Metabolic rate alterations in early excision and grafting versus conservative treatment

This study was done to determine whether early massive excision and grafting would decrease the hypermetabolic response that characterizes burn injury. Thirteen consecutively admitted adult males with burns over more than 45% of the total body surface area (TBSA) were randomly assigned to one of two treatment groups. One group was treated by excising the burn within 72 hours of injury and grafting with autograft overlaid with cadaveric allograft or cadaveric allograft alone depending on available donor sites and size of recipient areas. The second group was treated conservatively with daily hydrotherapy and twice daily applications of topical antimicrobial agents until granulating beds could receive autografts. Resting energy expenditure (REE) was calculated from measurement of vO2 and vCO2 at the patient's bedside. The responses of the two groups were comparable: the REE was approximately 20-30% above the predicted basal metabolic rate (BMR). Excisional therapy did not markedly decrease the hypermetabolic response to burn injury.