OBJECTIVES

Reducing the amount of harvested donor skin (HDS; autograft) needed for definitive wound closure can improve outcomes in patients with severe burns. Consensus for what constitutes a clinically significant reduction in the amount of HDS is not available. Our objective was to convene a Delphi Consensus Panel (DCP) to determine the threshold of clinical significance for reduction in the amount of HDS to achieve definitive closure in deep-partial-thickness (DPT) and full-thickness (FT) burns.

METHODS

A two-round DCP (defined a priori as > 70% panelist agreement) was conducted among 15 burn physicians with at least three years of post-residency experience and total career experience of caring for ≥ 500 patients. Round 1 consisted primarily of open-ended questions about clinical decision making and treatment practices for DPT and FT. Round 2 required evaluation of treatment scenarios to gain consensus regarding thresholds for clinical significance for the reduction in amount of HDS for treatment of DPT and FT burns.

RESULTS

Fourteen (93.3%) panelists completed both rounds. In Round 1, most panelists reported that reduction of HDS was important for both DPT (n=10; 66.7%) and FT (n=9; 60.0%) burns with the percent total body surface area (%TBSA) being the most important factor in clinical decisions. The most important outcomes after definitive closure were scar quality/cosmesis and functioning. In Round 2, consensus was achieved in a meaningful reduction in the amount of HDS in improving patient outcomes (n=14; 100%). Consensus was also achieved for a threshold for clinical significance for reduction in HDS: 50% reduction for DPT [20 %TBSA] and FT [10 %TBSA] burns (n=13; 92.9% and n=12; 85.7%, respectively) and 35% reduction for mixed DPT and FT burns [45 %TBSA] (n=14; 100%).

CONCLUSIONS

Thresholds for clinical significance of HDS reduction in DPT and FT burns were established via the DCP.