The Surgical clinics of North America
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Surg. Clin. North Am. · Aug 2014
ReviewOn the horizon: research priorities in burns for the next decade.
This review demonstrates that many advances have been made in burn care that have made dramatic differences in mortality, clinical outcomes, and quality of life in burn survivors; however, much work remains. In reality, the current standard of care is insufficient and we cannot be satisfied with the status quo. We must strive for the following goals: no deaths due to burn, no scarring, and no pain. These particular goals have only begun to be confronted.
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As a result of continuous development in the treatment of burns, the LD50 (the burn size lethal to 50% of the population) for thermal injuries has risen from 42% total body surface area (TBSA) during the 1940s and 1950s to more than 90% TBSA for young thermally injured patients. This vast improvement in survival is due to simultaneous developments in critical care, advancements in resuscitation, control of infection through early excision, and pharmacologic support of the hypermetabolic response to burns. This article reviews these recent advances and how they influence modern intensive care of burns.
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The early management of burn patients requires a set of supportive procedures in addition to excision and closure operations. Most supportive procedures related to vascular access, tracheostomy, and enteral feeding access are identical to those required by trauma patients and are not covered here. ⋯ Subsequently, acute excision and closure operations dominate patients' needs. These operations have evolved in recent years to be less ablative, less bloody, and less physiologically stressful.