Chapter 8: Burns

KEY POINTS

INTRODUCTION

Surgical care of the burned patient has evolved into a specialized field incorporating the interdisciplinary skills of burn surgeons, nurses, burn therapists, and other healthcare specialists. However, recent mass casualty events have been a reminder that healthcare systems may be rapidly pressed to care for large numbers of burn patients. Naturally, general surgeons may be at the forefront in these events, so it is crucial that they are comfortable with the care of burned patients and well equipped to provide the standard of care.

BACKGROUND

Burn injury historically carried a poor prognosis. With advances in fluid resuscitation¹ and the advent of early excision of the burn wound,² survival has become an expectation even for patients with severe burns.³ Continued improvements in critical care and progress in skin bioengineering herald a future in which functional and psychologic outcomes are equally important as survival alone. With this shift in priority, the American Burn Association (ABA) has emphasized referral to specialized burn centers after early stabilization. Specific criteria should guide transfer of patients with more complex injuries or other medical needs to a burn center (Table 8-1). The ABA has published standards of care⁴ and created a verification process to ensure that burn centers meet those standards.⁵ Because of increased prehospital safety measures, burn patients are transferred longer distances for definitive care at regional burn centers⁶; data from one burn center with a particularly wide catchment area confirmed that even transport times averaging several hours did not affect the long-term outcomes of burn patients.⁷