The evolution of early excision in burns during the last three decades – A systematic review

Radhianie Djan1,3, dr. Zainul  Halim1, dr. Aditya Wardhana1,2,3

1Burn Unit, Cipto Mangunkusumo National General Hospital, 2Plastic and Reconstructive Surgery Division, Department of Surgery, Cipto Mangunkusumo National General Hospital, 3Faculty of Medicine, Universitas Indonesia

Background: Many countries remain unclear on selecting which procedures are best in treating deep partial and full-thickness burns since the introduction of early tangential excision. Therefore, this systematic review sought to compare early excision procedure with another approach (e.g. conservative approach, delayed excision) on its outcome among burn patients worldwide.

Method: The literature search was performed in PubMed, MEDLINE via Ovid, and Cochrane Library databases using MeSH terms and a combination of Boolean terms of “early excision” and “burns”. Search was limited to only articles written in the English language, human only participants and no restriction on publication date applied. The outcome of interest was mortality, the length of hospital stay (LOS), blood loss, complications or morbidity, bacterial colonization, infection, sepsis.

Result: There are 16 studies (1894 patients) included in this review. Numerous definitions used in describing early excision procedure in each of the studies. The majority of studies reported that early excision has a lower incidence of mortality, lower length of stay (LOS), less incidence of complications after burns, less colonization of bacteria, less incidence of infection and sepsis compared to conservative and delayed excision. However, high incidence of blood loss among early excised patients is reported on 6 studies with high significance value.

Conclusion: Although tangential excision has disadvantages on a great volume of blood loss in severe burns, this approach needs to be conducted as early as possible considering its benefits on mortality, LOS, complications, infection, bacterial colonization, and sepsis incidence.

Tangential excision, early excision, burns.

Dr. Radhianie Djan is currently a general practitioner who works as a research assistant in Burn Unit, Plastic Reconstructive Division in Cipto Mangunkusumo National General Hospital.


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