Early versus Delayed Excision and Grafting in Deep Burns: Impact on Healing Time and Hospital Stay

Abstract

Excision and grafting is the standard surgical treatment of deep burns, but the optimal timing remains debated. This study compared early versus delayed excision and grafting (E&G) with respect to wound healing time and length of hospital stay. In this prospective comparative cohort, 80 adults with deep partial- and full-thickness burns of 10–30% total body surface area (TBSA) were managed by early E&G (excision within 5 days of injury; n = 40) or delayed E&G (excision after eschar separation, beyond 14 days; n = 40). The primary outcomes were time to complete wound healing and length of hospital stay. Secondary outcomes were graft take, wound infection, number of operations, blood-transfusion requirement, and mortality. Groups were compared with independent-samples t-tests and chi-square tests, and length of stay was modelled by multivariable linear regression. The two groups were comparable at baseline (mean age 35.5 years; mean TBSA 18.4%). Early E&G was associated with shorter time to complete healing (24.3 ± 6.1 vs 38.7 ± 8.9 days; mean difference 14.4 days; 95% CI 11.0–17.8; p < 0.001) and shorter hospital stay (19.8 ± 5.7 vs 31.4 ± 8.2 days; mean difference 11.6 days; 95% CI 8.5–14.7; p < 0.001). Graft take was higher (92.4% vs 88.1%; p = 0.03) and wound infection lower (17.5% vs 37.5%; p = 0.045) in the early group. Early E&G required more blood transfusion (3.1 ± 1.4 vs 1.9 ± 1.1 units; p < 0.001). Mortality did not differ (5.0% vs 7.5%; p = 0.64). Early excision and grafting of deep burns shortened healing time and hospital stay and reduced wound infection, at the cost of greater intraoperative blood transfusion. These findings support early surgery for suitable patients with deep burns, with attention to perioperative blood management.