Burn surgery and blood loss – a review

Abstract

Objectives: Blood loss has long been recognised as a significant problem in burn surgery. Efforts have been made in the past to quantify this loss and determine what factors influence it the most. Several researchers have been able to produce and validate formulae that predict the volume of blood loss during excisional surgery. Accurately determining this allows appropriate volumes of blood to be ordered, reducing risk to patients and saving scarce resources. This article reviews the literature on blood loss in burns surgery, including influencing factors, methods of prediction and effective management. Methods: A literature review was conducted to examine methods used to measure, calculate and reduce blood loss in burn surgery. The validity of these methods and the limitations on accuracy will be discussed. Alternative methods shall also be considered. Results: Most current methods of estimating blood loss attempt to determine the volume of erythrocytes required to return haemoglobin concentrations to their pre-operative level. Various formulae have been developed to calculate this volume. Conclusions: Several authors have produced formulae that predict the volume of blood loss to a significant degree of accuracy. Different techniques have been shown to significantly reduce blood loss. In other areas of surgery, thromboelastometry has been used to identify the levels of specific blood component defects. The use of this method in burns surgery could, in the future, help develop a protocol for operative blood transfusion.