COMMENTS ON SPECIAL SURGICAL-TREATMENT OF SEVERE BURN INJURIES

The life of severely burned patients nowadays is endangered especially by infections and septic complications deriving from the wounds. This danger can be obviated only by early excision of all deep necrotic ar eas and immediate wound closure, ideally with autografts. The correct estimation of the depth of burn is decisive for effective local surgic al therapy, which is guided mainly by visible criteria. Conservative t reatment is employed for first-degree and superficial second-degree bu rns, while operative therapy is needed for deep second-degree and thir d-degree burns. The required immediate wound closure with autografts i s problematic after necrectomy of burns larger than 40% TBSA. To exten d the limited skin reserves, autografts are meshed or combined with ho mografts. Defects can be covered temporarily with vital or non-vital h omografts until donor sites for split-thickness skin grafts are healed . Cultured epithelial autografts at present are not suitable for routi ne use. After deep burns, no matter what kind of operative treatment i s used, scars are left. The scars raise difficulties with regard to ae sthetics and function. Permanent pressure in the early stages of after care is an effective method of accelerating the maturation of scars an d improving their appearance.