[The use of the laser knife for excision grafting of deep burns in children under 3].

Surgical excision of deep burns followed immediately by skin grafting justifies itself by the reduction of delay of wound healing and by the same token of the improved functional and morphological results obtained. Its draw-back is that it is very hemorrhagic and is thus difficult to apply to children. Out of 120 children under 3 years old, hospitalised over two years for widespread burns, 29 of them fulfilled the conditions of excision of deep burns followed by grafting. In the first three in whom the excision was performed with a scalpel, the blood loss ranged from 140 to 500 ml. But in the fourth case also done with a scalpel, the blood loss was dramatic and required a blood compensation of 3,600 ml. The technique was therefore abandoned and we reverted to the classic technique in the 10 following patients, before we could dispose of a laser knife in the last twelve patients. The blood loss was minimal or ranged between 10 to 20 ml with a maximum of 40 ml in one case. The draw-back is that the graft cannot be performed immediately and a delay of 8 days at least is required until the tissue-bed is appropriate to a successful grafting. Analysis of the results show that, there exists a significant difference in the length of wound healing treated traditionally as compared to that of excision followed by immediate grafting. The recourse to the laser-knife, by eliminating the risk of hemorrhage, allows the use of the technique of excision-immediate grafting in young children.