Comparison of serial debridement and autografting and early massive excision with cadaver skin overlay in the treatment of large burns in children.

Thirty-two children admitted from 1977 through 1981 were treated by serial debridement of their burn wounds with 1:1.5 to 3:1 meshed autografting of granulating tissue as it became available. Thirty-two burned children treated from 1981 to 1984 were treated by early total excision to fascia with application of 4:1 expanded autograft and cadaver skin for complete closure. The ages (6.8 +/- 0.6 years), sex distribution, and mean per cent third-degree burn (64 +/- 1%) were the same in both groups. There were seven deaths in each group. Overall operating time (10.3 +/- 0.8 hours) and units of blood loss (28.3 +/- 3.5) were indistinguishable in the survivors of both groups. The survivors of the early excision group underwent fewer operative procedures, (5.8 +/- 0.5 vs. 7.6 +/- 0.5) and had a greatly decreased length of hospital stay (57 +/- 5 vs. 97 +/- 8). The ultimate functional and aesthetic consequences of the two techniques must be compared.