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.