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KMID : 0853020070100010026
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Journal of Korean Burn Society
2007 Volume.10 No. 1 p.26 ~ p.30
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Wound Infection after Burn Injury － The Clinical Role of Tissue Biopsy －
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Kim Jong-Hyun
Kim Do-Hern
Hur Jun
Chun Wook
Yoon Dae-Keun
Cheon Sung-Eun
Kang Hee-Jun
Kim Byung-Chun
Jang Woo-Young
Shim Jung-Won
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Abstract
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Backgrounds: Early, en-masse excision of the burned tissue is often recommended for prevention of sepsis. As yet, its extent is frequently limited in patients with more than 60% TBSA burn and with lack of donor site. Only the third degree and infected burn wound should be removed, leaving the other area to heal spontaneously. Clinically, gross inspection is difficult to determine the accurate depth of wound infection. The microscopic examination would assess the bacterial invasion (suspicious vs. frank infection) better, offering information for the appropriate timing of surgical removal after the injury.
Methods: The study duration was 7 months, from April to October of 2005. The wound infection was classified by the standard of abbreviated burn severity index (ABSI). The full layer skin from epidermis to subcutaneous fat layer was obtained with 6 mm biopsy needle for the pathology. The histological status of burn wound was graded on the basis of the density and depth of penetration of microorganisms.
Results: Fifty-eight patients (M：F = 43：15), aged 46.5 years, with 48.2% TBSA burn and ABSI of 9.74 were enrolled. Tissue biopsy was taken at 7.32 days after the injury. The most common depth of invasion was stage IIa, involving the viable tissue immediately subjacent to subeschar space. The bacteria invasion types (stage II; n=47, 81.1%) were more common than colonizations (stage I; n=11, 18.9%). As the days after the injury increase, significantly more progression in the depth of invasion was noted.
Conclusions: The progression of infection can be prevented by the excision of burn eschar within 3∼5 days after the injury. The tissue biopsy could be one of the useful clinical assessment tools, overcoming the difficulties of diagnosis of wound infection in the second and third degree large burns. The tissue examination on regular interval would be helpful to diagnose the wound infection, to decide the surgical timing, and to guide antimicrobial treatment. (Journal of Korean Burn Society 2007;10:26-30)
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KEYWORD
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Wound infection, Tissue biopsy, Burn wound infection staging
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