Published : 31 March 2026

Effectiveness of Tumescent in Reducing Blood Loss in Tangential Excision for Adult Burn Patients: A Systematic Review

  • Aditya Wardhana
  • Albireza Ruhimat

Volume 13, Issue 1, (2026) Jurnal Plastik Rekonstruksi | Pages : 8-12

DOI: 10.14228/jprjournal.v13i1.43   Reader : 0 times PDF Download : 0 times

Abstract

Introduction: T Tangential excision is a standard surgical approach for managing deep burns, yet it often results in considerable intraoperative blood loss. This can lead to increased transfusion needs and a higher risk of postoperative complications. Among the strategies developed to minimize bleeding, tumescent infiltration—using diluted vasoconstrictors such as epinephrine—has gained interest due to its affordability, simplicity, and applicability in resource-limited settings.
Method: This systematic review followed PRISMA 2020 guidelines. Literature searches were conducted in CENTRAL, MEDLINE (via PubMed), Scopus, and EBSCOhost. Included studies comprised randomized controlled trials, cohort studies, and case series assessing the impact of tumescent infiltration on intraoperative blood loss in adult patients undergoing tangential excision. Extracted data included study design, patient demographics, burn characteristics, surgical techniques, and outcomes related to blood loss and transfusion. Risk of bias was assessed using RoB 2.0 and ROBINS-I tools.
Results: Seven studies were included for qualitative synthesis, most of which were cohort designs involving patients with full-thickness burns covering 1–50% of Total Body Surface Area (TBSA). The use of tumescent infiltration—commonly employing epinephrine concentration between 1:500.000 until 1:2.000.000 dilution—consistently demonstrated reduced intraoperative blood loss compared to conventional techniques such as adrenaline-soaked gauze. The degree of blood loss reduction varied across studies, influenced by TBSA, unit used, surgical methods, and infiltration protocols.
Conclusion: Tumescent infiltration using epinephrine is an effective and safe method for reducing intraoperative bleeding in adult burn patients undergoing tangential excision even though there are differences in measurement of bleeding and tumescent concentration. Further multicenter cohort studies with standardized blood loss measurements are needed to confirm these findings and support wider adoption.

Data Availability

All data generated during this study are included in this published article [and its supplementary information files].

References

  1. Yakupu A, Zhang J, Dong W, et al. The epidemiological characteristic and trends of burns globally. BMC Public Health 2022; 22: 1596.
  2. World Health Organization. Burns, https://www.who.int/news-room/fact- sheets/detail/burns (accessed 8 January 2024).
  3. Wardhana A, Basuki A, Prameswara ADH, et al. The epidemiology of burns in Indonesia's national referral burn center from 2013 to 2015. Burns Open 2017; 1: 67-73.
  4. Abarca L, Guilabert P, Martin N, et al. Epidemiology and mortality in patients hospitalized for burns in Catalonia, Spain. Sci Rep 2023; 13: 14364.
  5. Thibodeaux KT, Speyrer MS, Thibodeaux RP, et al. Management of postoperative bleeding in surgically debrided wounds: topical haemostat versus electrocautery. J Wound Care 2020; 29: 444-451.
  6. Posluszny JA, Gamelli RL. Anemia of Thermal Injury: Combined Acute Blood Loss Anemia and Anemia of Critical Illness. J Burn Care Res Off Publ Am Burn Assoc 2010; 31: 229-242.
  7. Wardhana A, Aurino L, Menna C. Preoperative Blood Loss Prediction Formulas in Burn Surgeries: A Review. J Burn Care Res 2023; 44: 641-648.
  8. Piorun K, Maruszewska A, Antoniewski J, Gutowska I. Burns: Classification, Pathophysiology, and Treatment: A Review. Int J Mol Sci. 2023 Feb 13;24(4):3749.
  9. Datta PK, Roy Chowdhury S, Aravindan A, Saha S, Rapaka S. Medical and Surgical Care of Critical Burn Patients: A Comprehensive Review of Current Evidence and Practice. Cureus. 2022 Nov 15;14(11):e31550. doi: 10.7759/cureus.31550. PMID: 36540501; PMCID: PMC9754771.
  10. Robertson RD, Bond P, Wallace B, Shewmake K, Cone J. The tumescent technique to significantly reduce blood loss during burn surgery. Burns. 2001 Dec;27(8):835-8.
  11. Lin, YM., Yu, C. & Xian, GZ. Calculation methods for intraoperative blood loss: a literature review. BMC Surg. 2024;24:394
  12. Robertson RD, Bond P, Wallace B, Shewmake K, Cone J. The tumescent technique to significantly reduce blood loss during burn surgery. Burns. 2001 Dec;27(8):835-8. doi: 10.1016/s0305-4179(01)00057-2.
  13. Gumus N. Tumescent infiltration of lidocaine and adrenaline for burn surgery. Ann Burns Fire Disasters. 2011 Sep 30;24(3):144-148.
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Keywords

  • Tumescent infiltration
  • Tangential excision
  • Burn surgery
  • Blood loss reduction

Author Information

Aditya Wardhana

Plastic and Reconstructive Surgery Division, Department of Surgery, Cipto Mangunkusumo Hospital, Jakarta, Indonesia.

Email: aditya_wrdn@yahoo.com

ORCID : https://orcid.org/0000-0002-7577-8357

Albireza Ruhimat

Plastic and Reconstructive Surgery Division, Department of Surgery, Cipto Mangunkusumo Hospital, Jakarta, Indonesia.

Email: albirezar@gmail.com

ORCID : https://orcid.org/0009-0005-6930-9713

Article History

Submitted : 14 July 2025
Revised : 14 July 2025
Published : 31 March 2026

How to Cite This

Wardhana, A., & Ruhimat, A. (2026). Effectiveness of Tumescent in Reducing Blood Loss in Tangential Excision for Adult Burn Patients: A Systematic Review. Jurnal Plastik Rekonstruksi, 13(1), 8–12. https://doi.org/10.14228/jprjournal.v13i1.43

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