Early Excision And Grafting Versus Conservative Treatment In The Management Of Major Burns: A Comparative Study

Background : 1 Full thickness burns lose their eschar in 2-6 weeks through bacterial collagenase production and daily mechanical debridement . The practice of leaving these dead tissues only serves as a nidus for infection that can lead to the patient's death. Hence the standard procedure is surgical removal of eschar with grafting techniques. Methods:Atotal of 50 patients divided in 25 patients in each group were included first group was managed conservatively and second underwent th early excision and grafting within 5 day upto 10% TBSA. Results: Early excision and grafting patients required significantly (p=0.04) more blood transfusions than conservatively managed patients. The mean hospital stay was significantly (p=0.05) lower by 10 days in early excision and grafting than conservatively managed. Conclusion : Early Excision and Grafting group was found to have significantly shorter hospital stay with decresed painful debridement but required more blood transfusions than conservatively managed patients

Malignization of Oral Leukoplakia and the Need for Early Excisional Biopsy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Cancer of the oral cavity is a disease of the head and neck that is difficult to treat. Periodic observation and biopsy are important for its early diagnosis once a premalignant lesion in the oral cavity is confirmed. The purpose of this study was to determine the importance of early excisional biopsy by investigating the histological features of oral leukoplakia and the rate of malignant change in the oral cavity. SUBJECTS AND METHOD: A total of 327 patients who underwent punch biopsy of oral cavity from January 2011 to December 2017 were reviewed retrospectively for the presence of initial gross lesions and for their biopsy results. The histological findings of 6 initial gross lesion groups were compared. Additional excisional biopsies were performed in the seven oral cavity subsites. RESULTS: There were 33 cases of oral leukoplakia. The punch biopsies of 3 of these cases (9.1%) showed malignancy. Additional excisional biopsies were performed in 6 cases, 4 of which were malignant (66.7%). Additional excisional biopsies of the tongue were performed in 14 cases (9.0%), 5 of which (35.7%) were malignant. The rate of atypia in leukoplakia (9.1%) was higher than in other atypia groups. Additional excisional biopsies were performed in 3 cases (100%) of atypia of leukoplakia, all of which were assessed to be malignant. CONCLUSION: For tongue leukoplakia, performing an early excisional biopsy rather than an incisional biopsy is recommendable. Moreover, additional excisional biopsies are needed when the initial biopsy is suggestive of hyperkeratosis, parakeratosis, or atypia.

Clinical Experiences in Management of the Extensive Flame Burns Dorsal Hand by Early Excision and Graft

This study was carried out to examine the effect of early excision and graft for the preservation of the maximal function on the dorsal hand with deep second degree and third degree flame burns. From December 1996 to October 1998, 11 flame burn patients admitted to our hospital burn unit. Nine patients had injured burns less than 20% Total Burn Surface Area, and 2 patients were 70% Total Burn Surface Area(mean 18.4%). We had performed the excision 3-8 days(mean 4.6 days) after burn injury. Ten (90.9%) of eleven patients survived, and 1 patient (Total Burn Surface Area 70%) died of sepsis after early excision. The duration of immobilization was 8-17 days (mean 11.5 days). Twelve months later, the range of motion in all patients has been continued to maintain nearly normal range of motion. We conclude that early excision and grafting was recommended as the preferred form of treatment in patients with deep second degree and third degree on the extensive flame burns of dorsal hand.

The Clinical Study of Electrical Burns / 대한정형외과학회잡지

Electrical burns constitude a unique type of thermal injury. Not only may there be a cutaneous burn but frequently hidden local and regional tissue damage exists. Tissue injury and tenden vascular necrosis are complete within eight to ten days follwoing the insult and additional tissue damage can occur because of infection and toxicity of necrotic tissue. Early excision and early graft can prevent this progressiv muscle necrosis because marginally viable tissue at the periphery are saved by the increased vascularity provided by immediate use of flaps or grafting. We have treated 67 cases of electrical burn from 1975 to 1979. The brief summary of the observations were as follows: 1. Good results were obtained in 15 cases after treatment of early excision and early graft. 2. Simultaneous involvements of hand, wrist, elbow, and shoulder were found because of tetanic contraction in alternating current in 21 cases. 3. In one case of spinal atrophic paralysis due to direct injury to spinal cord, paraplegia was permanent.