Burn Treatment for the Unburned

A burn center, in which the endemic microbial flora varies across time and can cause miniepidemics of life-threatening infections, seems an unlikely site for the care of unburned patients with large open wounds.¹ Heimbach and associates² demonstrate that it is in a burn center that patients with toxic epidermal necrolysis (TEN) can receive the wound care needed to prevent further skin injury and the general supportive care needed to minimize the physiological consequences of a large open wound.

The treatment employed by the authors emphasizes measures to protect the surface exposed by the epithelial slough from further damage and prevent extension of the depth of the injury. Saline solution is recommended for cleansing the open wound and the entiretỳ of the wound is thereafter covered with a biologic dressing—porcine cutaneous xenografts. Two decades ago, Miller et al³ demonstrated that prevention of surface desiccation of partial-thickness burns by