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The Optimal Time for Early Excision in Major Burn Injury
Pornprom Muangman MD*, Stephen R Sullivan MD**,***,
Shari Honari BSc**, Lorenz H Engrav MD, FACS**,***,
David M Heimbach MD, FACS**, Nicole S Gibran MD, FACS**
* Division of Trauma, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University
** Department of Surgery, University of Washington, Harborview Medical Center,
Box 359796, 325 Ninth Avenue, Seattle, WA 98104, USA
*** Division of Plastic Surgery, Department of Surgery, University of Washington,
Harborview Medical Center, Box 359796, 325 Ninth Avenue, Seattle, WA 98104, USA
Introduction: Early excision and grafting (E&G) drastically changed burn care in America by reducing morbidity, mortality and hospital length of stay (LOS). The present study was intended to determine whether an optimal time window exists between resuscitation and wound sepsis for the first E&G in a patient with a large burn.
Material and Method: The authors conducted a retrospective study of patients admitted between January 1994 and December 2000 with > 40% TBSA burns and at least 1 E&G procedure. Patients were grouped according to the day of their first operation. Patients allowed to heal indeterminate burns prior to excision and grafting of deep partial or full thickness burns were grouped as > d7 and were excluded from the present study. The authors correlated the time of first excision with infection, mortality and LOS.
Results: Seventy-five patients were identified and 12 patients allowed to heal indeterminate burn prior to excision and grafting of deep partial or full thickness burns were excluded. Sixty-three remaining patients included 51males and 12 females. Mean burn size was 49% of total body surface area (TBSA) (44% deep partial or full thickness) and the mean age was 36 years. There were 61 flame (2 combined with electrical injuries), 1 scald and 1 chemical burn. Twelve died (19%) and 52 patients developed 121 infections. Whereas there was no statistical difference in mortality for patients operated on different days (p > 0.2), 60% of patients operated within the first 48 hours after injury died; this was not significant due to a small patient number.
Conclusions: The present data suggest that patients who undergo early excision and grafting within seven days following a major burn > 40% TBSA have equivalent infection or mortality rates regardless of when the first operation occurs between post burn day(PBD) 2 and PBD 7 (p > 0.2).
Keyword : Burn, Early excision, Grafting, Optimal time
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