Tourniquet and subcutaneous epinephrine reduce blood loss during burn excision and immediate autografting

Blood loss has been reduced using both tourniquets and epinephrine-injected subeschar during burn wound excision. This study quantified and compared blood loss in extremities distal to an inflated tourniquet with that after subeschar infusion of 1:1,000,000 epinephrine in saline into the trunk or proximal extremities. Tangential excision of eschar to viable dermis or fat was followed by immediate application of meshed autograft. Blood loss was calculated by determining the difference of preoperative and postoperative hemoglobin values and the volume of whole blood administered between these. With tourniquets for limbs, 2.07 +/- 0.34% of circulating blood volume per 1% body surface excised was lost; whereas after epinephrine injection 3.42 +/- 0.39% of blood volume per 1% body surface excised was lost (P < 0.05). Both methods effectively reduced blood loss when compared with excision followed by delayed autograft application. Where there was a choice the tourniquet was more effective.