Early excision and grafting versus delayed grafting in deep burns of the hand


  • Mohammed Leithy Ahmed Badr Department of General Surgery, Faculty of Medicine, Menoufia University, Egypt
  • Tarek Fouad Keshk Department of Plastic Surgery, Faculty of Medicine, Menoufia University, Egypt
  • Yahia Mohammed Alkhateeb Department of General Surgery, Faculty of Medicine, Menoufia University, Egypt
  • Ashraf Moustafa Esmail El Refaai MBBCH, Faculty of Medicine, Alexandria University, Egypt




Early excision and grafting, Delayed excision and grafting, Hand, 5D-itching scale, Vancouver score


Background: Deep burns of the hand are considered severe, because even a small wound may cause profound functional disability, ugly scar and psychosocial problems. The aim of the study is to compare early excision and grafting versus delayed grafting in deep burns of the hand.

Methods: This study was conducted on 30 patients with deep burns of the hand. Patients were randomly divided in to two equal groups. Group I included 15 patients who were subjected to early excision and grafting within the first week after injury while group II included 15 patients who were subjected to delayed excision and grafting two weeks after injury. The study was conducted on patients presented to Plastic and Reconstructive Surgery Department of Abou Qir General Hospital in the period from December 2016 to December 2017.

Results: The results of early excision and grafting were better than delayed grafting regarding the intake, infection and post-burn contraction (mean 91.33±7.67 in group I and 83.67±10.08 in group II with p value=0.026).

Conclusions: Early excision and grafting of the hand is a better alternative than delayed excision and grafting as regards better graft intake, less wound infection, less contractures, less risk of regrafting, less hospital stay, less 5D-itching scale and Vancouver score and more cost effectiveness.



Ayaz M, Bahadoran H, Arasteh P, Keshavarzi A. Early excision and grafting versus delayed skin grafting in burns covering less than 15% of total body surface area; a non- randomized clinical trial. 2014;2(4):141-5.

Asmaa M, Fouad MG, Tarek FK, Sheikh YME, Ibrahim AH. Retrospective study of mortality and causes of death in Menofia University Burn Center. Menoufia Med J. 2014;27:290-5.

Rehim S, Singhal M, Chung K. Dermal skin substitutes for upper limb reconstruction: current status, indications and contraindications. Hand Clin. 2014;30(2):239.

Vinita P, Khare N, Chandramouli M, Shende N, Bharadwaj S. Comparative analysis of early excision and grafting vs delayed grafting in burn patients in a developing country. J Burn Care Res. 2016;37(5):278-82.

Enshaei A, Masoudi N. Survey of early complications of primary skin graft and secondary skin graft (delayed) surgery after resection of burn waste in hospitalized burn patients. 2014;6:98-102.

Joo SY, Cho YS, Cho SR, Kym D, Seo CH. Effects of pain Scrambler therapy for management of burn scar pruritus: a pilot study. Burns. 2017;43(3):514-9.

Schiefer JL, Rath R, Ahrens E, Grigutsch D, Graff I, Stromps JP, et al. Evaluation of scar quality after treatment of superficial burns of the hands and face with Dressilk or Biobrane-An intra-individual comparison. Burns. 2017;44(2):305-17.

Jackson DM. The diagnosis of the depth of burning. Br J Surg. 1953;40:588-96.

Tompkins RG, Burke JF, Schoenfeld DA, Quinby WC Jr, Behringer GC, Ackroyd FW. Prompt eschar excision: A treatment system contributing to reduced burn mortality. A statistical evaluation of burn care at the Massachusetts General Hospital (1974-1984). Ann Surg. 1986;204:272-81.

Winfree J, Barillo DJ. Burn management: nonthermal injury. Nurs Clin North Am. 1997;32:275-96.

Khadjibayev AM, Fayazov AD, Djabriyev DA, Kamilov UR. Surgical treatment of deep burns. Ann Burns Fire Disasters. 2008;21(3):150-2.






Original Research Articles