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Pathogenesis of edema formation in burn injuries

  • World Progress In Surgery
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Abstract

One of the obvious acute features of cutaneous thermal injury is the swelling of the involved tissue. This swelling is caused by a fluid shift from circulating plasma. Along with the evolution of intravenous fluid therapy in trauma and surgery, the implementation of such therapy to burn victims has improved survival. Edema generation aggravated by fluid therapy may, however, represent a source of increased morbidity. This paper presents a review of the literature on postburn edema generation, focusing mainly on fluid physiology. It is well documented that fluid is lost from the circulation into burned tissue because of a moderate increase in capillary permeability to fluid and macromolecules and a modest increase in hydrostatic pressure inside the perfusing microvessels. Recently it was discovered that a very negative interstitial pressure develops in thermally injured skin. This pressure constitutes a strong “suction” adding markedly to the edema generating effect of increased capillary permeability and pressure.

Résumé

Un des problèmes majeurs dés brûlures cutanées est l'oedème tissulaire. Cet oedème est dû à un déplacement des liquides à partir du plasma circulant. L'utilisation des techniques de remplissage intraveineux, courante dans les traumatismes et au cours de la chirurgie, a contribué à améliorer le pronostic des brûlures graves. La majoration des oedèmes par cette thérapeutique peut entrainer une morbidité supplémentaire. Dans cet article, est présentée une revue de la littérature sur la génèse des oedèmes post-brûlures, insistant surtout sur les aspects physiologiques des déplacements liquidiens. La fuite de liquides de la circulation générale vers les tissus brûlés est bien connue. Elle est secondaire à une perméabilitè capillaire accure pour les liquides et les macromolécules ainsi qu'à une augmentation de la pression hydrostatique à l'intérieur des microvaisseaux de la peau. Récemment, il a été mis en évidence une chute importante de la pression interstitielle dans la peau brûlée. Cette chute de pression crée un effet “pompe” qui majore l'oedème déjà favorisé par les facteurs précités.

Resumen

Una de las características obvias de las lesiones térmicas cutáneas agudas es el edema del tejido afectado. El edema es causado por migración de líquido a partir del plasma circulante, Coincidente con la evolución y avances de la terapia con líquidos intravenosos en el trauma y la cirugía, se ha implementado tal modalidad terapéutica en víctimas de quemaduras con mejoría de la tasa de sobrevida. La formación del edema, agravado por la terapia con líquidos parenterales, puede significar una fuente de mayor morbilidad.

El presente artículo es una revisión de la literatura sobre formación del edema de las quemaduras, enfocado principalmente desde el aspecto de la fisiología de los líquidos. Está bien documentado el que los líquidos escapan de la circulación hacia los tejidos quemados debido a moderado aumento de la permeabilidad capilar para los líquidos y macromoléculas y de un modesto incremento de la presión hidrostática en la microvasculatura. Recientemente se ha descubierto que se desarrolla presión intersticial muy negativa en la piel que ha sufrido lesión térmica. Esta presión constituye una especie de mecanismo de “succión”, el cual contribuye en forma notoria al efector generador de edema por las aumentadas permeabilidad capilar y presión hidrostática.

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Authors and Affiliations

  1. Department of Anesthesiology, Department of Physiology, and Burn Center, University of Bergen, Bergen, Norway

    Tjøstolv Lund M.D., Ph.D., Henning Onarheim M.D., Ph.D. & Rolf K. Reed M.D., Ph.D.

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  1. Tjøstolv Lund M.D., Ph.D.
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  2. Henning Onarheim M.D., Ph.D.
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  3. Rolf K. Reed M.D., Ph.D.
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Lund, T., Onarheim, H. & Reed, R.K. Pathogenesis of edema formation in burn injuries. World J. Surg. 16, 2–9 (1992). https://doi.org/10.1007/BF02067107

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