Clinical efficacy of surgical versus conservative management in patients with second-degree burns: a systematic review
Keywords:
second-degree burns; skin grafting; conservative wound management; scarring; treatmentAbstract
Introduction: Second-degree burns present a challenge due to their high incidence and variable prognosis, comprising approximately 60–70% of all burns requiring specialized care. The main controversy in the management of these injuries centers on deep dermal burns (DDB), where the difficulty in predicting spontaneous re-epithelialization versus the need for surgery directly influences therapeutic decisions. This systematic review aimed to determine the comparative clinical efficacy of surgical versus conservative management in patients with second-degree burns. Materials and methods: The review was conducted using the PRISMA 2020 methodology, performing a systematic search of the PubMed/MEDLINE, Scopus, Embase, and Web of Science databases between April and May 2026, identifying 4,218 initial records. After removing duplicates and applying eligibility criteria, 13 studies published between 2021 and 2026 were selected for final inclusion. Results: The synthesis of the analyzed evidence reveals that conventional early excision reduces healing time (17.6 vs. 40.2 days) and hospital stay; enzymatic debridement with NexoBrid® achieved a reduction in surgical excision from 48.1% to 1.5% and a graft-free healing rate of 39%; hydrosurgery demonstrated better dermal preservation (p < 0.001) and significantly better POSAS scores (2.42 vs. 2.54; p = 0.023). Discussion: The findings confirm that there is no single therapeutic strategy; the results support a therapeutic hierarchy in which the choice of technique should be personalized according to the extent, depth, anatomical area, and functional goals of the patient. Early excision remains the standard of care for managing systemic risks, while advanced technologies such as enzymatic debridement and hydrosurgery offer superior results in skin preservation and scar quality. Conclusions: The management of second-degree burns should focus on preserving tissue, reducing complications, and improving long-term quality of life, with appropriate technique selection being a determining factor for optimizing functional and aesthetic outcomes.
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