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. 2020 Jun 11;28(4):232–242. doi: 10.1177/2292550320928553

Table 2.

Timing of Debridement.

Study Patients (IG/CG) Intervention Comparison Outcomes (IG/CG) Study type Country/ setting LoE
Ayaz et al6 Burn <15% TBSA
Age (mean): 21.9/ 20.1
Female: 38.5%/40.7%
TBSA: 6.3%/5.29%		 n = 27
Early excision and grafting
(referred to centre less than 14-day post-injury)		 n = 27
Delayed excision and grafting (not consented for early excision or were referred to the hospital more than 14 days post-injury)

  • Length of hospital stay (days, mean): 7.92/9.38 (P = .654)

  • Graft success (6 months): 96.8/92.8 (P = .033)

  • Itching (5D-itch scale, 6 months): 8.61/ 8.9 (P = .977)

  • Appearance of scare (Vancouver scar scale, 6 months): 0.38/0.55 (P = .393)

 Cohort study Iran, level I burn centre 3-
Barret and Herndon7 Thermal injuries
Age (mean): 7.5/7.2
Female: 36%/47%
TBSA: 34%/42%		 n = 12
Acute excision (within 24 hours)		 n = 8
Delayed excision

  • Bacterial colonization (6 days): IG < CG (P < .05)

  • Bacterial counts (6 days): IG < CG (P = .001)

  • Infection rates (6 days): IG < CG (P = .001)

 Cohort study United States, University hospital 3-
Elmasry et al8 Burns
Age (median): 31.5/47
Female: 15.3%/8.5%
TBSA: 31%/30%		 n = 62
Early and total excision of full thickness burns followed by immediate autograft		 n = 107
Sequential smaller excisions and delayed coverage with an autograft		 Length of hospital stay/%TBSA (days, mean): 1.6/1.9 (P = 0.21)
 Cohort study Sweden, NR 3-
Saaiq et al9 Burns up to 40% TBSA
Age (mean): 29.1/ 28.8
Female: 24/23
TBSA: 30.6%/ 30.5%		 n = 60
Early excision (within 4-7 days of sustaining burn injury)		 n = 60
Delayed excision
(within 1-4 weeks post-burn)

  • Poor graft take (<80%): 1.6%/21.6% (P < .05)

  • Length of hospital stay ≤ 7 days: 90.0%/21.66% (P < .05)

 Cohort study Pakistan, burn centre 3-
Xiao-Wu et al10 Acute burns
Children
TBSA > 40%
10% full-thickness burns
Age (mean): 5.4/8.5/5.5
Female: 32.7%/45.2%/31.0%
TBSA: 62.2%/60.3%/59.8%		 Early debridement (day 0-2) Intermediate debridement (3- 6 days)
Late debridement (7-14 days)

  • Mortality: 15.1%/9.5%/10.3% (ns all comparisons)

  • Invasive infection: IG < CGs (statistical significant higher in both late groups)

  • Sepsis: IG < CGs (statistical significant higher in both late groups)

  • Adult respiratory distress syndrome: 8.1%/19.0%/10.3% (ns all comparisons)

  • Pneumonia: 15.1%/21.4%/13.8% (ns all comparisons)

  • Pulmonary edema: 38.4%/42.9%/41.4% (ns all comparisons)

  • Total blood transfusion (mean): 1.83/1.97/1.67 (ns all comparisons)

  • Length of hospital stay (mean, days per TBSA): 0.66/0.71/0.79 (statistical significant between early and late group)

Cohort study United States, children hospital 3-
Al-Qattan and Pitkanen11 n = 15
Alkali drain cleaner burns
Age (mean): 27 years
Women: 5
TBSA: 2%		 Delayed primary excision and grafting (7-9 days) NA

  • Grip strength (1 year): 85–105% of the contralateral hand

  • Range of motion (1 year): 14

  • Colour and texture of the grafted skin (1 year): excellent = 0; satisfactory = 12; poor = 3

 Case series Saudi Arabia, University hospital 4
Chen et al12 Major burn
Age (mean): 29/30
Female: 25%/23.3%
TSBA: 58%/55%		 Removal of dead devitalized tissue and allografting in escharectomy within 72 Removal of dead devitalized tissue and allografting after about 7 days

  • Insulin Sensitivity Index (5 days): IG < CG (P < .01)

  • Infused Rate of Total 20% Glucose (5 days): IG < CG (P < .01)

 Cohort study China, University hospital 4
Bhat13 n = 300
Chemical burns		 Early excision of chemical burns within 48h NA NR Case series Saudi Arabia, hospital 4-
Tang et al14 n = 16
Deep facial burns
TBSA (range): 8%-30%		 Early escharectomy and concurrent
composite razor-thin skin autografting and acellular dermal matrix scaffold for treating deep facial burns		 NA Take rat (day 12): 97.3
Haemorrhage or Hematoma: 0		 Case series China, department of burns 4-
Zhang et al15 n = 5
Burned by para-Chloronitrobenzene
Female: 0		 Early and thorough wound debridement NA NR Case report China, department of burns 5

Ordered by LoE, significant results marked in bold, unsystematic reviews are listed but were excluded from further analysis (IG: intervention group; CG: control group; NA: not applicable; NR: not reported; ns: not statistical significant (P > .05); TBSA: total body surface area; LoE: level of evidence)