OBJECTIVE

Optimization preoperative planning of initial tangential excision in burn patients during acute toxemia phase.

MATERIAL AND METHODS

A two-stage, single-center cohort retrospective-prospective study was conducted. The first stage an analysis of medical records of 102 patients with burn disease hospitalized at the Republican Burn Center from 2019 to 2024 was performed. At the second stage, the developed algorithm was used in the treatment of patients in the prospective group (25 patients).

RESULTS

The volume of intraoperative blood loss during primary tangential necrectomy was determined depending on the risk of developing disseminated intravascular coagulation (DIC). In the high-risk subgroup of DIC, the established volume of blood loss per 1 cm2 of necrectomy was 0.96 [0.70; 1.18] ml, for the average-risk subgroup — 0.69 [0.45; 1.06] ml, in the low-risk subgroup — 0.53 [0.43; 0.67] ml, p<0.001. The obtained results formed the basis for the algorithm for calculating the area of primary radical tangential necrectomy in the period of burn toxemia depending on the degree of risk of developing DIC, taking into account the risk of developing DIC, the volume of circulating blood and the relative volume of blood loss per unit of necrectomy area. The absolute error in all subgroups was 123 [64; 183] ml, the relative error was 9.8 [4.2; 13.9]%, the Spearman coefficient (rho) when comparing the calculated and actual volume of blood loss was 0.74. The effectiveness of the proposed algorithm in patients with burn toxemia was assessed.

CONCLUSION

The application of the calculation algorithm for primary tangential wound excision area, which accounts for the risk of DIC syndrome development, circulating blood volume, and relative blood loss per unit area of wound excision, enables objective optimization of preoperative planning, achieving maximal efficacy in patients with both low and high risk of DIC syndrome development.