Procedures Procedure

Authors: Rami Mossad Ibrahim, MD, Elisabeth Lauritzen, MD, Frederik Gulmark, Hansen Med. Stud., Anne Mosebo, Med. Stud., Magnus Balslev Avnstorp, MD and Rikke Holmgaard, MD, PhD

Surgery is performed:

If the burns are mainly deep
If the chances of healing are low
When the patient is stabilized after the resuscitation phase

Hands and face are often left untouched during surgery at this time. However, wounds without healing in these areas will need surgery after 2-3 weeks.

Positioning

The optimal per-operative position of the patient allows the surgeon to harvest skin from donor sites and graft to the recipient site
In cases of burns on the back and flanks, the patient will be repositioned peri-operatively

Instruments

Zimmer Dermatome is most often used to harvest the grafts and is attached to compressed air or is battery driven
Watson knifes can be used both for harvesting grafts and debride necrosis
Rougines and Versajet can be used to debride the necrosis
Bandage is applied to the donor site and remaining for 2 weeks
Bacteriostatic dressings and compression bandages are stapled on top of the grafts to apply an even pressure supporting the adhesion to the wound bed

Antibiotics

Administration of per-operative antibiotics must be evaluated individually

Transfusion

Due to extensive blood loss during surgery, blood transfusion should be planned pre-operatively
Expect approximately ½ portion of blood per % on the extremities and 1 portion of blood per % on truncus
Administration should be 1:1:1/2 (Sag-M:Plasma:Trombocytes) (14)

Excision technique

The chosen technique depends on the depth of the burn. Evaluation of the blood circulation of the tissue play a play when deciding excision technique and can be done in advance using Laser Doppler Imaging (15).