Journal of pediatric surgery
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The large mass of devitalized tissue that comprises the burn eschar is gradually becoming recognized as the principal source of complications in the burn patient. Clinical observations suggest that the topical agent silver sulfadiazine does not penetrate the eschar sufficiently to prevent bacterial infection from becoming established in the deeper levels of the wound but does penetrate to a depth of approximately 1.5 mm in bactericidal concentrations. ⋯ This is less than the depth to which silver sulfadiazine is capable of penetrating in bactericidal concentrations, and greatly enhanced control of burn wound sepsis is achieved. Early laminar excision of the eschar, combined with silver sulfadiazine dressings, aggressive resurfacing of the wound, and increased emphasis on nutrition, is an approach to management of the victims of thermal trauma that should significantly improve survival in patients with burn injuries greater than 60% body surface area.