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

Abstract

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.

Keywords

early excision and grafting - burn patients - eastern India

• References

• 1 Forjuoh SN. Burns in low- and middle-income countries: a review of available literature on descriptive epidemiology, risk factors, treatment, and prevention. Burns 2006; 32 (05) 529-537
• 2 Janzekovic Z. A new concept in the early excision and immediate grafting of burns. J Trauma 1970; 10 (12) 1103-1108
• 3 Herndon DN, Barrow RE, Rutan RL, Rutan TC, Desai MH, Abston S. A comparison of conservative versus early excision. Therapies in severely burned patients. Ann Surg 1989; 209 (05) 547-552
• 4 Thompson P, Herndon DN, Abston S, Rutan T. Effect of early excision on patients with major thermal injury. J Trauma 1987; 27 (02) 205-207
• 5 Desai MH, Rutan RL, Herndon DN. Conservative treatment of scald burns is superior to early excision. J Burn Care Rehabil 1991; 12 (05) 482-484
• 6 Subrahmanyam M. Early tangential excision and skin grafting of moderate burns is superior to honey dressing: a prospective randomised trial. Burns 1999; 25 (08) 729-731
• 7 Engrav LH, Heimbach DM, Reus JL, Harnar TJ, Marvin JA. Early excision and grafting vs. nonoperative treatment of burns of indeterminant depth: a randomized prospective study. J Trauma 1983; 23 (11) 1001-1004
• 8 Ong YS, Samuel M, Song C. Meta-analysis of early excision of burns. Burns 2006; 32 (02) 145-150
• 9 Vinita P, Khare NA, Chandramouli M, Nilesh S, Sumit B. Comparative analysis of early excision and grafting vs delayed grafting in burn patients in a developing country. J Burn Care Res 2014; 37 (05) 278-282
• 10 Gallaher JR, Mjuweni S, Shah M, Cairns BA, Charles AG. Timing of early excision and grafting following burn in sub-Saharan Africa. Burns 2015; 41 (06) 1353-1359
• 11 Pietsch JB, Netscher DT, Nagaraj HS, Groff DB. Early excision of major burns in children: effect on morbidity and mortality. J Pediatr Surg 1985; 20 (06) 754-757
• 12 Demling RH. Improved survival after massive burns. J Trauma 1983; 23 (03) 179-184
• 13 Xiao-Wu W, Herndon DN, Spies M, Sanford AP, Wolf SE. Effects of delayed wound excision and grafting in severely burned children. Arch Surg 2002; 137 (09) 1049-1054
• 14 Irei M, Abston S, Bonds E, Rutan T, Desai M, Herndon DN. The optimal time for excision of scald burns in toddlers. J Burn Care Rehabil 1986; 7 (06) 508-510
• 15 Ahuja RB, Goswami P. Cost of providing inpatient burn care in a tertiary, teaching, hospital of North India. Burns 2013; 39 (04) 558-564