Arguments in favor of early wound excision include which of the following statement(s)?

a. Enhanced survival is seen in patients with large burn injuries

b. Hospital stays can be shortened with this technique

c. Early burn excision results in fewer painful dressing changes

d. A decrease in duration and intensity of the hypermetabolic response is observed

Early removal of extensive areas of devitalized tissue with immediate biologic closure of the resulting wounds is the core surgical objective of the first burn week. The policy of early excision is now widely practiced in the United States and is carried out as an excision of the entire wound coincident with fluid resuscitation, or more commonly, by staged excision of all deep partial and full thickness components of the wound (less the face, palms, soles, and genitals) over the first three to seven days after injury. The increasing popularity of early excision is based upon several documented and perceived advantages over the traditional approach of allowing eschar to be liquefied by bacterial proteases until separation occurs, leaving a bed of granulation tissue which is subsequently autografted. Documented advantages include improved survival in patients with injuries involving more than 30–40% of the body surface, truncated hospital stays, lowered cost, and fewer painful dressing changes. Although not proven, conventional wisdom suggests that a decrease in the duration and intensity of the hypermetabolic response, improved immunologic function and less hypertrophic scarring result from early excision.