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Osteosynthesis and Trauma Care 2007; 15(1): 17-20
DOI: 10.1055/s-2007-970068
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

Early Necrectomy: Special Management in Anesthesiology and Intensive Care

C. Hafner-Chvojka 1 , W. Junginger 1
  • 1Department of Anesthesiology and Intensive Care, Marienhospital Stuttgart, Stuttgart, Germany
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Publikationsverlauf

Publikationsdatum:
10. April 2007 (online)

    Lizenzen und Reprints

Abstract

Performing early necrectomy in severely burned patients creates organizational and special medical problems for the operating team. As we have performed early necrectomy since 1996 in our hospital, our solutions to these problems are presented here showing the data of 30 patients, ABSI 7-13, who underwent early necrectomy in our hospital. In our opinion, early necrectomy is helping to terminate post-burn edema rapidly, allowing an early extubation and mobilization of the severely burned patient with all its benefits.

Key words

Early necrectomy - post-burn edema - SIRS

References

  • 1 Arturson G. Pathophysiology of the burn wound and pharmacological treatment. The Rudi Hermans Lecture, 1995.  Burns. 1996;  22 255-274
    CrossrefPubMedGoogle Scholar
  • 2 Baxter CR. Fluid volume and electrolyte changes of the early postburn period.  Clin Plas Surg. 1974;  1 693-709
    PubMedGoogle Scholar
  • 3 Bertin-Maghit M, Goudable J, Dalmas E, Steghens J-P, Bouchard C, Gueugniaud P-Y, Petit P, Delafosse B. Time course of oxidative stress after major burns.  Intensive Care Med. 2000;  26 800-803
    CrossrefPubMedGoogle Scholar
  • 4 Carleton SC, Tomassoni AJ, Alexander JK. The cardiovascular effects of environmental traumas: Cardiac problems associated with burns.  Cardiol Clin. 1995;  13 257-262
    PubMedGoogle Scholar
  • 5 Foex BA, Shelly MP. The cytokine response to critical illness.  J Accid Emerg Med. 1999;  13 154-162
    PubMedGoogle Scholar
  • 6 Giroir BP, Horton JW, White DJ, Mcintyre KL, Lin CQ. Inhibition of tumor necrosis factor prevents myocardial dysfunction during burn shock.  Am J Physiol. 1994;  267 H118-124
    PubMedGoogle Scholar
  • 7 Harms BA, Balazs IB, Kramer GC, Demling RH. Microvascular fluid and protein flux in pulmonary and systemic circulations after thermal injury.  Microvasc Res. 1982;  23 77-86
    CrossrefPubMedGoogle Scholar
  • 8 Horton JW. Free radicals and lipid peroxidation mediated injury in burn trauma: the role of antioxidant therapy.  Toxicology. 2003;  189 75-88
    CrossrefPubMedGoogle Scholar
  • 9 Horton JW, Baxter CR, White DJ. Differences in cardiac responses to resuscitation from burn shock.  Surg Gynecol Obstet. 1989;  168 201-213
    PubMedGoogle Scholar
  • 10 Horton JW, Burton KP, White DJ. The role of toxic oxygen metabolites in a young model of thermal injury.  J Trauma. 1995;  39 563-569
    PubMedGoogle Scholar
  • 11 Horton JW, White J, Baxter CR. The role of oxygen-derived free radicals in burn induced myocardial contractile depression.  J Burn Care Rehabil. 1988;  9 589-598
    PubMedGoogle Scholar
  • 12 Huribal M, Cunningham ME, D'Aiuto ML, Pleban WE, McMillen MA. Endothelin-1 and prostaglandin E2 levels increase in patients with burns.  J Am Coll Surg. 1995;  180 318-322
    PubMedGoogle Scholar
  • 13 Kaufmann TM, Horton JW. Burn-induced alterations in cardiac beta-adrenergic receptors.  Am J Physiol. 1992;  262 H1585-1591
    PubMedGoogle Scholar
  • 14 Kugawata Y, Sugimoto H, Yoshioka T, Sugimoto T. Left ventricular performance in patients with thermal injury or multiple trauma: a clinical study with echocardiography.  J Trauma. 1992;  32 158-165
    PubMedGoogle Scholar
  • 15 MacLennan N, Heimbach DM, Cullen BF. Anesthesia for major thermal injury.  Anesthesiology. 1998;  89 749-770
    CrossrefPubMedGoogle Scholar
  • 16 Monaffo WW. Initial management of burns.  N Engl J Med. 1996;  335 1581-1586
    CrossrefPubMedGoogle Scholar
  • 17 Rawlingson A, Shendi K, Greenacre SA. et al . Functional significance of inducible nitric oxide synthase induction and protein nitration in the thermally injured cutaneous microvasculature.  Am J Pathol. 2003;  162 1373-1380
    PubMedGoogle Scholar
  • 18 Riley-Paull KL, Munster AM. The role of cytokines in thermal injury.  Crit Care Report. 1990;  2 4-8
    PubMedGoogle Scholar
  • 19 Shirani KZ, Vaughan GM, Mason Jr AD, Pruitt Jr BA. Update on current therapeutic approaches in burns.  Shock. 1996;  5 4-16
    PubMedGoogle Scholar
  • 20 Tanaka H, Lund T, Wiig H, Reed RK, Yukioka T, Matsuda H, Shimazaki S. High dose vitamin C counteracts the negative interstitial fluid hydrostatic pressure and early edema generation in thermally injured rats.  Burns. 1999;  25 569-574
    CrossrefPubMedGoogle Scholar
  • 21 Tanaka H, Matsuda T, Miyagantani Y, Yukiaka T, Matsuda H, Shimazaki S. Reduction of resuscitation fluid volumes in severely burned patients using ascorbic acid administration.  Arch Surg. 2000;  135 326-331
    PubMedGoogle Scholar
  • 22 Thomson PD, Till GO, Woolliscroft JO. Superoxide dismutase prevents lipid peroxidation in burned patients.  Burns. 1990;  16 406-408
    CrossrefPubMedGoogle Scholar
  • 23 Tobiasen J, Hiebert JM, Edlich RF. A practical burn severity index.  J Burn Care Rehabil. 1982;  3 229-232
    PubMedGoogle Scholar
  • 24 Youn Y-K, LaLonde C, Demling R. The role of mediators in the response to thermal injury.  World J Surg. 1992;  16 30-36
    CrossrefPubMedGoogle Scholar

Correspondence

Dr. med. Claudia Hafner-Chvojka

Klinik für Anästhesiologie und operative Intensivmedizin

Marienhospital Stuttgart

Böheimstraße 33

70199 Stuttgart

Germany

Telefon: +49/711/6489 27 16

Fax: +49/711/6489 27 17

eMail: claudiahafner@vinzenz.de