Early excision and grafting of burn wounds has largely replaced the conservative, non-excisional approach, due mainly to improvements in resuscitation and the introduction of primary tangential excision. A critical review of the literature on the effects of early excision and grafting on mortality and other important patient outcomes, such as infective complications and functional and aesthetic results is presented. A number of variables, such as the exact timing and technique of surgery, the size of the wound, the presence of inhalation injury, and age may all influence the effect of this approach.