Variations in Burn Excision and Grafting: A Survey of the American Burn Association

It is unknown whether variations in burn care affect outcomes or affect the success of emerging therapeutics. The purpose of this study was to assess burn surgeons' preferences in excision and grafting to determine if surgical technique affects outcomes. A 71-item survey evaluating skin grafting techniques and preferences was emailed to members of the American Burn Association in July and August 2015. The survey was anonymous and voluntary. Relationships between variables were evaluated using Fisher's exact test. A P-value of <=.05 was deemed statistically significant. The survey was sent to 607 burn surgeons, and the response rate was 24%. Clinical judgment is the most widely used method to determine depth of injury. Surgeons who practice in the United States and surgeons who are board certified in general surgery are more likely to determine depth of the burn based on clinical judgment alone (P < .001). Fifty-six percent of surgeons will perform excision as early as postburn day 1 and 73% will excise greater than 20% TBSA in one setting. Surgeons at centers with bed number of <= 10 (P = .024) or surgeons with board certification in plastic surgery (P = .008) are more likely to excise deep partial-thickness burns with an attempt to retain viable dermis. Geographic location, board certification, and burn unit size all contribute to variations in practice. Strong individual preferences make standardization of therapies challenging and may affect the success of new technologies. Burn surgery continues to be an art as much as a science, and accurate documentation of techniques and outcomes is essential for optimizing successes and documenting failures of new treatment methods.