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Modulation of Inflammatory and Catabolic Responses in Severely Burned Children by Early Burn Wound Excision in the First 24 Hours
Juan P. Barret, MD, PhD;
David N. Herndon, MD
Arch Surg. 2003;138:127-132.
Hypothesis Early burn wound excision modulates the hypermetabolic response in severe pediatric burn injuries.
Design Before-after trial.
Setting 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 1 ; interleukin 6, interleukin 10, tumor necrosis factor  , and anabolic hormone (growth hormone, insulinlike growth factor type 1) levels preoperatively and 24 hours and 5 days postoperatively.
Main Outcome Measures 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.
From the Department of Surgery, University of Texas Medical Branch, and Galveston Shriners Hospital, Galveston (Drs Barret and Herndon); and the Department of Surgery, Division of Plastic Surgery, University Hospital Groningen, Groningen, the Netherlands (Dr Barret). Dr Barret is now with Broomfield Hospital, Chelmsford, England.
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