Jm. Still et al., AN EVALUATION OF EXCISION WITH APPLICATION OF AUTOGRAFTS OR PORCINE XENOGRAFTS WITHIN 24 HOURS OF BURN INJURY, Annals of plastic surgery, 36(2), 1996, pp. 176-179
An evaluation of feasibility and safety of excising burn wounds within
24 hours of injury was carried out. Over a 2-year period, 124 patient
s were admitted and taken to the operating room within 24 hours of ini
tial burn injury. All cases were from one surgeon's practice. There we
re 99 males and 28 females. Age ranged from 8 months to 93 years. Burn
size ranged from 0.5% to 70%, with a mean of 17.59%. Time from injury
to surgery varied from 2 hours 10 minutes to 23 hours 40 minutes, wit
h a mean of 14.42 hours. All patients admitted within 24 hours of inju
ry were considered for immediate excision. Patients admitted too late
in their course to receive excision within 24 hours were not included
in the evaluation. Second-degree burns were treated with tangential de
bridement and porcine xenografts. If third-degree burns were obviously
present, electrocautery excision was carried out followed by cadaver
grafting or autografting as appropriate. Blood loss ranged from 0 to 2
000 cc (mean, 215.08 cc) for the first surgery. The mean number of ope
rations per patient was 1.72. Very large burns underwent staged proced
ures. There were five deaths (4.0%) in the group. There were no operat
ive deaths. Twenty-three patients required readmission for further tre
atment, usually including surgery. It appears that excision within 24
hours of injury is safe. There is the obvious benefit of a reduced hos
pital stay by decreasing the time to surgery and the theoretical advan
tage obtained by early removal of sources of infection.