Zawacki B E
Ann Surg. 1974 Jul;180(1):98-102. doi: 10.1097/00000658-197407000-00015.
It has been suggested that the ultimate depth of burn necrosis might be minimized by prevention or reversal of the progressive capillary stasis which occurs in the early postburn hours. To study the role of wound dehydration in determining burn depth, 5% body surface area, 75 C, 10 second burns (in which the zone of stasis included the full thickness of skin) were inflicted on the backs of guinea pigs and subsequent mechanical trauma was prevented. At various times postburn, water content, (and after India ink perfusion) depth of capillary stasis and histological structure of burn were studied in the following groups: 1) blister intact; 2) blister removed; and 3) blister replaced by several different types of dressing. Reversal of capillary stasis was least and necrosis full-thickness in depth in undressed wounds with blister removed. Reversal of capillary stasis was complete and necrosis absent with blister replaced by fresh split-thickness porcine skin and correlated with prevention of wound dehydration. Similar, though less complete, prevention of necrosis occurred with blister intact or replaced by sialastic film. Other dressings were associated with deep necrosis or gross infection. These and other data suggest that in the zone of stasis, capillary stasis may be reversed and necrosis avoided by appropriate prevention of wound dehydration. Clinical correlations are suggested.
有人提出，通过预防或逆转烧伤后早期出现的进行性毛细血管淤滞，可将烧伤坏死的最终深度降至最低。为了研究创面脱水在确定烧伤深度中的作用，对豚鼠背部造成5%体表面积、75℃、10秒的烧伤（其中淤滞区包括皮肤全层），并防止随后的机械性创伤。在烧伤后的不同时间，对以下几组进行了研究：1）水疱完整；2）水疱去除；3）水疱用几种不同类型的敷料替代。去除水疱的未包扎创面毛细血管淤滞的逆转最少，坏死深度达全层。用新鲜的中厚猪皮替代水疱时，毛细血管淤滞完全逆转且无坏死，这与防止创面脱水有关。水疱完整或用水凝胶膜替代时，也有类似但不太完全的坏死预防效果。其他敷料则与深部坏死或严重感染有关。这些及其他数据表明，在淤滞区，通过适当预防创面脱水，可逆转毛细血管淤滞并避免坏死。文中还提出了临床相关性。
