Reversal of Capillary Stasis and Prevention of Necrosis in Burns

It has been suggested that the ultimate depth of burn necrosis might be minimized by prevention or reversal of the progressive capillary stasis which occurs in the early postburn hours. To study the role of wound dehydration in determining burn depth, 5% body surface area, 75 C, 10 second burns (in which the zone of stasis included the full thickness of skin) were inflicted on the backs of guinea pigs and subsequent mechanical trauma was prevented. At various times postburn, water content, (and after India ink perfusion) depth of capillary stasis and histological structure of burn were studied in the following groups: 1) blister intact; 2) blister removed; and 3) blister replaced by several different types of dressing. Reversal of capillary stasis was least and necrosis full-thickness in depth in undressed wounds with blister removed. Reversal of capillary stasis was complete and necrosis absent with blister replaced by fresh split-thickness porcine skin and correlated with prevention of wound dehydration. Similar, though less complete, prevention of necrosis occurred with blister intact or replaced by sialastic film. Other dressings were associated with deep necrosis or gross infection. These and other data suggest that in the zone of stasis, capillary stasis may be reversed and necrosis avoided by appropriate prevention of wound dehydration. Clinical correlations are suggested.