Safety and efficacy of excision and direct closure in acute burns surgery: Outcome analysis in a prospective series of 100 patients and a survey of UK burns surgeons’ attitudes |
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Institution: | 1. Department of Orthopedic Surgery, Seoul National University, College of Medicine, SMG-SNU Boramae Medical Center, Boramae-ro 5-gil 20, Dongjak-gu, Seoul 07061, Republic of Korea;2. Department of Orthopaedic Surgery, Yanbian University Hospital, 1327 Juzi St, Yanji 133000, Jilin Province, China;3. Department of Basic Science, Hongik University, 94 Wausan-ro, Mapo-Gu, Seoul 04066, Republic of Korea;4. Institute of Medical and Biological Engineering, Seoul National University Medical Research Center, 101, Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea |
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Abstract: | Many burns surgeons avoid excision and direct closure of acute burns owing to concerns over wound dehiscence, scarring and infection. There is no evidence in the literature to support this practice. We present outcomes of a prospective series of 100 patients who underwent excision and direct closure of 138 burns over a 2-year period, along with results from a survey sent to 33 senior burns surgeons to gauge attitudes towards direct closure in burns surgery. 47% of survey respondents never perform direct closure. Dehiscence was cited as the most common concern, followed by hypertrophic scarring (HTS). In our cohort, the superficial dehiscence rate was 12% and the HTS rate was 16%, with no scarring contractures. Patients with healing time greater than 14 days were more likely to develop HTS (p = 0.008), as were those with wound dehiscence (p = 0.014). Patients undergoing part-grafting in addition to direct closure took significantly longer to heal than those undergoing direct closure alone (p = 0.0002), with the donor site or graft delaying healing in the majority. Excision and direct closure of acute burn wounds avoids donor site morbidity and has an acceptable complication rate. It is a safe and effective treatment for full thickness burns in selected cases. |
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Keywords: | Acute burns Excision and direct closure Hypertrophic scarring Dehiscence Burns surgery |
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