Impact of early excision in acute burns: A randomized controlled trial from a tertiary centre in North India

Early excision and grafting is widely practiced in high-income countries for deep burns; however, its benefit and feasibility in resource-limited settings remain debated. Evidence from randomized studies in low- and middle-income countries is limited.

To compare early versus delayed excision and grafting in acute burn patients in terms of hospital stay, organ dysfunction, wound microbiology, graft take, and transfusion requirements.

This prospective, parallel-group, superiority randomized controlled trial with a 1:1 allocation ratio was conducted in the Department of Burns and Plastic Surgery at a tertiary care teaching hospital in North India from April 2024 to September 2025, comparing early versus delayed excision and grafting in acute burn patients, with follow-up completed during the same admission period. Adults aged 18-60 years with 10-40% total body surface area (TBSA) deep second- or third-degree burns were randomized into early excision (≤7 days post-burn) or delayed excision groups. The primary outcome was length of hospital stay. Secondary outcomes included Sequential Organ Failure Assessment (SOFA) score on day 10, wound microbiology, graft take on postoperative day 7 and transfusion requirements. Continuous variables were analysed using the Mann-Whitney U test and categorical variables using Fisher's exact test.

Thirty-six patients were randomized (18 early excision, 18 delayed excision). Early excision significantly reduced median hospital stay (13.5 vs 28.5 days, p = 0.009). The median time from burn injury to excision was 4.5 days (IQR: 3-6 days) in the early excision group and 30.5 days (IQR: 23.5-42.5 days) in the delayed excision group. No significant differences were observed in SOFA score, blood transfusion requirements, or mortality. There was no statistically significant difference in overall burn wound culture positivity between groups (p = 0.092). However, polymicrobial infections occurred significantly more frequently in the delayed excision group (44.4% vs 5.6%, p = 0.017). Graft take during the index admission was lower in the early excision group.

Early excision significantly reduced hospital stay and was associated with fewer polymicrobial wound infections without increasing organ dysfunction or transfusion requirements. Larger multicentre randomized studies are warranted to confirm these findings and further evaluate graft-related outcomes.