Objective To observe the clinical efficacy and inflammation of tangential excision within 24 hours after burn with massive deep Ⅱdegree burn wounds for elderly patients. Methods From Jan. 2010 to Dec. 2013, a total of 82 elderly patients with massive deepⅡdegree burn wounds were divided into the observation group ( giveing tangential excision within 24 hours after burn) and the control group ( giveing tangential excision within 3~5 d after burn) according the time of tangential excision treatment. The amount of infused fluid, u-rine, levels of serum inflammatory factors, survival rate of skin grafts, wound healing time, hospitalization time and the complications were compared between the two groups. Results There was no significant difference in the amount of infused fluid, plasma and urine between the two groups in the first day and fifth day (P>0. 05). The levels of TNF-αsignificantly decreased after 3 days of therapy compared with the control group (P<0. 05). The levels of IL-6 significantly decreased and IL-10 significantly increased from the first day of therapy in the ob-servation group compared with the control group (P<0. 05). The survival rate of skin grafts in the observation group was significantly higher than that in the control group, and time of wound healing and hospitalization in the observation group was significantly shorter than that in the control group (P<0. 05). The complication rate of the observation group was 11. 1% which was significantly lower than that in the control group 29. 7% (P<0. 05). Conclusion To treat burn with massive deepⅡdegree burn wounds for elderly patients with tangential excision within 24 hours which can effectively reduce the inflammatory, reduce wound infection and improve the success rate of skin grafting.