Early surgical excision and autologous skin grafting in major thermal burns. A narrative literature review
DOI:
https://doi.org/10.14748/vdrb2n61Keywords:
burns, early surgical excision, autologous skin grafting, total body surface area, in-hospital mortality, retrospective cohort, wound infectionAbstract
Introduction: Major thermal burns affecting ≥ 20% of the total body surface area (TBSA) remain among the most devastating and life-threatening conditions associated with high mortality, infectious complications and prolonged hospitalization. Early surgical excision followed by autologous skin grafting has emerged as the gold standard in modern burn care, yet considerable variation persists in clinical practice regarding optimal timing, technique selection and perioperative management.
Aim: This review aims to comprehensively review and summarize the published evidence regarding early surgical excision and autologous skin grafting in extensive thermal burns and timing of the surgery and its impact on clinical outcomes—in-hospital mortality, infectious complications and bacteremia, length of stay, transfusion requirements, and graft take.
Materials and Methods: A narrative literature review was conducted, including randomized controlled trials, meta-analyses, systematic reviews, retrospective and prospective cohort studies retrieved from PubMed/Medline, EMBASE, and the Cochrane Library. An additional search of recent sources (2021–2025) was performed to update the evidence base.
Results: The evidence consistently demonstrates that early excision and grafting within 5–7 days post-injury is associated with reduced in-hospital mortality in patients without inhalation injury (RR 0.36, 95% CI 0.20–0.65), shorter hospital stay (mean difference of 12.66 days, 95% CI 9.80–15.53) and lower wound infection rates. Large database evidence supports a time-dependent effect, with lower mortality (3.84% vs. 6.09%) and fewer wound infections when excision occurs within three days. Ultra-early excision (within 72 hours) demonstrates additional benefits including higher graft success and decreased infection. A disadvantage might be the increased blood transfusion demands, although modern hemostatic techniques may mitigate this effect.
Conclusion: The current evidence supports early surgical excision as an effective strategy for improving clinical outcomes in major thermal burns. Methodological challenges, including survival bias and lack of standardized definitions, warrant cautious interpretation of the evidence and further researching the topic.
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