The Burn Wound and Its Care

Thermal injury of the skin results in striking anatomic, metabolic, and physiologic disturbances which prejudice survival of burn patients. Identification of burn wound sepsis and description of its pathogenesis led to the development of effective topical burn wound chemotherapy. Mafenide acetate (Sulfamylon Cream), now employed in more than 2,000 burn patients, is applied to control bacterial proliferation within the burn wound prior to eschar separation. Other topically applied agents may be used for this purpose. Cutaneous allografts and heterografts serve as temporary physiologic dressings after eschar separation, providing continuing bacterial control until autografting. Control of burn wound bacterial proliferation has been associated with the emergence of other opportunistic burn wound infections, ie, fungal and viral, necessitating frequent biopsy monitoring of the burn wound. A significant improvement in survival of burn patients thus managed is documented. In burns involving large areas of skin, the patient is exposed to death first, from shock; second, from toxemia due to absorption of poisons from the injured surfaces; third, from loss of function of the absent skin covering; and fourth, from exhaustion due to the longcontinued fight for recovery.