Surgery>>>>>Burns
Question 13#

Which is FALSE concerning surgical treatment of burn wounds?

A. Tangential excision consists of tangential slices of burn tissue until bleeding tissue is encountered. Thus, excision can be associated with potentially significant blood loss
B. Human cadaveric allograft is a permanent alternative to split-thickness skin grafts when there are insufficient donor sites
C. Bleeding from tangential excision can be helped with injection of epinephrine tumescence solution, pneumatic tourniquets, epinephrine soaked compresses, and fibrinogen and thrombin spray sealant
D. Meshed split thickness skin grafts allow serosanguinous drainage to prevent graft loss and provide a greater area of wound coverage

Correct Answer is B

Comment:

The strategy of early excision and grafting in burned patients revolutionized survival outcomes in burn care. Excision is performed with repeated tangential slices using a Watson or Goulian blade until viable, diffusely bleeding tissue remains. The downside of tangential excision is a high blood loss, though this may be ameliorated using techniques such as instillation of an epinephrine tumescence solution underneath the burn. Pneumatic tourniquets are helpful in extremity burns, and compresses soaked in a dilute epinephrine solution are necessary adjuncts after excision. A fibrinogen and thrombin spray sealant (Tisseel Fibrin Sealant; Baxter, Deerfield, IL) also has beneficial effects on both hemostasis and graft adherence to the wound bed. Since full thickness burns are impractical for most burn wounds, split-thickness sheet autografts harvested with a power dermatome make the most durable wound coverings, and have a decent cosmetic appearance. In larger burns, meshed auto grafted skin provides a larger area of wound coverage. This also allows drainage of blood and serous fluid to prevent accumulation under the skin graft with subsequent graft loss. Areas of cosmetic importance, such as the face, neck, and hands, should be grafted with nonmeshed sheet grafts to ensure optimal appearance and function. Options for temporary wound coverage include human cadaveric allograft, which is incorporated into the wound but is rejected by the immune system and must be eventually replaced.