Modulation of inflammatory and catabolic responses in severely burned children by early burn wound excision in the first 24 hours.
OBJECTIVE
Early burn wound excision modulates the hypermetabolic response in severe pediatric burn injuries.


METHODS
Before-after trial.


METHODS
A 30-bed burn referral center in a private, university-affiliated hospital.


METHODS
We studied 35 severely burned children who were divided into 2 groups. One group (n = 20) was treated with early burn wound excision within 24 hours after the injury. The second group (n = 15) was treated conservatively with silver sulfadiazine in other burn facilities for 5 days, and burn wounds were surgically excised when patients were admitted to our burn center on day 6 after the injury. Data compiled included oxygen consumption and acute-phase protein, interleukin 1beta; interleukin 6, interleukin 10, tumor necrosis factor alpha, and anabolic hormone (growth hormone, insulinlike growth factor type 1) levels preoperatively and 24 hours and 5 days postoperatively.


METHODS
Acute-phase and hypermetabolic responses.


RESULTS
Early burn wound excision abrogated the hypermetabolic response in pediatric burn patients. Patients who underwent conservative treatment had a significantly more severe inflammatory and hypermetabolic response at the same time interval and significantly lower levels of anabolic hormones.


CONCLUSIONS
Early burn wound excision is a safe therapeutic approach that modulates the hypermetabolic response after burn injury. It was superior to the conservative treatment of silver sulfadiazine and delayed excision, and it should be considered when treating all severe full-thickness burns.
Barret
Juan P
JP
Department of Surgery, University of Texas Medical Branch, and Galveston Shriners Hospital, Galveston, USA. bconsjb@meht.nhs.uk
Herndon
David N
DN
D000210:Acute-Phase Reaction; D002053:Burn Units; D002056:Burns / Q000378:metabolism / Q000601:surgery* / Q000628:therapy; D016022:Case-Control Studies; D002648:Child; D016207:Cytokines / Q000097:blood; D005260:Female; D013006:Growth Hormone / Q000097:blood; D006801:Humans; D018972:Insulin-Like Growth Factor Binding Protein 3 / Q000097:blood; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008297:Male; D010101:Oxygen Consumption; D012837:Silver Sulfadiazine / Q000008:administration & dosage; D013997:Time Factors
D016207:Cytokines; D018972:Insulin-Like Growth Factor Binding Protein 3; D007334:Insulin-Like Growth Factor I; D013006:Growth Hormone; D012837:Silver Sulfadiazine