Israel JS, Greenhalgh DG, Gibson AL, et al.
Journal of burn care & research : official publication of the American Burn Association. Date of publication 2017 Jan 1;volume 38(1):e125-e132.
1. J Burn Care Res. 2017 Jan/Feb;38(1):e125-e132. doi: 10.1097/BCR.0000000000000475.
Variations in Burn Excision and Grafting: A Survey of the American Burn
Association.
Israel JS(1), Greenhalgh DG, Gibson AL.
Author information:
(1)From the *Division of Plastic Surgery, Department of Surgery, University of
Wisconsin, Madison; †Division for Burn Surgery, Department of Surgery, University
of California, Davis Medical Center, Sacramento; and ‡Division of Trauma, Acute
Care Surgery, Burn and Surgical Critical Care, University of Wisconsin, Madison.
It is unknown whether variations in burn care affect outcomes or affect the
success of emerging therapeutics. The purpose of this study was to assess burn
surgeons' preferences in excision and grafting to determine if surgical technique
affects outcomes. A 71-item survey evaluating skin grafting techniques and
preferences was emailed to members of the American Burn Association in July and
August 2015. The survey was anonymous and voluntary. Relationships between
variables were evaluated using Fisher's exact test. A P-value of ≤.05 was deemed
statistically significant. The survey was sent to 607 burn surgeons, and the
response rate was 24%. Clinical judgment is the most widely used method to
determine depth of injury. Surgeons who practice in the United States and
surgeons who are board certified in general surgery are more likely to determine
depth of the burn based on clinical judgment alone (P < .001). Fifty-six percent
of surgeons will perform excision as early as postburn day 1 and 73% will excise
greater than 20% TBSA in one setting. Surgeons at centers with bed number of ≤10
(P = .024) or surgeons with board certification in plastic surgery (P = .008) are
more likely to excise deep partial-thickness burns with an attempt to retain
viable dermis. Geographic location, board certification, and burn unit size all
contribute to variations in practice. Strong individual preferences make
standardization of therapies challenging and may affect the success of new
technologies. Burn surgery continues to be an art as much as a science, and
accurate documentation of techniques and outcomes is essential for optimizing
successes and documenting failures of new treatment methods.
DOI: 10.1097/BCR.0000000000000475
PMID: 27893575 [Indexed for MEDLINE]
