Effects of burn wound excision on bacterial colonization and invasion

Juan P. Barret, David Herndon

Research output: Contribution to journalArticle

124 Citations (Scopus)

Abstract

Rates of survival after thermal injury have improved in the past two decades, and rates of wound infections and sepsis have decreased during the same period. Early excision has been advocated as one of the major factors, but its safety and efficacy and the exact timing of burn excision are still under debate. It was hypothesized that acute burn wound excision (in the first 24 hours after burning) would be superior to conservative treatment and delayed excision in preventing bacterial colonization and invasion. Twenty consecutive patients with thermal injuries were studied. Twelve patients underwent acute burn wound excision, and eight patients underwent conservative treatment and delayed excision. The second group of patients received topical treatments in another facility and underwent delayed excision after transfer to our service, on postburn day 6. Quantitative bacteriological assessments of the excised wound and biopsy samples of the wound bed, obtained before autografting and/or homografting, were performed. The effects of time on bacterial counts, differences between superficial and deep biopsy samples, and the effects of early versus late debridement were studied. Patients admitted early exhibited bacterial counts of less than 105 bacteria per gram of tissue. Patients in this group did not experience infection or graft loss. Patients admitted late exhibited counts of more than 105 bacteria (p = 0.001, compared with early admission). Three patients in the late excision group experienced infection and graft loss (p < 0.05, compared with the early excision group). Burn wound excision significantly decreased bacterial colonization for all patients (p < 0.001). Greater bacterial colonization and higher rates of infection were correlated with topical treatment and late excision (p < 0.001). It is concluded that burn wound excision significantly reduces bacterial colonization. Patients who undergo topical treatment and delayed burn wound excision exhibit greater bacterial colonization and increased rates of infection. Acute burn wound excision should be considered for all full-thickness burns.

Original languageEnglish (US)
Pages (from-to)744-750
Number of pages7
JournalPlastic and Reconstructive Surgery
Volume111
Issue number2
DOIs
StatePublished - Feb 2003

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Wounds and Injuries
Bacterial Load
Infection
Hot Temperature
Bacteria
Transplants
Biopsy
Autologous Transplantation
Homologous Transplantation
Debridement
Wound Infection
Burns
Sepsis
Therapeutics
Survival Rate
Safety
Conservative Treatment

ASJC Scopus subject areas

  • Surgery

Cite this

Effects of burn wound excision on bacterial colonization and invasion. / Barret, Juan P.; Herndon, David.

In: Plastic and Reconstructive Surgery, Vol. 111, No. 2, 02.2003, p. 744-750.

Research output: Contribution to journalArticle

Barret, Juan P. ; Herndon, David. / Effects of burn wound excision on bacterial colonization and invasion. In: Plastic and Reconstructive Surgery. 2003 ; Vol. 111, No. 2. pp. 744-750.
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