Background: Early excision and grafting has been the preferred method of managing major burns around the world since 1970. Considering the advances in health care and the development of new antibiotics over the past 50 years, delayed grafting as a technique for the management of burns over 15%-20% of total body surface area (TBSA) could have comparable results to that of early excision. This study aims to highlight the outcomes of practicing delayed grafting in burn patients. Methods: A case series analysis was performed of 51 patients who were admitted to the burns unit in Sultan Qaboos Hospital Salalah with over 20% TBSA between January 2014 and December 2019. The patients received prophylactic antibiotics and silver sulphadiazine dressing until the burn eschar had completely separated, followed by grafting. Results: Two patients were lost during the entire duration of the study. The mortality rate was comparable to that of early excision, while the rate of hypertrophic scarring was lower than the range reported by other studies. Conclusion: In the management of patients with over 20% TBSA, delayed grafting after complete separation of eschar is still a valid technique.
References
[1]
Janzekovic, Z. (1970) A New Concept in the Early Excision and Immediate Grafting of Burns. The Journal of Trauma: Injury, Infection, and Critical Care, 10, 1103-1108. https://doi.org/10.1097/00005373-197012000-00001
[2]
Miroshnychenko, A., Kim, K., Rochwerg, B. and Voineskos, S. (2021) Comparison of Early Surgical Intervention to Delayed Surgical Intervention for Treatment of Thermal Burns in Adults: A Systematic Review and Meta-Analysis. Burns Open, 5, 67-77. https://doi.org/10.1016/j.burnso.2021.02.003
[3]
Shlash, S.O., Madani, J.O., Deib, J.I., Alsubhi, F.S., Saifi, S.S., Helmi, A.M., Al-Mutairi, S.K. and Khurram, J.A. (2016) Demographic Characteristics and Outcome of Burn Patients Requiring Skin Grafts: A Tertiary Hospital Experience. International Journal of Burns and Trauma, 6, 30-36.
[4]
Alajmi, M., Aldosari, K.H. and Al-Ghamdi, S. (2021) Clinical, Epidemiological, and Management Aspects of Burn Injuries in Saudi Arabia—A Cross-Sectional Study. Saudi Journal of Biological Sciences, 28, 4342-4347. https://doi.org/10.1016/j.sjbs.2021.04.021
[5]
Bhat, F.A. (2006) Early Sequential Excision of Chemical Burns—Our Experience in Riyadh Burns Unit. Annals of Burns and Fire Disasters, 19, 78-79.
Dokter, J., Felix, M., Krijnen, P., Vloemans, J.F.P.M., van Baar, M.E., Tuinebreijer, W.E., Breederveld, R.S. and The Dutch Burn Repository Group (2015) Mortality and Causes of Death of Dutch Burn Patients during the Period 2006-2011. Burns, 41, 235-240. https://doi.org/10.1016/j.burns.2014.10.009
[8]
Keshavarzi, A., Ayaz, M. and Dehghankhalili, M. (2016) Ultra-Early versus Early Excision and Grafting for Thermal Burns up to 60% Total Body Surface Area: A Historical Cohort Study. Bulletin of Emergency and Trauma, 4, 197-201.
[9]
Forbinake, N.A., Ohandza, C.S., Fai, K.N., et al. (2020) Mortality Analysis of Burns in a Developing Country: A CAMEROONIAN Experience. BMC Public Health, 20, Article No. 1269. https://doi.org/10.1186/s12889-020-09372-3
Jeschke, M.G., Pinto, R., Kraft, R., Nathens, A.B., Finnerty, C.C., Gamelli, R.L., et al. (2015) Morbidity and Survival Probability in Burn Patients in Modern Burn Care. Critical Care Medicine, 43, 808-815. https://doi.org/10.1097/CCM.0000000000000790
[12]
García-Díaz, A., Durán-Romero, A.J., Gacto-Sánchez, P., Carbajal-Guerrero, J., Gómez-Cía, T. and Pereyra-Rodríguez, J.J. (2021) Trends in Burn Injury Mortality in Spain (1979-2018): Sex-Specific Age-Cohort-Period Effects. Burns, 47, 714-720. https://doi.org/10.1016/j.burns.2020.08.001
[13]
Sadeghian, F., Moghaddam, S.S., Saadat, S., Niloofar, P., Rezaei, N., Amirzade-Iranaq, M.H., et al. (2019) The Trend of Burn Mortality in Iran—A Study of Fire, Heat and Hot Substance-Related Fatal Injuries from 1990 to 2015. Burns, 45, 228-240. https://doi.org/10.1016/j.burns.2018.09.006
[14]
Kilyewala, C., Alenyo, R. and Ssentongo, R. (2017) Determinants and Time to Blood Transfusion among Thermal Burn Patients Admitted to Mulago Hospital. BMC Research Notes, 10, Article No. 258. https://doi.org/10.1186/s13104-017-2580-2
[15]
Palmieri, T.L., Holmes IV, J.H., Arnoldo, B., Peck, M., Potenza, B., Cochran, A., et al. (2017) Transfusion Requirement in Burn Care Evaluation (TRIBE): A Multicenter Randomized Prospective Trial of Blood Transfusion in Major Burn Injury. Annals of Surgery, 266, 595-602. https://doi.org/10.1097/SLA.0000000000002408
[16]
Al-Busaidi, S., Mohammed, A., Murugan, V.K. and Thankappan, S. (2013) Colistin Effectiveness and Nephrotoxicity: Experience from a Tertiary Care Burns Unit in Oman. European Journal of Plastic Surgery, 36, 443-448. https://doi.org/10.1007/s00238-013-0827-2
[17]
Chiang, R.S., Borovikova, A.A., King, K., Banyard, D.A., Lalezari, S., Toranto, J.D., et al. (2016) Current Concepts Related to Hypertrophic Scarring in Burn Injuries. Wound Repair and Regeneration, 24, 466-477. https://doi.org/10.1111/wrr.12432
