An evaluation of excision with application of autografts or porcine xenografts within 24 hours of burn injury

An evaluation of feasibility and safety of excising burn wounds within 24 hours of injury was carried out. Over a 2-year period, 124 patients were admitted and taken to the operating room within 24 hours of initial burn injury. All cases were from one surgeon's practice. There were 99 males and 28 females. Age ranged from 8 months to 93 years. Burn size ranged from 0.5% to 70%, with a mean of 17.59%. Time from injury to surgery varied from 2 hours 10 minutes to 23 hours 40 minutes, with a mean of 14.42 hours. All patients admitted within 24 hours of injury were considered for immediate excision. Patients admitted too late in their course to receive excision within 24 hours were not included in the evaluation. Second-degree burns were treated with tangential debridement and porcine xenografts. If third-degree burns were obviously present, electrocautery excision was carried out followed by cadaver grafting or autografting as appropriate. Blood loss ranged from 0 to 2000 cc (mean, 215.08 cc) for the first surgery. The mean number of operations per patient was 1.72. Very large burns underwent staged procedures. There were five deaths (4.0%) in the group. There were no operative deaths. Twenty-three patients required readmission for further treatment, usually including surgery. It appears that excision within 24 hours of injury is safe. There is the obvious benefit of a reduced hospital stay by decreasing the time to surgery and the theoretical advantage obtained by early removal of sources of infection.