Timing and Extent of Tangential Excision may significantly impact Burn Patient Outcomes, reveals study

A new study published in the Annals of Surgery identified the optimal timing and surgical approaches for the first tangential excision in patients with severe burns covering ≥70% of their total body surface area (TBSA). This research analyzed data from 185 patients injured in the Kunshan factory explosion, the findings have significant implications for burn care management by potentially improving survival outcomes for the most critical cases. 

Tangential excision is the gold-standard surgical procedure for full-thickness burns, involves the removal of burned tissue to minimize infection risks and improve healing. While early intervention is widely accepted as beneficial, the timing and scope of this procedure remain debated for patients with burns exceeding 70% TBSA.

The findings suggest that performing the first tangential excision more than 3 days after the burn significantly increased mortality risk, with a hazard ratio of 2.37. The patients undergoing excision of areas exceeding 48% TBSA during the initial procedure had a hazard ratio of 2.41 for decreased survival.

These findings were validated through Kaplan-Meier survival analysis, which confirmed that delayed surgeries and excessively large excision areas were associated with a higher incidence of complications and poorer overall survival. External validation using a 10-year dataset of 144 severely burned patients reinforced these outcomes.

Also, this study underlined the importance of wound coverage methods. The patients with greater use of autografts (skin grafts from the patient’s own body) demonstrated significantly better survival rates when compared to those relying on temporary skin substitutes. However, the choice of coverage was influenced by factors like the severity of the injury, the availability of autologous skin, and resource constraints at the treatment center.

The subgroup analysis revealed that hemodynamic stability, hospital resources, and the availability of treatment modalities influenced the timing and surgical area. Tailored treatment approaches are recommended to address individual patient needs and the challenges posed by limited autologous skin or intensive care resources. Overall, this research highlighted the importance of initiating tangential excision within 3 days and limiting the excised area during the first surgery to under 48% TBSA for severely burned patients.

Source:

Huang, R., Yao, Y., Xie, S., Li, J., Zhang, W., Liu, Y., Xian, S., Sun, H., Wu, G., He, H., Li, L., Wu, X., Li, Y., Zhang, H., Lu, B., Zhou, J., Zhou, Y., Xu, D., Xia, Z., & Ji, S. (2025). Optimal timing and approaches for first tangential excision in patients with ≥70% TBSA burns: Insights from a retrospective cohort of a mass casualty incident. Annals of Surgery. https://doi.org/10.1097/sla.0000000000006626