Advantage of Early Tangential Necrectomy in Extensive Pediatric Burns
AJTES Vol 3, No 2, July 2019.
Full Text PDF



How to Cite

Karavdić, K. (2019). Advantage of Early Tangential Necrectomy in Extensive Pediatric Burns. Albanian Journal of Trauma and Emergency Surgery, 3(2), 361-386.


Background: An extensive burn is one of the most serious injuries. The modern treatment of pediatric burns is a logical exercise in resuscitation, infection control, surgical wound care, nutrition and psychologic and physical rehabilitation. The conventional methods of local therapy, especially in extensive and deep burns, cannot prevent infection. The fact is that the necrotic burn tissue always gives rise to infection and must therefore be excised. Tangential excision is a diagnostic procedure as well as a surgical preparation of a recipient bed for skin graft.  Clinical parameters of sixty extensively burned children have been evaluated, divided into two groups (surgically and non-surgically treated) and in four subgroups (under and over the 25% TBSA). The following criteria have been used to compare the results: pain, fever, body weight, duration of the hospital stay, wound infenction, laboratory values.

Aim of research: The aim of our research was to demonstrate the efficacy of early tangential necrectomy in the treatment of extensive burns in children as well as in preventing the burn diseases.

Material and methods: Clinical parameters of sixty extensively burned children have been evaluated, divided into two groups (surgically and non-surgically treated) and in four subgroups (under and over the 25% TBSA). The following criteria have been used to compare the results: pain, fever, body weight, duration of the hospital stay, wound infection, laboratory values.

Results: The boys comprised 58.3% of the respondents and the girls were 41,7% of the respondents. The most common cause was the hot liquid of 73.3%, open flame 23.3% and the contact with hot metal 3.3%. The body temperature was significantly higher in control group compared to the examined group (p <0.001) significantly lower hematocrit values in the control group compared to the examined group (p = 0.002).      The results show that hospitalization lasted considerably longer in patients in the control group than in the examined group (p = 0.003).

The incidence of bacterial infection of the burns is significantly higher in control compared to the examined group of patients (p = 0.007). The most commonly isolated bacteria in the study group was Staphylococcus aureus (15/30 or 50% of all subjects). Acinetobacter spp. was isolated in 9 patients (30% of respondents). Serratia spp. And Enterococcus Foecalis were isolated in 6 patients (20%). Pseudomonas aeruginosa was isolated in 3 patients (10%). Three patients (10%) did not isolate any bacteria during hospitalization

Conclusions: The method of early tangential necrectomy of extensively burned children significantly reduce morbidity and mortality (it improves the general condition of the patient, improves clinical and laboratory parameters, reduces the possibility of infection of the wound, reduces the possibility of sepsis, reduces the length of hospitalization).The most optimal time to perform an early tangential necrectomy is the period between the 4th and the 6th day after the injury. In extensively burned children over 30% of the total body surface, an early tangential necrectomy should be performed on an area of about 20% of the total body surface as a prevention of blood loss due to necrectomy and autotransplantation. With extensively burned children over 40% of the total body surface, taking homotransplants from parents or close relatives reduces morbidity and mortality.
Full Text PDF


Demling R.H.Lawrence W.Way. Opekotine i druge termičke povrede.Hirurgija, savremena dijagnostika i liječenje.1990.;260-77.

A.R.Moritz,F.C.Henriquez. Studies of thermal injury II.The relative importance of time and surface temperature in the causation of cutaneous burns.Am J Pathol 1947;23:695-720.

D.M.Jackson. The Diagnosis of the Depth of Burning.British Journal of Surgery 1953.40:588-96.

J.V.Boykin,E.Eriksson,R.N. Pittman. Microcirculation of scald burn:an in vivo experimental study of the hairless mouse ear.Burns 1980;7:335-8.

G.S.Johnson,T.Lineberger,A.L.Hothem,K.Adams,T.Hikson,W.Winkewerdwe. Erythrocyte flexibility in the burned patient.1979;6:91-5.

B.E.Zawacki. The local effects of burn injury. The Art and Science of Burn Care.Rockville,MD:Aspen,1987:29.

B.A.B.A.Pruitt,J.A.Moncrief. Current trends in burn research.J Surg Res 1967;7:280-93.

C.Jelenko,J.M.Ginsburg. Water holding lipid and water transmision through homeothermic and poikilothermic skins.Proc Soc Exp Biol Med 1971;139:1059-62.

F.P.Underhill The significance of anhydremia in extensive surface burn.JAMA 1930;95:852-7.

F.D.Moore The body-weight budget:basic fluid therapy for the early burn.Surg Clin North Am 1970;50:1249-65.

C.P.Artz,J.A.Moncrief The burn problem.In Artz The treatment of Burns.Philadelphia:W.B.Saunders,1969:1-22.

B.A.Pruitt,A.D.Mason,J.A.Moncrief Hemodynamic changes in the early post burn patients:the influence of fluid administration and of a vasodilator (hydralazine).J Trauma 1971;11:36-46.

L.Leape Initial changes in burnes:tissue changes in burned and unburned skins of Rhesus monkeys.J Trauma 1970;10:488-92.

W.W.Monafo The treatment of burn shock bytheintravenous and oral administration of hypertonic lactatedsalinesolution.J Trauma 1970;10:575-86.

C.R.Baxter Problems and complications of burn shock resuscitacion.Surg Clin North Am 1978;58:1313-22.

R.H.Demling Fluid resuscitacion.The Art and Science of Burn Care.Rockville:Aspen,1987:189-202.

S.W.Merrel,J.R.Saffle,J.J.Sullivan,P.D.Navar,M.Kravitz,G.D.Warden Fluid resuscitacion in thermally injured children.Am J Surg 1986;152:664-9.

T.A.Graves,W.G.Cioffi,W.F.McManus,A.D.Mason,B.A.Pruitt Fluid resuscitacion of infants and children with massive thermal injury.J Trauma 1988;28:1656-9.

H.Rode,D.M.Heimbach Surgical treatment of thermal injuries.1990.830-8.

Janzekovic Z: A new concept in early excision and immediate grafting of burns. J Trauma 1970; 10:1003-1008

Kucan J.Burns.Plastic Surgery:Indications,Operations and Outcomes Ch 134 2002.2385-97.

Derganc M. Introduction to the Symposium.Present Clinical Aspects of Burns-A Symposium,Maribor 1968. 13-21.

O.Marinković,D.Bajec,P.Radojković. Results of Treatment of Burns in Children with Silver Nitrate Solution Method.Present Clinical Aspects of Burns-A Symposium Maribor 1968.75-9.

E.J.Lowburn. Infection in Burns. British Journal of Plastic Surgery.1967.;211-21

D.M.Jackson,P.A.Stone.Tangential Excision and Grafting of Burns-The Method and a Report of 50 Consecutive Cases.British Journal of Plastic Surgery.1972.25, 416-26.

G.Magliacani The Surgical Treatment of Burns:Skin Substitutes.Annals of the Mediterranean Burns Council,vol 3.1990.220-35.

Zaidi M.M., Abusetta A., Brogowski K, Agrawal P.L., Franka M.R. Analysis of burned children treated in the burns and plastic surgery center, Tripoly Libya, in the year 1992Annals of Burns and Fire Disasters - vol. X - n. 1 – March 1994.

Z.Janžekovič The Dermal Burn.Present Clinical Aspects of Burns-A Symposium Maribor 1968.215-22.

Shahin A., Shadata G., Franka M.R., Abusetta A., Brogouski A., Ezzaidi Complications of burns in children – a study of 266 sverely burned children admitted to a burns centre Annals of Burns and Fire Disasters - vol. XI - n. 1 – March 1988.

Barret J.P., Wolf S.E.,Desai M.H., Herndon D.N. Total burn wound burn excision of massive paediatric burns in the first 24 hours post-injury Annals of Burns and Fire Disasters - vol. XII - n. 1 - March 1999

Matthew B. Klein, MD; David Heimbach Menagement of the Burn Wound ACS Surgery Principles 2006.

Heimbach D, Early burn excision and grafting:Surg Clin North Am 1987 Feb;67(1):93:107.

Sørensen S. Early tangential necrectomy, Jurn Plast.Surg ,2005.44 (2):23:191.

Engrav LH,Edlich et al: Early excision and grafting vs nonoperative treatment of burns of indeterminent depth:A randomized prospectiver study.J Trauma 1983;23:1001.

Cramer K,Lowbury E. et al: Local prophylactic chemoterapy for burns. Lancet 1992.2,958-963.

D'Alesandro MM; Gruber DF Quantitative and functional alterations of peripheral bloodneutrophils after 10% and 30% thermal injury. D'Alesandro MM; Gruber DF Journal of burn care & rehabilitation [J Burn Care

Rehabil] 1990 Jul-Aug; 11 (4), pp. 295-300.

Desai MH, Herndon DN, Broemeling L, et al: Early burn wound excision significantly r e duces blood loss. Ann Surg 1990; 211:753-762

Housinger TA,Brinkerhoff C.,Warden GD. The relationship between pllatelet count, sepsis, and survival in pediatric burn patients. Archives of surgery 1993. 128(1) 65-7.

Z.Janžekovič.Consistent Application of Generally Adopted Surgical Principles in the Treatment of the Burn Wound.Present Clinical Aspects of Burns-A Symposium Maribor 1968.100-12.

A.M.Kahn,V.L.McCrady,V.J.Rosen:Burn Wound Biopsy. Scand.J.Plast.Reconstr. Surg.,1979.13;53.

A.M.Kalus.Application of Ultrasound in Assessing Burn Depth.20.Lancet,1979. 28:188.

T.J.H.Essex, P.O.Byrne.A Laser Doppler Scanner for Imaging Blood Flow in Skin. J.Biomed.Eng.,1991.13.189.

B.Albsjom,J.Micheels,B.Sorensen.Laser Doppler Flowmetry Measurements of Superficial Dermal, Deep Dermal and Subdermal Burns.Scand.J.Plast.Reconstr.Surg. 1984.18:75.

A.Zuckerman.Fluorescin Fluorescence Photography for the Evaluation of Burns.J.Biol.Photogr.1983.51:33.

B.Celikoz,M.Deveci,A.Nisanci.Early Tangential Excision with the Guidance of Methylene Blue Application.Annals of Burns and Fire Disasters.vol XII 1999. 76-81

Di Lonardo A., Ferrante M., Maggio G., Bucaria V., Del Zotti M., Brienza E.Histological assesment of the level of burn wound infection:Diagnostic and therapeutic strategies. Annals of Burns and Fire Disasters.vol II 2004. 52-14

J.M.Still,E.J.Law,K.Belcher,D.Thiruvaiyarv.Decreasing Lenght of Hospital Stay by Early Excision and Grafting of Burns.SMJ1996.

Pallua N.,Surgical prevention of post-traumatic infection by immediate necrectomy of burn wounds, Langenbecks Arch Chir Suppl Kongressbd.1996;113:1144-8.

Thompson P, Herndon DN, Abston S, et al: Effective early excision on patients with major thermal injury. J Trauma 1987; 27:205-207

MacMillan BG, Artz CP: A planned evaluation of early excision of more than 25% of the body total in burns. Surg Forum 1957; 8:88

Herndon D, Gore D, Cole M, et al: Determinant of mortality in pediatric patients with greater than 70% full thickness total body surface area thermal injury treated by early total excision and grafting. J Trauma 1987; 27:208-212

Scott-Conner CE, Coil JA, Conner HF, et al: Wound closure index: a guide to prognosis in burn patients. J Trauma 1986; 26:123-127

Wolfe RA, Roy LD, Flora JD, et al: Mortality differences in speed of wound closure among specialized burn care facilities. JAMA 1983; 250:763-766

Chicarilli ZN, Cuono CB, Heinrich JJ, et al: Selective aggressive burn excision for high mortality subgroups. J Trauma 1986; 26:19-25

Tchervenkov JI, Epstein M, Silberstein E, et al: Early burn wound excision and skin grafting post burn trauma restores in-vitro neutrophil delivery of inflamm atory lesions. Arch Surg 1988; 123:1477-1481

Maurage C.,Robert M.,Mercier C.,Billard J. Burns in Children :10 – year experience of the Pediatric Surgical Service of Tours (apropos of 850 cases). J Anesth Analg 1977;34 (6):1303-13.

Desai MH, Rutan RL, Herndon DN. Conservative treatment of scald burns in superior to early excision. J Burn Care Rehabil 1991;12:482-4.

Tompkins RG, Remensnyder JP, Burke JF et al. Significant reductions in mortality for children with burn injuries through the use of prompt eschar excision. Ann Surg 1988:577-85.

Janežič A. Experience with cultured epithelial autografts in the treatment of patients with extensive full thickness thermal injuries Annals of Burns and Fire Disasters - vol. XIV - n. 3 - september 2001.

Herndon DN, Parks DH. Comparasion of serial debridement and autografting and early massive excision with cadavar skin overlay in the treatment of large burns in children. J Trauma 1986;26:149-52.

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.