Selective aggressive burn excision for high mortality subgroups.
Traditional teaching recommends major burn procedures be limited to successive 20% total body surface area (TBSA) excision and grafting procedures. This format theoretically reduces the surgical stress and limits the transfusion requirements to a level reasonably tolerated by patients. We have treated 14 patients with thermal burns involving greater than 30% TBSA. These patients underwent excisions ranging from 30 to 70% TBSA at the initial operative escharectomy. Tangential and fascial excisions were employed, depending upon the depth of injury, and autografts and/or allografts were utilized for wound closure. The results of this technique yielded an overall 71% survival. Time from burn to last autograft and hospital stay tended to be shortened or unchanged when compared to national averages. This series demonstrates the feasibility of performing early major escharectomy in a selected burn population without apparent increased surgical risk compared to patients treated by conventional staged excision. Although burn wound sepsis and mortality appeared favorably affected by this technique, the small population size was unsuitable for adequate statistical analysis.