Meta-analysis of early excision of burns.
OBJECTIVE
This meta-analysis sought to establish if early excision and grafting is better or equivalent to the conservative treatment of burns in both children and adults with minor or major burns. The outcomes of interest are mortality, wound healing time, duration of sepsis, operating hours, complications of surgery, length of hospital stay, blood transfusion requirements and long term morbidity like joint contractures and hypertrophic scarring.


METHODS
We searched MEDLINE (1966-July 2004), EMBASE (1980-August 2004) and the Cochrane Central Register of Controlled Trials (CENTRAL) with the keywords 'early excision' and 'burns'. This yielded 441 articles of which 15 were randomized controlled trials. Only six trials met the inclusion criteria.


RESULTS
There was a significant reduction in mortality with early excision of burns when compared with traditional treatment only in patients without inhalational injury (RR 0.36, 95% CI 0.20 to 0.65). The blood transfusion requirement is significantly higher in the early excision group but the length of hospital stay was significantly shorter (WMD -8.89, 95% CI -14.28 to -3.50). There was no conclusive evidence on the difference between the two groups in terms of duration of sepsis, wound healing time and skin graft take.


CONCLUSIONS
Early excision of burns is beneficial in reducing mortality (in patients without inhalational injury), length of hospital stay. The only drawback is the greater volume of blood loss.
Ong
Yee Siang
YS
Singapore General Hospital, Department of Plastic Surgery, Outram Road, Singapore 169608, Singapore. yeesiang_susan@hotmail.com
Samuel
Miny
M
Song
Colin
C
D000328:Adult; D001803:Blood Transfusion; D002056:Burns / Q000601:surgery*; D002648:Child; D017439:Cicatrix, Hypertrophic / Q000209:etiology; D006085:Graft Survival; D006801:Humans; D007902:Length of Stay; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D018805:Sepsis / Q000517:prevention & control; D016038:Skin Transplantation / Q000379:methods*; D014945:Wound Healing; D014946:Wound Infection / Q000517:prevention & control