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Comparison of Functional Prognosis between Early and Delayed Skin Grafting in Burn Patients

比較燒傷病患早期植皮與延後植皮的功能預後

摘要


Background and Purpose: Currently, no exact clinical guidelines have been established for deciding whether to perform early skin grafting within 2 weeks or late skin grafting after 2 weeks for deep second- to third-degree burns. Moreover, for reference, studies that involve a large number of burn patients are lacking. Therefore, this study took advantage of the experience in treating 499 young burn patients from Taiwan Water Park explosion in 2015 to compare the impact of early skin grafting with that of late skin grafting on a patient's subsequent quality of life. Methods: Burn patients from the Taiwan Water Park explosion who were admitted to the Tri-Service General Hospital because of second- to third-degree burns of ≤ 50% of the total body surface area (TBSA) were included. We compared their quality of life between patients with early skin grafting and those with late skin grafting after 2 weeks. The choice of early or late interventions depended on the surgeons' preference and clinical conditions. They were evaluated by using the 36- item Short Form (SF-36) questionnaire, where the first and second evaluations were performed 1 month after the burn and prior to discharge from the hospital, respectively. Results: Twenty patients, consisting of 14 men and 6 women, fulfilled the following characteristics: mean TBSA of 38.58% ± 17.18%, mean length of hospital stay of 57.89 ± 18.68 days, and mean age of 22.89 ± 4.88 years. There were 11 patients in the early group and 9 in the late group. No significant difference in scores for all the SF- 36 categories was found between two groups during the first evaluation. During the second evaluation, which was conducted prior to discharge, the early skin grafting group significantly scored better than the late skin grafting group in terms of physical functioning (p = 0.028), social functioning (p = 0.049), role-emotional (p = 0.049), and physical health (p = 0.007). Conclusion: Based on our experience in treating a large number of burn patients from the Taiwan Water Park explosion in 2015, as the treatment of second- to third-degree burns of ≤ 50% of the TBSA, early skin grafting attained better functional prognosis than late skin grafting or treatment with dressing change alone, especially in the physical health dimension, which is highly important for young burn patients. Clinical Relevance: Patients with burn wounds of second- to third-degree and ≤ 50% TBSA can consider to receive early skin grafting to get better functional prognosis.

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