Excision of the burn wound in patients with large burns
W. F. McManus, A. D. Mason Jr and B. A. Pruitt Jr
US Army Institute of Surgical Research, Fort Sam Houston, Tex 78234.
The known major determinants of survival for patients with burn injury are
age, burn size, inhalation injury, and infection. The clinical courses of
210 patients with burns of 30% of the body surface or greater treated from
Jan 1, 1983, through Dec 31, 1985, were reviewed to determine whether
excision of the burn wound could be identified as a factor in survival
after massive burn injury. The predominant site of infection changed from
the burn wound to the lung, with pneumonia being the most common bacterial
infection in patients whose wounds were treated as described. Effective
topical control of bacterial proliferation and excision of the burn wound
have resulted in replacement of invasive bacterial wound infection by
nonbacterial burn wound infection. The apparent advantages of excision,
particularly in large burns, may reflect only patient selection, since only
those patients who are considered to be physiologically stable and able to
tolerate the physiologic stress of excision are considered for operation.
