Total burn wound excision in major burn injury; Two decades experience at St Andrew’s

Peter Dziewulski FFICM FRCS FRCS(Plast)1

1Clinical Director, Consultant Plastic and Reconstructive Surgeon, St Andrews Centre for Plastic Surgery and Burns, Chelmsford, Essex CM1 7ET

There remains worldwide variation in the surgical management of major deep or full thickness burns in both adult and paediatric patients.  In our burn service over the past two decades the standard of care has been to perform total or near-total excision of full thickness burns in all patients within 24 hours of the patient’s injury or admission to the Burns Service.

Early wound excision improves survival, decreases burn wound sepsis, shortens length of stay and provides better aesthetic and functional outcomes when compared to serial excision and grafting or conservative non-surgical debridement using topical agents.  Retrospective studies, comparative randomised controlled trials and meta-analysis studies have confirmed the benefits of this approach.

Data was presented on this approach to major burn injury in our service at ANZBA in 2009.   We have continued to collect data and analyse the effect of early total or near total surgical excision in major burn injury over the past two decades.

Early total excision of major burns can be safely performed within a regional burns centre. It requires the participation of an extensive multi-disciplinary team and specialised facilities. Such improvements in acute care are reflected in improvements in survival rates and functional discharge outcomes.

The talk will describe our approach, experience and outcomes and will update ANZBA on data previously presented.


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