Comparative Study of Early Excision and Skin Graft versus Late Skin Graft in Burn Patients

Résumé

Introduction: Burn results in disruption of functional integrity of tissues caused by a pathological influx of energy. Depending upon the depth of the tissue damage, the burn may be superficial, partial-thickness and full-thickness burn. Full-thickness burn involves the epidermis and the entire dermis as well. Though early burn excision and skin grafting was first introduced by Wilms in 1901 and applied to large burns by Janzekovic in 1970, it gained widespread popularity in recent years. Presently it is a well-accepted procedure. The purpose of this study is to evaluate the outcome of early excision & skin grafting versus late skin grafting in the burn patients. Methods: This study was carried out in the Department of Plastic Surgery and Burn unit, Dhaka Medical College Hospital, Dhaka, between April 2013 to March 2014. The enrolled patients divided randomly in two groups, the group I- early excision and skin graft and group II- late skin graft. Results: Mean age of study population was 6.7(±2.1) years in group I and 8.10(±1.66) years in group II; with a range of 3 to 12 years. Males were predominant, 17(56.67%) in group I and 18(60%) in group II. Overall male: female ratio was 1.4:1. The cause of burn in group I- 09(30%) were electric burns and 21(70%) were flame burns; in group II- 3(10%) were electric burn and 27(90%) were flame burns. In group  I mean percentages of skin graft take on 5th day was 97.90%(±4.55) and 91.0%(±8.44) in group II (p <0.05), that was statistically significant. On 10th day mean skin graft take was 97.7% and 90.0% in group I and group II respectively. Conclusion & Recommendation: Early excision and skin grafting have become the standard procedure for most of the deep dermal burns. This study showed a significant difference in favor of early excision and skin grafting over delayed skin grafting in respect to graft take, post graft complications and length of hospital stay.