title: 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.
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.
authors.affiliation: Burns Service, Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, United Kingdom. Electronic address: bainage@hotmail.com.
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Bain
authors.affiliation: Burns Service, Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, United Kingdom.
authors.forename: Tim
authors.initials: T
authors.lastname: Wang
authors.affiliation: Burns Service, Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, United Kingdom.
authors.forename: Gordon
authors.initials: G
authors.lastname: McArthur
authors.affiliation: Burns Service, Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, United Kingdom.
authors.forename: Greg
authors.initials: G
authors.lastname: Williams
authors.affiliation: Burns Service, Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, United Kingdom.
authors.forename: Joanne
authors.initials: J
authors.lastname: Atkins
authors.affiliation: Burns Service, Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, United Kingdom.
authors.forename: Isabel
authors.initials: I
authors.lastname: Jones
mesh_terms: D001291:Attitude of Health Personnel; D002056:Burns / Q000601:surgery*; D017439:Cicatrix, Hypertrophic / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006406:Hematoma / Q000453:epidemiology; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D016038:Skin Transplantation; D066231:Surgeons; D013529:Surgical Wound Dehiscence / Q000453:epidemiology; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D058106:Wound Closure Techniques; D014945:Wound Healing
keywords: Acute burns; Burns surgery; Dehiscence; Excision and direct closure; Hypertrophic scarring