Burn Wound Closure,
OTAGO UNIV DUNEDIN (NEW ZEALAND) DEPT OF SURGERY
Pagination or Media Count:
Wound closure should be carried out at the earliest possible stage. In suitable cases it can be done almost immediately, i.e., at day 2 or 3, with some form of excision being followed by the immediate application of autograft. If necessary, further staged excisions can follow at 2-4 day intervals. Wound closure becomes a problem in the extensive deep burn of over 60 where there is a shortage of the patients own skin for grafting. It should be noted that over 90 of burn cases in the U.S. population involve less than 60 of the body surface area. It is an unfortunate paradox of transplantation biology that the tissue grafts which are technically easy, skin, bone marrow, pancreatic islets for example - are immunologically difficult. In closing large burn wounds we are thus in the business of time-borrowing, by such expedients as temporary biological coverings and artificial coverage of the wound. History records a wide variety of burn wound coverings, ranging from tannic acid in both old and recent times, to the so-called artificial skins of modern investigative technology. The recent clinical use of biological skin scaffolds is an exciting development. This concept provides a biogradable template as a deep layer, acting as a scaffold for a neodermis, together with a temporary silastic covering which is replaced in stages by this autograft. Initial reports have been good, and we await their further experience with interest.