Early tangential excision and skin grafting of moderate burns is superior to honey dressing: a prospective randomised trial

Abstract

Methods: In this prospective trial, 50 burn patients were randomised to be treated either with early tangential excision and skin grafting or by the application of honey dressings, with delayed skin grafting as necessary. The 25 patients in the tangential excision (TE) group had burns of 23±4%, 12% of which was full thickness. The honey treated patients (HT), (N=25), had burns of 24±4%, 13% of which was full thickness. Seventeen of the TE patients were operated upon on day 3, the remainder before day 6 post burn. Eleven of the HT patients eventually required skin grafting. Cosmetic and functional results were assessed at 3 months post discharge. Results: In the TE group, the skin grafting take rate was 99±3%. In the HT group, the graft take rate was 74±18% ( P<0.01). The mean percentage of blood volume replaced was 35±12% in TE patients vs. 21±15% in HT patients ( P<0.01). Only one TE patient died due to status asthmaticus, while there were 3 deaths, all from sepsis, in the HT patients. At 3 month follow-up, 92% of the TE patients had good to excellent functional and cosmetic results vs. 55% in HT patients, 3 of whom had significant contractures. Conclusion: Early tangential excision and skin grafting was clearly superior to expectant treatment using topical honey in patients with moderate burns in this randomised, prospective study performed at a General Hospital in the Indian subcontinent. The availability of suitable allogenic blood is a potential problem when TE is employed.