Acute excision or exposure treatment? Results of a randomized controlled clinical trial

An evaluation of a total of 2,460 patients treated with exposure during the period 1962-1971, marked that the exposure method showed satisfactory results, but also that there are clear upper limits for the possibilities of this method. The approach of treatment was reconsidered and consequently very severely burned patients were excised acutely in the years 1972-1975. It was proved plausible, permissable and practically possible. On May 1, 1976, a randomized, controlled clinical trial commenced: Patients admitted for fresh burns were divided into groups: one group was unsuited for trail (U), (e.g. small children, electric burns etc.); of the remaining patients every even was treated with acute excision (A), (i.e. operation within 24 hours post burn), every odd patient according to the classical exposure method (E), employed by our unit: exposure followed by excision and transplantation of all unhealed burned areas no later than day 14 post burn. The results concerning mortality in the first 2-year material are presented. In the first year, which began a few months after moving from a 115 year old hospital into a quite new university hospital, the mortality is found to be twice as high as that found the second year. The reasons are the difficulties caused as a result of moving to new larger buildings, needing an increase of staff with two thirds, all of which are inexperienced in the care of burned patients. The mortality is exactly the same in the group treated with acute excision (A) as the group treated with exposure (E). The trial must continue and results of studies concerning morbidity will be published later.