Book contents
- Frontmatter
- Contents
- List of contributors
- Preface
- Acknowledgements
- 1 Pathophysiology of burn shock
- 2 Assessment of thermal burns
- 3 Transportation
- 4 Resuscitation of major burns
- 5 Inhalation injury
- 6 Monitoring of the burn patient
- 7 The paediatric burn patient
- 8 Nutrition
- 9 Infection in burn patients
- 10 Anaesthesia for the burned patient
- 11 Surgical management
- 12 Postoperative care of the burned patient
- 13 Prognosis of the burn injury
- 14 Complications of intensive care of the burned patient
- Index
11 - Surgical management
Published online by Cambridge University Press: 02 December 2009
- Frontmatter
- Contents
- List of contributors
- Preface
- Acknowledgements
- 1 Pathophysiology of burn shock
- 2 Assessment of thermal burns
- 3 Transportation
- 4 Resuscitation of major burns
- 5 Inhalation injury
- 6 Monitoring of the burn patient
- 7 The paediatric burn patient
- 8 Nutrition
- 9 Infection in burn patients
- 10 Anaesthesia for the burned patient
- 11 Surgical management
- 12 Postoperative care of the burned patient
- 13 Prognosis of the burn injury
- 14 Complications of intensive care of the burned patient
- Index
Summary
Introduction
Historical perspective
Since the days of Hippocrates, traumatic wound management has been based on the fundamental surgical principle of immediate debridement of necrotic tissue and primary wound closure. Until recently, burns have always been the exception to this fundamental principle. With the ability of topical agents to control burn wound sepsis, topical therapy dominated burn treatment. Although the benefit to the patient by way of control of burn wound sepsis was enormous, it is well to recognize that this control was at the cost of slower spontaneous formation of burn eschar and, perhaps more importantly, an unstated philosophy implying that dead tissue produced by burning must be allowed to demarcate spontaneously before removal and that wound closure by skin graft must be carried out only after the development of a clean granulating recipient bed, thus resulting in a prolonged time between injury and wound closure. The past 10 years have seen the development of safe and effective blood replacement, improved monitoring equipment and, importantly, an understanding of the nutritional requirements of the thermally injured patient. The early excision and grafting of the burn wound have dramatically changed traditional burn care; however, this change has only been accepted slowly.
Early removal of large areas of full thickness burn to reduce the mortality and morbidity associated with thermal injuries has been attempted with varying degrees of success during the past 50 years.
- Type
- Chapter
- Information
- Critical Care of the Burned Patient , pp. 150 - 163Publisher: Cambridge University PressPrint publication year: 1992