Lessons learnt from 2,409 burn patients operated by early excision

During the last 12 years early excision of burns followed by immediate grafting has been the standard procedure at the Burns Unit in Ljubljana. The results, although greatly superior to the classical approach, show that the early removal of burned tissue before the 5th postburn day does not solve the problem in all cases. No problems were observed in deep dermal and subdermal burns not exceeding 40% of the body surface in the average healthy young individual. These cases can be helped and fully rehabilitated in 6 weeks with less disfigurement and functional disability. In burns exceeding 40% of the body surface or in smaller burns affecting patients in unfavorable age and health groups, the above method is not so easy to apply because of problems involving a number of factors: the timing and the selection of the area to be excised, the availability of grafts, blood loss, and coagulation problems, the indications for the use of tourniquet, the problem of excision of infected areas, etc. It is important to work out a strategy for each individual case. The authors show that the improvement of diagnosis and understanding of the deep dermal burn will lead to better results.