Effects of Delayed Wound Excision and Grafting in Severely Burned Children

Open Access
Publisher Website
Google Scholar
Abstract
THE BURN wound is considered to be a major source of inflammatory mediators, which play an important role in initiating and maintaining the postburn inflammatory response. The consequent acute-phase reaction, changes in vascular permeability, alteration in the coagulation system, impairment of gut function, hypermetabolic response, and immune depression are associated with the increased mortality and morbidity after severe burns.1 A potential solution to avert these deleterious changes is to excise the wound before the response is maximized. Early burn wound excision and grafting, a surgical procedure performed to remove the burn wound eschar and cover the exposed wound with autograft, allograft skin, or artificial skin substitutes, is considered routine management in the treatment of the severely burned patients in most burn centers.1-3 When compared with conservative wound treatment with serial debridement and delayed grafting, early wound excision and grafting was associated with decreased blood loss,4 diminished wound infections,5,6 and shortened hospital stay7,8 in patients with medium or severe burns. However, its contribution to improved survival in extensive burns is debated.4,7-9