Effect of single dose intravenous tranexamic acid on blood loss in tangential excision of burn wounds - A double blind randomised controlled trial.

INTRODUCTION: This study was carried out to evaluate role of intravenous tranexamic acid (TXA) in reducing blood loss during tangential excision of burns. METHODS: This was a single center, prospective double-blinded parallel arm superiority randomized placebo-controlled trial. Patients (15-55 years) with deep dermal thermal burns <30% undergoing tangential excision were randomly assigned (1:1) to TXA and placebo groups. Patients in TXA and placebo groups received injection TXA 15 mg/kg and 10 ml saline respectively, 10 min preoperatively. Primary outcome was volume of blood loss per square centimeter area of burn excised. Secondary outcomes were total volume of blood loss, postoperative hemoglobin, intraoperative fluid requirement, blood transfusion, graft take and length of hospitalization (LOH). RESULTS: Thirty patients were included. Both groups were comparable in terms of Body Mass Index (BMI) preoperative hemoglobin, area of burn excised, duration of surgery and the intraoperative temperature. The average blood loss per square centimeter burn area excised was found to be significantly lower in TXA when compared to placebo group (mean difference: 0.28 ± 0.025 ml/cm2; p = 0.000). The total volume of blood loss was lower in TXA group (258.7 ± 124.10 ml vs 388.1 ± 173.9 ml; p = 0.07). None of the patients required transfusion. The requirement of intra-operative fluids was similar between the two groups (crystalloids: p = 0.236; colloids: p = 0.238). Postoperative hemoglobin, length of hospitalization and graft-take were comparable between the two groups. CONCLUSION: TXA reduced blood loss per unit burn area of tangential excision in <30%TBSA burn, however, we found no significant effect on postoperative Hb and transfusion.

The role of recruited minced skin grafting in improving the quality of healing at the donor site of split-thickness skin graft-A comparative study.

INTRODUCTION: The donor area of split thickness skin graft harvest usually takes 2-3 weeks to heal. A few studies have shown that application of minced skin grafting helps to reduce this time. The objective of this comparative study was to find the role of recruited minced skin grafting on the overall quality of healing at the split thickness skin graft donor area. MATERIALS AND METHODS: The study included 30 patients undergoing split thickness skin graft for acute traumatic wounds. We selected two donor areas of nearly equal size on medial and lateral side of either thigh in each case. They were randomly allocated to control area and study area using an envelope technique. Minced graft was applied over the study area. Same dressing and post operative care were done for both the areas. RESULTS: In our study we found average time for complete epithelialization at control area was 28.17+/-5.590days whereas it was 21.93+/-2.420days in the study area. The earlier epithelialisation time of study area compared to control area was significant on statistical analysis. Vancouver scar scale (VSS) comparison at third month and one year follow up showed significant difference of scores (1 versus 0) as the scars were hypopigmented at control area and comparatively better pigmented at study area. We found visual analogue score for Pain and pruritus to be better for study area at the end of first, second and third month. CONCLUSION: In this study we conclude that, recruited minced skin grafting to the donor site of split skin graft leads to better quality of healing in terms of early epithelialisation, better quality of scar, better pigmentation, less pain and pruritus, thus leading to improved quality of healing.