الفهرس 
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Abstract
Burn injury is one of the most devastating forms of injuries and is also one of the biggest health concerns in the developing world. It is a formidable public health issue in terms of mortality, morbidity, and permanent disability.
The depth of burn is important in evaluating the severity of a burn, planning for wound care, and predicting functional and cosmetic results.
The study is a non-randomized clinical trial being performed during a18-month period from July 2021 to December 2022 in plastic surgery department, Sohag university hospital, Egypt.
The study was conducted with the aim to; compare the outcome of early excision and grafting (EEG) versus dressing and delayed grafting (DDG) of deep burn and to compare the length of hospital stay and expenditure between (EEG) versus (DDG).
The patients were assigned to two study groups; the early excision and grafting group (group A) and the delayed grafting group (group B) based on their own choice and consent. Those who did not have consent for early excision and grafting and those who were referred to the hospital more than 10 days post burn were considered as group (B) . Each group included 20 patients.
All the patients included in the study were resuscitated on arrival in our department, detailed history then taken and burn evaluation carried out regarding to total burn surface area (TBSA) according to Lund and Browder chart and burn depth according to clinical examination, Dressing was done with topical antimicrobial agent under complete sterile condition then fluid resuscitation with lactated Ringer’s solution according to modified Parkland’s formula.
During the first three days of burn injury adequate resuscitation and stabilization of the patient was carried out. Then re-evaluation of the patients done in the fourth day regarding the burn condition ”burn depth ”, in the fourth day the deep burn that need surgery could be more certain, and then in this time we divided the patients into two groups : group A ”early excision and grafting ” and group B ” dressing and delayed grafting ”.
Summary and conclusion
The early excision done within 10 days post burn in our study, In DG group, patients had their dressings changed every other day with topical antibiotics until spontaneous eschar separation or after surgical debridement of adherent eschar , dressing continued until good granulation tissue formed in the site of burn made it suitable bed for grafting, then for delayed grafting more than 10 days post burn, the dressing was then removed on the 5th postoperative day.
The variables that were measured and compared amongst the two groups included: Blood transfusion units, graft take pattern, number of operations, length of hospital stay, functional outcome, and cosmetic outcome.
The data obtained were analyzed statistically using SPSS version (17.0).
The result of the study:
• As regard total blood transfusion in both studied groups there was highly statistical significant difference in group A as compared to group B where P- value 0.001, As regard graft taken in both studied groups there was statistical significant difference in group A as compared to group B where P- value 0.004 as shown in table 6 and graph 7, In group A, there were 17 cases good, 2 cases fair and one case poor as regard graft taken. While in group B, there were 5 cases good, 8 cases fair and 7 cases poor. There was statistical significant difference in group A as compared to group B where P- value < 0.001, 0.03 and 0.01 respectively, As regard number of operations in both studied groups there was statistical significant difference in group A as compared to group B where P- value 0.001, As regard hospital stay in both studied groups there was statistical significant difference in group A as compared to group B where P- value < 0.001, As regard functional deformity in both studied groups there was statistical significant difference in group A as compared to group B where P- value 0.001.
As regard cosmetic outcome evaluated by two scoring system:
1-Modified Vancouver scar scale; there was statistical significant difference in group A as compared to group B where P- value < 0.001.
2-Sohag burn scar scale; there was also statistical significant difference in group A as compared to group B where P- value < 0.001
Summary and conclusion
Conclusion:
Early excision and grafting of deep burn is associated with better outcome regarding decrease blood transfusion requirements, improve graft taken, decrease numbers of operations, decrease hospital stay, improve functional outcome and improve cosmetic outcome; we recommend that early excision and grafting could be the first option in management of deep burn.
Recommendation
Recommendation
At the end of our study we suggest a new modification of the scoring system for evaluating the burn scar regarding the cosmetic aspect; we recommend its application instead of the previous score MVSS.