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A prospective randomized double-blind trial was performed comparing conventional low-dose heparin with a low molecular weight heparin fragment for thromboprophylaxis in elective general abdominal surgical patients. The first dose of the heparin fragment was given the evening before surgery, and further doses were given thereafter every evening. There were 1002 analysable patients, 826 having received correct prophylaxis. Of these 1002 patients, 64 per cent were operated on for malignant disease. A total of 20 patients died, 10 in each group. The 5·0 per cent, P= 0·02). The frequency of bleeding was 6·7 per cent among patients with correct prophylaxis with the heparin fragment (9·2–5·0 per cent, P= 0·02). The frequency of bleeding was 6·7 per cent among the heparin fragment patients and 2·7 per cent among the patients given conventional heparin (P= 0·01), but all bleeds were of minor degree and there was no difference in the reoperation rate for bleeding, or in the transfusion requirements. Local pain at the injection site was reported significantly less often among patients given the heparin fragment.

Hyaluronan (HYA) is a polysaccharide found in the interstitial matrix in most tissues. HYA is removed by lymphatic drainage and degraded in local lymph nodes and in the liver. Its normal concentration in human plasma is very low (10-100 μg 1-1). Following major burn injury in sheep plasma HYA can increase to levels tenfold greater than normal. In the present study, serum HYA concentrations were determined in 10 severely burned patients (burn size: 28±5% of body surface area (mean±SEM)). Serum HYA concentration was 206±71 (ig l-1 at 24 h post-injury, twice the upper normal HYA concentration, and remained moderately elevated for the first week post-injury.It appears that mobilization and transport of HYA from the tissues is increased after thermal injury. Increased systemic concentrations of an interstitial matrix component have not previously been reported in burn patients. Possibly, plasma concentrations of connective tissue components might serve as indicators of the severity and extent of burn injuries.

Treatment of patients suffering extensive cutaneous burns continues to challenge all involved. Although this review begins with basic pathophysiology, it deals mainly with resuscitation and intensive care of burn patients. After the initial phase, infection control and pulmonary problems secondary to inhalation injury and/or systemic infection are main determinants of morbidity and mortality. The principles of early excision and autografting are presented together with anaesthetic considerations and guidelines for metabolic support.