[Escharectomy during shock stage in extremely burned].

In order to stop excessive plasma loss, to alleviate noxious effects of devitalized tissues on the body, and to shorten the hospitalization time, we have attempted to perform extensive escharectomy during the shock period in extensively burned patients. Group 1 consisted of 17 patients, aged 19 to 45 years, with mean total burn area 58 +/- 15.9% TBSA, and full-thickness injury involving 32.0 +/- 17.2% TBSA. The first escharectomy was done at 26.2 +/- 14.6 h postburn, and excision area averaged 32.0 +/- 7.1% (24% to 46%). In 13 of them, Swan-Ganz catheter was introduced to monitor the hemodynamic changes. It was found that RAP, PAP, PAWP, ABP, HR, CO and CI were all stable during and after the operation. Group 2 consisted of 29 patients, in whom escharectomy was begun 4-5 days postburn. The mean healing time of the patients in group 1 was 31.7 days, which was shorter than that of group 2 (40.1 days). The duration of hemoconcentration was shorter in group 1. The amount of blood transfusion was almost 1000 ml less in group 1 during the first two weeks. Less antibiotics were used with fewer visceral complications in group 1. The authors believe that escharectomy during the burn shock stage is feasible.