Surgical options in extensive burns management

Background – hypothesis and objective: In the past decades, extensive burn care has improved to the extent that burn victims can now frequently survive. Current treatment of a severe burned patient extends beyond the preservation of life and function; the ultimate goal is the return of survivors, as full participants, back to their families, work field and communities. Methods: This paper is based on our experience in treating patients with extensive burns. We had two panels as follows: 148 subjects with extensive burns in one original retrospective study (2002-2009) and other 47 new patients with extensive burns enrolled in other original prospective study (2010-2011). We selected the subjects with extensive burns who received allotransplant (n = 59). Our study aimed to identify and quantify the main psychosocial difficulties in patients with extensive burns who received allotransplant, also taking into account the surgical procedures applied in each case. Results: One of the major problems a surgeon faces is the nature of the decision he has to make regarding a treatment (conservative versus operative), based on the exact determination of burn wound depth. In case of early excision, deep lesions and suitable grafting represent the chosen surgical treatment in our center. The benefits of skin allografts are well known due to their contribution to burn management. Conclusions & discussion: This paper is designed as a guideline and instruction manual to help those with less experience through particular situations in surgical burn care. Early excision and immediate coverage of the burn wounds represent nowadays the standard care for extensive burned patients. For patients with massive thermal injury, temporary coverage with allografts is essential. The use of allograft has multiple benefits because it plays both as physiologic and mechanical barriers.