Acute Excision or Exposure Treatment?

Abstract

Which treatment, acute excision or exposure, is the method of choice in the treatment of patients with small, medium-sized or large burns, and superficial or deep burns respectively? In an attempt to give an answer to this question a Randomized, Controlled, Clinical Trial was carried out by the Burns Unit in Copenhagen. The RCCT consisted of all patients (570) admitted primarily for burn injuries over the 3-year period 1976–79. Patients who would be too difficult to compare were sorted out (unsuited for trial—421 patients). The remaining patients were stratified into two groups: group A = patients treated with excision of all burned areas (superficial dermal plus deep dermal plus subdermal burns) and grafted as quickly as possible after the accident, and consequently in the shock-phase (73 patients), and group E = patients treated with exposure until day 14 post-burn, at which time all non-spontaneously healed areas were excised and grafted (76 patients). The stratification was successful, and it was revealed that the two groups were comparable with regard to the extent and depth of the burn and the age of the patients. The following parameters were used: the crude mortality rate and the time and causes of death. The morbidity estimated by the kind and number of complications; especially the number of infected patients and the severity of the infections. The resource expenditure expressed in number of bed-days, duration of operations and amount of blood transfusions. Late results are described elsewhere. When treated with acute excision (A) patients suffering from burn injuries of less than 15% of the body surface were hospitalized over a shorter period and sustained fewer complications and infections. No statistical differences were found between group A and E if the burn injury was above 15%.