Introduction

The period following the Second World War has seen remarkable advances in burn treatment. Today, patients routinely survive injuries of 80 per cent total body surface area (TBSA) or more. (CD Figure,...!..) Although advances in critical care, infection control, nutrition, and other areas have improved the support of patients with major burns, only the ability to remove large burns safely, and to obtain rapid coverage with skin or skin substitutes, has made it possible for burns to be closed and to heal. Burn surgery techniques are described by Hejm.bach.and Engray.(!,98,4), and Mujjerefa/ (1,996). Figure 1, gives an outline of the role of surgical therapy.

Fig. 1 Approach to the surgical therapy of the burn wound.

CD Figure 1. Probit survival curves for 6417 patients treated at 21 burn centers in the United States during the period 1991 to 1993. Patients are divided into age groups; for each age group the probability of survival is plotted against burn size expressed as per cent TBSA. These curves demonstrate significant improvement over previously published statistics and help to illustrate the increased success of modern burn treatment. (Reproduced with permission from J.R. Saffle et al. Recent outcomes in the treatment of burn injury in the United States: a report from the American Burn Association Patient Registry. Journal of Burn Care and Rehabilitation, 16, 219-32 (1995).

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