Effects of burn wound excision on bacterial colonization and invasion
Effects of burn wound excision on bacterial colonization and invasion
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DOI：
10.1097/01.prs.0000041445.76730.23
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发表时间：
2003-02-01
影响因子：
3.6
通讯作者：
Herndon, DN
中科院分区：
文献类型：
--
作者：
Barret, JP;Herndon, DN
在过去的二十年中，热损伤后的存活率有所提高，同期伤口感染和脓毒症的发生率有所下降。早期切除一直被认为是主要因素之一，但其安全性和有效性以及烧伤切除的确切时间仍存在争议。据推测，急性烧伤创面切除（在烧伤后的第一个24小时内）在防止细菌定植和入侵方面优于保守治疗和延迟切除。研究了20名连续的热损伤患者。12例患者接受了急性烧伤创面切除术，8例患者接受了保守治疗和延迟切除。第二组患者在另一家机构接受局部治疗，并在烧伤后第6天转移到我们的手术台后接受延迟切除。对自体移植和/或同种移植前获得的切取伤口和伤口床活检样本进行定量细菌学评估。研究了时间对细菌计数的影响，浅表和深部活检样本之间的差异，以及早期与晚期清创的影响。早期入院的患者表现出每粒组织的细菌计数低于105个细菌。该组患者未发生感染或移植物丢失。晚入院患者的细菌计数超过105个（与早入院患者相比，p = 0.001）。晚期切除组中有3例患者发生感染和移植物丢失（与早期切除组相比，p <0.05）。烧伤创面切除显著降低了所有患者的细菌定植（p <0.001）。局部治疗和晚期切除与更大的细菌定植和更高的感染率相关（p <0.001）。可以得出结论，烧伤创面切除显着减少细菌定植。接受局部治疗和延迟烧伤创面切除的患者表现出更大的细菌定植和感染率增加。急性烧伤创面切除应考虑所有全层烧伤。
Rates of survival after thermal injury have improved in the past two decades, and rates of wound infections and sepsis have decreased during the same period. Early excision has been advocated as one of the major factors, but its safety and efficacy and the exact timing of burn excision are still under debate. It was hypothesized that acute burn wound excision (in the first 24 hours after burning) would be superior to conservative treatment and delayed excision in preventing bacterial colonization and invasion.,juries were Twenty consecutive patients with thermal injuries were studied. Twelve patients underwent acute burn wound excision, and eight patients underwent conservative treatment and delayed excision. The second group of patients received topical treatments in another facility and underwent delayed excision after transfer to our set-vice, on postburn day 6. Quantitative bacteriological assessments of the excised wound and biopsy samples of the wound bed, obtained before autografting and/or homografting, were performed. The effects of time on bacterial counts, differences between superficial and deep biopsy samples, and the effects of early versus late debridement were studied. Patients admitted early exhibited bacterial counts of less than 105 bacteria per grain of tissue. Patients in this group did not experience infection or graft loss. Patients admitted late exhibited counts of more than 105 bacteria (p = 0.001, compared with early admission). Three patients in the late excision group experienced infection and graft loss (p < 0.05, compared with the early excision group). Burn wound excision significantly decreased bacterial colonization for all patients (p < 0.001). Greater bacterial colonization and higher rates of infection were correlated with topical treatment and late excision (p < 0.001). It is concluded that burn wound excision significantly reduces bacterial colonization. Patients who undergo topical treatment and delayed burn wound excision exhibit greater bacterial colonization and increased rates of infection. Acute burn wound excision should be considered for all full-thickness burns.