Сalculation of primary tangential wound excision volume during burn toxemia in patients with high risk of DIC syndrome development

Objective. Optimization preoperative planning for initial tangential excision in burn patients during acute toxemia phase with high DIC risk.

Materials and methods. We conducted a single-center retrospective-prospective cohort study of 39 burn disease patients (28 retrospective and 11 prospective cases). All patients underwent primary tangential wounds excisions. For predicting the risk of DIC syndrome development, a model proposed earlier by the authors was used, accounting for the multiplicative effect of injury characteristics, age, physical examination data, and a laboratory indicator of fibrin degradation (D-dimer), while blood loss volume was calculated according to the Janelidze Research Institute of Emergency Medicine methodology.

Results. Application of the calculation algorithm for primary radical tangential wounds excisions area during burn toxemia – incorporating DIC syndrome risk, circulating blood volume, and relative blood loss per unit area of wounds excisions in high-risk DIC patients – resulted in: reduced blood loss relative to TBV (p = 0.005), lower mortality during burn toxemia (from 71.4 to 27.3 %, U = 86.0, p = 0.013) and increased survival time until fatal outcome (from 7 [7; 12] to 18 [8; 30] days, U = 52.5, p = 0.014).

Conclusion. The developed algorithm for calculating primary tangential necrectomy area – incorporating DIC syndrome risk, circulating blood volume, and relative blood loss per unit wounds excisions area in high-risk DIC patients – demonstrates high clinical efficacy.

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