml/1% area excised, respectively. Hb level of the first and second postoperative 24h were (97.7±11.1), (100.3±11.7) g/L, respectively.(3) Total burn area, full-thickness burn area, tangential excision time after injury, area excised, wound grafts and operation duration had significant impact on total blood loss (r=0.32,0.20,0.31,0.81,0.23,0.52, P<0.001 to 0.05). Area excised was the single predictor variable to total blood loss (r=0.841, r=0.707, P<0.001). Total blood loss volume was significantly increased in patients with over 30% area excised (P<0.001). However, blood loss of 1% area excised significantly increased with the decrease of area excised in patients with below 30% area excised (P<0.001 to 0.05). Blood loss of 1% area excised within 7 to 14 days postburn was significantly more than that within 4 to 6 days postburn (P<0.05). Limb surgeries without using tourniquet but using an improved hemostasis method, blood loss of per unit area had no significant difference when compared with using tourniquet (P>0.05).ConclusionsFor TESG perioperation of adult EDB,121.5、86.3 mL/1% area excised could respectively served as an reference value for budget of blood loss and transfusion, and Hb level should be sustained above 100g/L. The effective measures to reduce blood loss were operating surgery within 6 days postburn, controlling area excised below 30%TBSA, quick tangential excision and effective hemostasis, effective wound closure.