J.Jpn. Surg. Soc.. 99(1): 40-45, 1998

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Feature topic

IMMEDIATE BURN WOUND EXCISION AND GRAFTING DECREASES THE MORTALITY RATE AND HOSPITALSTAY DURATION IN EXTENSIVE BURN PATIENTS

The treatment of patiens with extensive burn injuries has begun to changed in recent years. Traditional methods have consisted of dressing the burn wound with topical antimicrobials, tubbing the patient daily, encouraging the shoughing off of eschar using surgical debridement as necessary, and finally, closing the granulating wound with split-thickness skin grafts after 2 to 4 weeks. An alteranative and more radical procedure is now being used with incrasing frequency : complete surgical excision of the eschar is performed as soon as the patient is hemodynamically stable after resuscitation from burn shock.
From 1991 to 1997, we performed immediate burn wound excision and grafting in 15 extensive burn patients within 24 hours after injurys. The mean burn surface area (BSA) was 48 ± 20％, and the mean burn index was 44 ± 19. The mean prognostic burn index (PBI＝burn index ＋ age) was 94 ± 23. There were 5 deaths, for an overall mortality rare of 33％, which is less than that experienced by 11 other burn units in Tokyo (51.4％). The duration of hospital stay of survivors was approximately 1 day/％BSA.

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