Timing of excision of full-thickness burns and the effect of delay on outcome

Abstract

Context: The time of debridement of burn wounds is controversial. This study assessed the outcomes of various times of excision of full-thickness thermal burns involving a total body surface area (TBSA) of 15%–40% when immediate grafting is not possible. Aims: This study aimed to compare mortality rate and hospital days between very early excision, delayed early excision, and delayed excision. Setting and Design: This was a retrospective observational research study of 103 patients older than 18 years with full-thickness thermal burns involving a TBSA of 15%–40%, admitted to our Adult Burns Unit from January 2014 to December 2016. Subjects and Methods: Only “traditional” burn wound dressings such as Jelonet, Melladerm, Anticoat, or bandages were used without immediate skin grafting. Using the STATA Version 14.2 (College Hill, TX) statistical program, the Mann–Whitney U-test was used to compare any two groups, the Kruskal–Wallis test to determine differences between any three groups and the Chi-square test to measure associations between gender and patient outcome. Linear regression was used to determine the predictors of the number of hospital days postsurgery. Results: With a median patient age of 34 years, 66% were male. The majority had delayed excision (41.7%), 34% had delayed early excision and 24.3% had very early excision. Conclusions: Where immediate cover after excision is not possible due to cost or availability, and the wound is only covered with “traditional” burn dressings, early excisions had no advantage over delayed excisions with regard to mortality rate or duration of hospital stay.