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Effects of delayed wound excision and grafting in severely burned children
Wu Xiao-Wu1, David N Herndon, Marcus Spies
1Shriners Hospitals for Children, 815 Market St, Galveston, TX 77550, USA.
Insights
Early surgical excision of severe burns in children significantly reduces complications. Delayed wound care increases infection and sepsis risk, highlighting the importance of timely intervention for better outcomes.
Area of Science:
- Pediatric surgery
- Burn management
- Wound healing
Background:
- Specialized burn centers have improved survival rates.
- Early wound excision is a key advancement in burn care.
- The impact of delayed excision on pediatric burn outcomes requires further investigation.
Purpose of the Study:
- To investigate the association between delayed wound excision and grafting and patient outcomes in pediatric burn cases.
- To determine if delayed surgical intervention leads to increased morbidity and mortality.
- To establish optimal timing for surgical management of extensive burns in children.
Main Methods:
- Retrospective analysis of 157 pediatric patients with extensive burns (≥40% TBSA, ≥10% full-thickness) admitted between 1995-1999.
- Patients were categorized into three groups based on the timing of their first operation: days 0-2, 3-6, and 7-14 post-burn.
- Outcomes assessed included mortality, operative procedures, hospitalization length, blood transfusions, wound contamination, invasive infection, and sepsis.
Main Results:
- No significant differences in mortality, operative procedures, or blood transfusions were observed between groups.
- Delayed excision (days 3-14) was associated with significantly longer hospitalizations.
- Increased rates of significant wound contamination (P=.008), invasive wound infection (P<.001), and sepsis (P=.04) were noted with delayed surgical intervention.
Conclusions:
- Delayed wound excision and grafting in pediatric patients with massive burns correlate with adverse outcomes.
- Early excision within 48 hours appears optimal for minimizing complications such as infection and sepsis.
- Timely surgical management is crucial for improving recovery and reducing hospitalization in severe pediatric burn cases.
Hypothesis:
Advances in burn treatment including early excision of the wound have increased survival in patients treated at specialized burn centers. We hypothesized that the patients with delayed wound excision and grafting would experience deleterious outcomes.
Methods:
From 1995 to 1999, 157 children with acute burns covering 40% or more of total body surface area and having more than 10% of full-thickness burns were admitted to our institution within 2 weeks of injury. Among them, 86, 42, and 29 patients underwent first operation on days 0 to 2, days 3 to 6, and days 7 to 14 after burn, respectively. Outcomes observed were mortality, number of operative procedures, length of hospitalization, blood transfused, incidence of wound bacterial and fungal contamination, invasive wound infection, and sepsis.
Results:
Demographic data for the groups showed no differences in sex or total body surface area burned. Mortality and number of operative procedures and blood transfusions were not different between groups. Hospitalizations were longer in the delayed groups, which was associated with a higher incidence of significant wound contamination (P =.008). Invasive wound infection also increased significantly with delay of excision (P<.001). An increased incidence of sepsis was seen in patients with delayed wound excision and grafting (P =.04).
Conclusions:
Delays in excision were associated with longer hospitalization and delayed wound closure, as well as increased rates of invasive wound infection and sepsis. Our data indicate that early excision within 48 hours is optimal for pediatric patients with massive burns.