伤及全层皮肤乃至部分皮下组织的Ⅲ度烧伤和伤及深层真皮伤后21 d内难以愈合的深Ⅱ度烧伤，是需要自体皮移植修复的深度烧伤(DB)。面积超过40%总体表面积(TBSA)者，病情复杂，供皮区相对缺乏。早期切除植皮是改善大面积深度烧伤(EDB)生存及后果的关键技术。本文以国内外代表性专著为基础，参考相关文献并结合本科经验，就EDB早期切除植皮中的几个关键问题进行了探讨。对烧伤创面深度的准确评估和对创面衍变过程的深刻理解，是创面处理的病理生理学基础。应贯彻损伤控制性手术理念，确定适宜的切除时机及面积。削痂术适用于深Ⅱ度和Ⅲ度烧伤，削除深度应以有效去除坏死组织至有生机真皮或皮下组织平面为度。肢体削痂可不用止血带，而是尽可能使患肢处于抬高状态分区快速削痂。对削痂后新鲜创面仍水肿明显者，可多点穿刺引流。对伤后14 d尤其是7 d以内削痂创面可行异体(种)皮移植过渡择期自体皮更植术，微粒皮移植宜用于伤后7 d后血运趋于改善的切除后创面。应加强围术期尤其是术中管理。EDB早期切除植皮治疗策略虽然取得了良好疗效，但更多是基于经验与实用的总结，仍需随机对照临床试验的确证。

The full-thickness burns involving the full-thickness skin to superficial subcutaneous tissue and the deep partial-thickness burns extending into the deep dermis and not to heal within 21 days post burn, are the deep burns that need to be repaired by autoskin grafting. For patients with deep burns over 40% total body surface area, the condition is usually critical, and the uninjured skin for grafting is relatively deficient. Early excision and skin grafting is a key technology of improving the survival and consequences of patients with extensive deep burns (EDB). This paper presents a review of the representative monographs, academic articles and our experiences on burn wound management with the aim of exploring and discussing the several key issues in early excision and skin grafting of EDB. The accurate assessment about burn wound depth and the profound understanding on wound development process are the pathophysiological basis of the wound management. The appropriate timing and area of excision burn wound should be chosen with the concept of damage control operation. Tangential excision is applicable to not only deep partial-thickness but also full-thickness burn wounds. The depth of tangential excision should effectively remove necrotic tissues and reach down to the level of the underlying viable dermis or subcutaneous tissue. Tourniquet can be not used during limb tangential excision surgery, instead, the wounded limb has been kept elevated as much as possible, meanwhile the surgery is quickly performed. If fresh wound after tangential excision is still obviously dropsical, multipoint puncture reaching down to fascia should be performed for drainage. The wound after tangential excision within 14 days especially 7 days post burn should be grafted with viable alloskin or xenoskin for temporary coverage and later on autoskin for permanent coverage. Grafting of autologous microskin overlain with sheet alloskin should be applied onto the wound after tangential excision, of which the blood supply tend to be improved after 7 days post burn. Perioperative especially intraoperative management should be strengthened. Although the treatment strategy on early excision and skin grafting of EDB has obtained the good curative effect, much of the treatment is derived from a compromise between empiricism and pragmatism and needs still to be confirmed by controlled clinical trials.