Systematic review of excision and grafting in burns: Comparing outcomes of early and late surgery in low and high-income countries

Wong, Lufee; Rajandram, Retnagowri; Allorto, N.L.

doi:10.1016/j.burns.2021.07.001

Cited by 27 publications

(13 citation statements)

References 33 publications

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“…They found that LOS was shorter in early excision, while mortality was lower in late excision, regardless of resource setting. 18 In our study, early excision was associated with earlier hospital discharge, but there was no significant difference in mortality rates between groups. We suggest that high-income countries may not actually have higher mortality associated with early excision, and this conclusion may be outdated.…”

Section: Discussionmentioning

confidence: 41%

“…A mature burn care infrastructure may be necessary to capture the benefits of early excision. Finally, Wong et al 18 noted that it was difficult to synthesize consensus findings because the existing literature on this topic spans mixed patient populations and uses variable definitions of excision timing.…”

Section: Discussionmentioning

confidence: 99%

“…Wong et al 18 performed a meta-analysis examining the impact of early versus late excision in high-income versus low-income countries. They found that LOS was shorter in early excision, while mortality was lower in late excision, regardless of resource setting 18 . In our study, early excision was associated with earlier hospital discharge, but there was no significant difference in mortality rates between groups.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Burn excision within 48 hours portends better outcomes than standard management: A nationwide analysis

Ramsey

O’Neil

Corona

et al. 2023

J Trauma Acute Care Surg

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Section: Discussionmentioning

confidence: 41%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Burn excision within 48 hours portends better outcomes than standard management: A nationwide analysis

Ramsey

O’Neil

Corona

et al. 2023

J Trauma Acute Care Surg

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show abstract

“…Of note, while there is an undisputed consensus that early burn wound excision is the gold standard of burn care, what ‘early’ actually means is still debated. Depending on the authors, the corresponding time limit typically varies from 24 h to a few days [ 2 , 3 ].…”

mentioning

confidence: 99%

Enzymatic debridement shall not modify the global strategy for mass burn events

2022

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“…Further, the overwhelming benefit of early excision and closure has not been replicated in low-income settings. 8 This is likely due to a failure of adequate resuscitation and implementation of holistic perioperative care that is so critical to the improved outcomes seen in early surgery. The burden is large enough that this cannot be the responsibility of the intensive care service alone but must become or return to be a skill of the attending surgeon.…”

mentioning

confidence: 99%

Burn-injured patients – the preferably unheard

Allorto¹,

Bishop²

2022

South African Journal of Surgery

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EDITORIAL "There's really no such thing as the 'voiceless'. There are only the deliberately silenced, or the preferably unheard." Arundhati RoyAnnually there are 11 million burn injuries globally, with 70% occurring in low-to middle-income countries, particularly in Africa and Southeast Asia. The impact is millions of disability-adjusted life years and 250 000 deaths per year. In South Africa, it is estimated that 1.6 million injuries occur annually and while the majority are minor, 10% are moderate or severe and require surgical care, with 3 200 of those requiring specialist surgical and multidisciplinary burn care. Burn injuries target a vulnerable group in society -children, the poor, the mental health care user and the epileptic. 1 Yet despite copious evidence describing the size and impact of the problem, meaningful societal and institutional change has yet to be implemented. 2 The acute principles of management are initially simple -assess the burn size and depth, start intravenous fluid resuscitation for burns greater than 10% of total body surface area, administer analgesia, clean and dress the wound, and refer appropriately. Sepsis is a common complication, and the recognition and appropriate management of sepsis is key. 3 Deep burns require excision and grafting, with moderate and major injuries needing more complex and specialist strategies.The case series published in this issue of SAJS highlights the shocking reality of preventable deaths and severe morbidities in children who should have a good prognosis with correct management. 4,5 This reflects a lack of understanding of the basic principles of resuscitation. The cases demonstrate failure to recognise sepsis and institute appropriate management. These principles should apply to any patient -why are they not being applied to a burn injured patient? Importantly, these poor outcomes are not the result of a lack of resources, where blame is often placed. This basic burn care should be accessible in South Africa, and the clinical care deficiencies likely reflect an underlying training problem. A paper published in the SAMJ in 2016 highlighted deficits in training at internship and registrar levels, with lack of skills development cited as a deterrent for working in the field of burns. 6 Urgent academic and institutional reform is required. Basic principles of burns care should be part of training at

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Systematic review of excision and grafting in burns: Comparing outcomes of early and late surgery in low and high-income countries

Cited by 27 publications

References 33 publications

Burn excision within 48 hours portends better outcomes than standard management: A nationwide analysis

Burn excision within 48 hours portends better outcomes than standard management: A nationwide analysis

Enzymatic debridement shall not modify the global strategy for mass burn events

Burn-injured patients – the preferably unheard

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