Selective Early Excision Versus a Conservative Surgical Approach. Management of Deep Burn Injury in a...

Area of Science:

• Trauma Surgery
• Burn Care Management
• Resource-Limited Healthcare

Background:

• Operative intervention for deep burn injury offers survival benefits, but this advantage may be limited in resource-restricted environments due to deficiencies in advanced burn care delivery.
• This study addresses the critical need to compare different operative approaches for deep burn injuries within a low-resource setting.

Purpose of the Study:

• To compare the mortality outcomes of two distinct operative strategies for managing deep burn injuries in a low-resource hospital.
• To evaluate the impact of early excision versus conservative management on patient survival and resource utilization.

Main Methods:

• A prospective, observational study was conducted at Grey's Hospital, comparing a Priority System (early excision) with a Conservative System (delayed grafting after eschar separation).
• The primary outcome measure was mortality, with secondary outcomes including acute kidney injury, intensive care unit (ICU) admission, sepsis rates, and length of stay.

Main Results:

• Mortality was significantly higher in the Priority System (10.8%) compared to the Conservative System (4.6%) (p=0.039).
• The Priority System also showed higher rates of acute kidney injury and ICU admissions, but lower sepsis rates.
• The Conservative System resulted in longer times from injury to first surgery and injury to discharge.

Conclusions:

• In a low-resource setting, conservative management with spontaneous eschar separation and delayed skin grafting improved mortality outcomes compared to early excision and grafting.
• Conservative surgical approaches are recommended for deep burn injuries when resource limitations preclude early excision and simultaneous closure.
• Early excision without immediate closure did not demonstrate a mortality benefit in this study population.