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• W2079554001 abstract "Sir: We read with great interest the article by Jewell et al.1 in the August 2007 issue of the Journal. We commend the authors on their study, but would like to highlight some areas which we believe need to be addressed further. The investigators fail to identify how burn depth was assessed for each patient. While clinical assessment alone is sufficient for clinical practice, for the purposes of objective, validated research, one does require some form of objective, reproducible technique to assess and compare depth of burn between patients and indeed along the course of the burn wound-healing period. Without such assessment, one cannot claim to be comparing “like with like,” and hence the whole basis of the study is invalidated. A deeper burn may have needed a deeper tangential excision and thus affected time for wound healing. Undoubtedly, the authors are aware of the many techniques to assess and compare burn wound depth in the literature. We recommend the histological method described by Watts et al.2 This is a validated, reproducible technique that fulfils the criteria for prospective longitudinal comparative studies. Furthermore, there are noninvasive techniques to assess and compare burn wound depth during the healing period, such as laser Doppler imaging, which is now in widespread use in most large burn centers.3 The study further fails to identify the level of burn wound excision, which is, of course, critical not only for skin graft “take” but also with respect to duration of burn wound healing and hence long-term outcome and eventual scarring. We were pleasantly surprised that the authors did not mention the cases that fail to heal fully in the usual 2-week period, as in our experience, complete burn wound healing is not universal. Many wounds have unstable areas that can take prolonged periods to eventually settle down fully. A table listing the time to 95 percent wound healing would have been more useful, but this would have required objective assessment methodology, as described above, and perhaps was beyond the scope of this article. We agree with the authors that there is still little objective information about the outcomes of grafted wounds, but would recommend that studies to further examine this be objective, randomized, and prospective, so as to accurately investigate and determine the outcome of such patients. Although we commend the authors for their detailed and obviously extensive preparation of this study, we do believe that the points raised invalidate the article’s conclusions and need to be addressed in relation to this study and also in any further studies of this nature. Mark Sheldon Lloyd, M.R.C.S., M.Sc., M.Phil. Robert H. Caulfield, A.F.R.C.S.I. Peter Dziewulski, F.R.C.S.(Plast.) St. Andrew’s Centre for Burns and Plastic Surgery Broomfield Hospital Chelmsford, Essex, United Kingdom" @default.
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• W2079554001 date "2008-05-01" @default.
• W2079554001 modified "2023-09-27" @default.
• W2079554001 title "Rate of Healing in Skin-Grafted Burn Wounds" @default.
• W2079554001 cites W1975578369 @default.
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• W2079554001 doi "https://doi.org/10.1097/prs.0b013e31816b1554" @default.
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