Early Excision and Grafting in Burns: An Experience in a Tertiary Care Industrial Hospital of Eastern India.

Introduction To compare the burn patients undergoing early excision and grafting (within 7 days of burn injury) with the patients undergoing late surgeries (more than 7 days after burn injury) to see if there was any difference in surgical and outcome parameters including length of stay, expenditure, and overall outcome of the patients. Material and Methods A retrospective analysis of the data collected from the burn care unit records over a period of one year was done. Fifty-eight patients who matched with our inclusion criteria were divided into two groups. An early excision group who underwent surgery within 7 days of sustaining burn injury ( n = 24) and a late excision group who underwent excision and grafting/debridement after 7 days of sustaining burn ( n = 34). Data recorded included demographic variables like age, sex, percentage total body surface area (TBSA) burn; nature of burn; date of sustaining burn; date of admission to the burn care unit; and treatment and outcome parameters like date of surgery, days from burn injury to first surgery, number of surgeries, type of surgery, percentage of TBSA resurfaced with skin graft, blood products used, length of stay, outcome, and total expenditure incurred by patients. Results There was no statistically significant difference in the number of surgeries done, the units of packed cell used, and the number of fresh frozen plasma (FFP) used between the early excision group and the late excision group. The length of stay was significantly low in the early excision group as compared with the late excision group. The expenditure incurred in the treatment of the early excision group was significantly lower than the cost of treatment of the late excision group. Conclusion Early excision and grafting in burn cases reduces the length of the stay of burn patients and, in turn, reduces the cost of treatment. However, having a dedicated burn care unit is important for the hospitals and both public and private hospitals should make a move in that direction.

Effects of early versus delayed excision and grafting on the return of the burned hand function.

BACKGROUND: Despite a general consensus regarding the impacts of early excision and grafting (EE and G) of burned hand on the reducing of treatment cost and hospital stay, there are some controversial issues about its effect on the outcome of hand function. This study conducted to compare the results of the EE and G and delayed skin grafting in deep hand burns regarding the hand functional outcome. MATERIALS AND METHODS: This study was conducted from April 2012 to November 2013 in sixty patients with deep thermal burns of the dorsal hand with total body surface area (TBSA) <20% who were admitted to special burn hospital. After standard primary burn care and resuscitation, necessary procedures (EE and G or more conservative treatment) were performed based on the patients' conditions. The patients were placed into early excision (No. =30) and delayed excision group (No. =30). Total active motion (TAM) of fingers, grip strength of the hand and the assessment of disabilities of the arm, shoulder and hand questionnaire, were measured in all patients 6 months after grafting. RESULTS: The average percentage of TBSA in the EE and G group was more than the delayed excision group (17.34% ±5.12% vs. 15.64% ±5.83%), this difference was not significant (P = 0.23). After 6 months, the average of the TAM and grip strength in the EE and G group was significantly more than that of the delayed group (P < 0.0001 and P = 0.019). CONCLUSION: The present study showed that EE and G with proper physical therapy and rehabilitation management provides a higher functional outcome in dorsal deep burned hand.

Timing of early excision and grafting following burn in sub-Saharan Africa.

BACKGROUND: This study sought to establish appropriate timing of burn wound excision and grafting in a resource-poor setting in sub-Saharan Africa. METHODS: All burn patients (905 patients) admitted to Kamuzu Central Hospital (KCH) Burn Unit in Lilongwe, Malawi over three years (2011-2014) were studied. RESULTS: 275 patients (30%) had an operation during their admission. In patients who received an operation, median age was 5 years (IQR, 2.7-19) and median total body surface area burn was 15% (IQR, 8-25). 91 patients (33%) had early excision (≤5 days) and 184 patients (67%) had late excision (>5 days). Mortality was significantly greater in the early group (25.3% vs. 9.2%, p=0.001). Controlling for total body surface area burn and age, the adjusted predictive probability of mortality were 0.256 (CI 0.159-0.385) and 0.107 (CI 0.062-0.177) if operated ≤5 and >5 days, respectively (p=0.0114). The odds ratio for mortality if operated >5 days is 0.34 (CI 0.15-0.79, p<0.000). CONCLUSIONS: Early excision and grafting in a resource-poor area in sub-Saharan Africa is associated with a significant increase in mortality. Delaying the timing of early excision and grafting of burn patients in a resource-poor setting past burn day 5 may confer a survival advantage.

Early excision and grafting, an alternative approach to the surgical management of large body surface area levamisole-adulterated cocaine induced skin necrosis.

Levamisole-adulterated cocaine as a cause of retiform purpura progressing to full-thickness skin necrosis was first documented in 2003 and currently comprises over 200 reported cases. Whereas, its presentation, pathophysiology, and diagnostic workup have been reasonably well-defined, only one publication has significantly detailed its surgical management. For this reason there exists a relative absence of data in comparison to its reported incidence to suggest a preferred treatment strategy. In the case mentioned, treatment emphasized delayed surgical intervention while awaiting lesion demarcation and the monitoring of autoantibodies. At our institution we offer an alternative approach and present the case of a 34 year old female who presented with 49% TBSA, levamisole-induced skin necrosis managed with early surgical excision and skin grafting. The patient presented three days following cocaine exposure with painful, purpura involving the ears, nose, buttocks, and bilateral lower extremities which quickly progressed to areas of full-thickness necrosis. Lab analysis demonstrated elevated p-ANCA and c-ANCA, as well as leukopenia, decreased C4 complement, and urinalysis positive for levamisole, corroborating the diagnosis. Contrasting the most thoroughly documented case in which the patient underwent first surgical excision on hospital day 36 and underwent 18 total excisions, our patient underwent first excision on hospital day 10 and received only one primary excision prior to definitive autografting. To our knowledge, this is the largest surface area surgically treated that did not result in surgical amputation or autoamputation of limbs or appendages, respectively. We contend that early excision and grafting provides optimal surgical management of this syndrome while avoiding the morbidity seen with delayed intervention.

Early Excision and Grafting versus Delayed Skin Grafting in Burns Covering Less than 15% of Total Body Surface Area; A Non- Randomized Clinical Trial.

OBJECTIVE: To compare outcome of patients with burns covering less than 15% of total body surface area(TBSA) undergoing early excision and grafting or delayed skin grafting. METHOD: This was a non-randomized clinical trial including 54 patients with less than 15% TBSA burn referring to Ghotboddin Hospital of Shiraz. They were assigned to two study groups, each group including 27 patients: the early excision and grafting group (EEG group) and the delayed grafting group (DG group). Patients were followed postoperatively for 6 months. Hospital stay, graft success rate, itching score and scar formation during 6 months of follow-up were recorded and compared between two study groups. RESULTS: During the study 1 patient was lost to follow-up in early excision and grafting group. Baseline characteristics were comparable between two study groups. The graft success rate was significantly higher in those patients who underwent early excision and grafting when compared to delayed grafting group (96.88% vs. 92.88%; p=0.033). However the length of hospital stay, itching and scar scores were comparable between two study groups after 6 months of follow-up. CONCLUSION: In patients with burns covering less than 15% TBSA, early excision and grafting is associated with higher graft success rates compared to the delayed excision and grafting. How ever length of hospital stay, itching and scar formation is comparable between the two techniques.

Early excision and grafting versus delayed excision and grafting of deep thermal burns up to 40% total body surface area: a comparison of outcome.

This is a study of 120 patients of either sex and all ages who had sustained deep burns of up to 40% of the total body surface area. Half the patients underwent early excision and skin autografting (i.e., within 4-7 days of sustaining burn injury) while the rest underwent delayed excision and skin autografting (i.e., within 1-4 weeks post-burn). Significant differences were found in favour of the early excision and grafting group with regard to the various burn management outcome parameters taken into consideration, i.e. culture positivity of wounds, graft take, duration of post-graft hospitalization, and mortality.

Il s'agit d'une étude portant sur 120 patients des deux sexes et de tous les âges qui avaient subi des brûlures profondes allant jusqu'à 40% de la surface totale du corps. La moitié des patients ont subi l'excision précoce suivie de l'autogreffe cutanée (dans les 4-7 premiers jours après la brûlure) et les autres l'excision et l'autogreffe cutanée retardée (à moins d'une à 4 semaines post-brûlure). Les Auteurs ont observé des différences significatives en faveur des patients du groupe excision/greffe précoce pour ce qui concerne les divers paramètres pris en considération des résultats de la gestion des brûlures, c'est-à-dire la positivité de la culture des lésions, la prise de la greffe, la durée de l'hospitalisation post-greffe et la mortalité.