Herndon D N, Rutan R L
Shriners Burns Institute-Galveston, Texas.
J Burn Care Rehabil. 1992 Jan-Feb;13(1):154-7. doi: 10.1097/00004630-199201000-00034.
The chief determinant of mortality in severe burn injuries has been the size and severity of the wound. Early massive excision of the wound has increased the median lethal dose to 98% of total body surface area burn but presents the problem of wound closure. Autograft substitutes must be used for a large burn. We report our experience with early massive excision in the treatment of 47 pediatric patients with burns who had greater than 80% total body surface area burn and greater than 80% full-thickness burn. Four patients died within hours of admission. Fifteen patients died of sepsis and multiorgan failure; the primary source of bacterial contamination was the open wound. The 28 survivors received approximately 2.0 m2 2:1 homograft until autograft became available. A case report of a 10-year-old boy illustrates the use of two types of cultured epidermal autograft, one "homegrown" and one commercially produced.
严重烧伤患者死亡的主要决定因素是伤口的大小和严重程度。早期大面积切除伤口已将致死中量提高到全身表面积烧伤的98%，但存在伤口闭合的问题。对于大面积烧伤必须使用自体移植替代物。我们报告了对47例烧伤患儿进行早期大面积切除治疗的经验，这些患儿的烧伤面积超过全身表面积的80%，且深度烧伤面积超过80%。4例患者在入院数小时内死亡。15例患者死于败血症和多器官功能衰竭；细菌污染的主要来源是开放性伤口。28名幸存者接受了约2.0平方米的2:1同种异体移植，直到有自体移植可用。一名10岁男孩的病例报告说明了两种培养的表皮自体移植的使用情况，一种是“自家培养的”，另一种是商业生产的。
