• Juan P Barret and David N Herndon.
• Department of Surgery, University of Texas Medical Branch, and Galveston Shriners Hospital, Galveston, USA. bconsjb@meht.nhs.uk
• Arch Surg Chicago. 2003 Feb 1;138(2):127-32.

HypothesisEarly burn wound excision modulates the hypermetabolic response in severe pediatric burn injuries.DesignBefore-after trial.SettingA 30-bed burn referral center in a private, university-affiliated hospital.MethodsWe 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.Main Outcome MeasuresAcute-phase and hypermetabolic responses.ResultsEarly 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.ConclusionsEarly 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.

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