Burn - Specific Secondary Survey

T he natural history of serious burns is characterized by burn shock, which is usually lethal to those with large burns during the first few postinjury days, burn wound sepsis, which commonly kills those who survive burn shock during the first few postinjury weeks, and postburn deformity in those who survive to heal their wounds by contraction and epithelialization. Each of these issues has been systematically addressed in recent years with varying but substantial success. Burn shock has been a focus of study for 50 yrs. Stimulated by care of victims of the 1930 Rialto Concert Hall (1) and 1942 Coconut Grove (2) fires, various resuscitation formulas based on body weight and burn size were promulgated (3, 4). Recognition of the need to individualize resuscitation has resulted in burn shock being now an infrequent cause of death. Control of burn wound sepsis had to wait until surgical, critical care, and blood banking techniques evolved to the degree that early identification, excision, and biological closure of deep wounds could be safely practiced. This was first systematically described in the 1970s in patients with small wounds, truncating hospital stays (5). In the 1980s and 1990s, with critical care and blood bank support, early surgery was subsequently used to address increasingly larger wounds, demonstrating markedly truncated hospital stays and enhanced survival in patients with large wounds, with burns over 30% of the body surface being commonly fatal before this (6, 7). Postburn deformity remains a difficult clinical problem. Early wound excision and closure seems to reduce deformity by eliminating the degree of contraction otherwise required for spontaneous closure of deep wounds, but optimal function is only realized in many patients through a series of reconstructive operations in the months and years after initial recovery. The absence of an animal model of hypertrophic scarring has contributed to the paucity of clinical tools for modification of this inevitable process.