Burn Debridement

About Burn Debridement

Burn debridement is the removal of dead and damaged tissue from deep burns, an essential step in preventing infection, promoting healing and preparing the wound for skin grafting. Deep partial thickness and full thickness burns do not heal well on their own, and early excision and grafting in the first days after injury, popularized by the Slovenian surgeon Zora Janzekovic in the 1970s, became a central principle of modern burn care after it was shown to reduce infection and improve survival in major burns. In tangential excision, thin layers of burned tissue are shaved away with a hand held knife, such as a Watson or Goulian knife, or a powered dermatome until healthy bleeding tissue is reached. Fascial excision removes all tissue down to the muscle fascia, which reduces blood loss and graft failure in very deep burns but leaves a greater contour deformity. Enzymatic debridement agents derived from bromelain offer a non surgical way to remove eschar in some burns. Escharotomy, incision through tight burned skin, is performed urgently when circumferential burns of the chest restrict breathing or burns of a limb restrict blood flow. The excised wound is covered with split thickness skin grafts from unburned areas, which may be meshed to cover larger areas, or with temporary coverings such as donor skin, pig skin or synthetic dermal substitutes when donor sites are limited. Meek micrografting and cultured skin allow small amounts of donor skin to cover large wounds. Management of major burns also involves careful fluid resuscitation guided by established formulas such as the Parkland formula, nutrition, infection control and rehabilitation. Inhalation injury and burn wound sepsis are major causes of death in severe burns.