THE KEY to survival for today's burn patients depends on the expedient closure of the wound after excision of the burned tissue. Yet this objective has become more difficult to accomplish now that many patients with burns that cover 80% or more of their bodies are surviving. With so much tissue burned, less healthy skin is available for autografts, and donor sites take longer to heal with each successive harvest.
"We've pushed back survival as far as we can with infection control, nutrition, techniques of excision, and so on. But unless we close the wound, the patient will still die," says William F. McManus, MD, a US Army colonel, and chief, Clinical Division, US Army Institute for Surgical Research (USAISR), Fort Sam Houston, San Antonio, Tex.
Typically, the dead, burned tissue is surgically excised around the fourth day after the injury. Yet the hypermetabolism, immunosuppression, and other physiological changes caused