The treatment of the patients with extensive burns has advanced dramatically in the past 10 years, and the mortality rate has also been reduced. The establishment of the skin-bank network as well as the development of emergency and critical care medicine can be cited as reasons Moreover, immediate burn wound excision and grafting for patients with extensive burns may be beneficial. Meticulous management is required perioperatively to perform these procedures safely during burn shock. Patients with extensive burns are susceptible to hypothermia while receiving massive fluid resuscitation. We use a warmer device (Level 1) to keep burn patients warm. From 1991 to 2003, we performed immediate burn wound excision and grafting in 26 extensively burned patients within 24 hours after burn injury. We completed the surgery within 2 hours and excised burn wounds covering 40% of the total body surface area (TBSA). The mean age was 57 +/- 22 (mean +/- SD years), the mean burn surface area (% of TBSA) was 47 +/- 20, the mean burn index was 45 +/- 19, and the mean prognostic burn index was 94 +/- 36. There were 15 survivors and 11 deaths, for an overall mortality rate of 43%.