• Gary Vercruysse


This chapter was designed to give the surgeon without much burn experience some guidance for initial and subsequent burn care. It is meant to serve as a reference, explaining not only the basics of burn wound resuscitation but also identifying and recommending therapy for the commonest problems, both immediate and late, faced by the surgeon when caring for burn patients. Finally it examines burn mechanisms with specific required care for successful management.


Burns Burn resuscitation Burn surgery Burn wound infection Complications after burns 


  1. 1.
    Ryan CM, et al. Objective estimates of the probability of death from burn injuries. N Engl J Med. 1998;338:362–6.CrossRefPubMedGoogle Scholar
  2. 2.
    Wolf SE, et al. Mortality determinants in massive pediatric burns - an analysis of 103 children with >=80% TBSA burns (>=70% full-thickness). Ann Surg. 1997;29:2075–80.Google Scholar
  3. 3.
    Till GO, et al. Oxygen radical dependent lung damage following thermal-injury of rat skin. J Trauma. 1983;23:269–77.CrossRefPubMedGoogle Scholar
  4. 4.
    Allison F, et al. Studies on the pathogenesis of acute inflammation. 1. The inflammatory reaction to thermal injury as observed in the rabbit ear chamber. J Exp Med. 1955;102:655–68.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Wilmore DW, et al. Influence of the burn wound on local and systemic responses to injury. Ann Surg. 1977;186:444–58.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Pruitt BA Jr. Protection from excessive resuscitation: “pushing the pendulum back”. J Trauma. 2000;49(3):567–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Saffle JR. The phenomenon of “fluid creep” in acute burn resuscitation. J Burn Care Res. 2007;28(3):382–95.CrossRefPubMedGoogle Scholar
  8. 8.
    Chung KK, Wolf SE, Cancio LC, et al. Resuscitation of severely burned military casualties: fluid begets more fluid. J Trauma Crit Care. 2009;67:231–7.CrossRefGoogle Scholar
  9. 9.
    Chung KK, Salinas J, Renz EM, et al. Simple derivation of the initial fluid rate for the resuscitation of severely burned adult combat casualties: in silico validation of the rule of 10. J Trauma. 2010;69(suppl 1):S49–54.CrossRefPubMedGoogle Scholar
  10. 10.
    Goodwin CW, et al. Randomized trial of efficacy of crystalloid and colloid resuscitation on hemodynamic-response and lung water following thermal-injury. Ann Surg. 1983;197:520–31.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Navar PD, et al. Effect of inhalation injury on fluid resuscitation requirements after thermal-injury. Am J Surg. 2004;363:1895–902.Google Scholar
  12. 12.
    Ivy ME, Atweh NA, Palmer J, et al. Intra-abdominal hypertension and abdominal compartment syndrome in burn patients. J Trauma. 2000;49:387–91.CrossRefPubMedGoogle Scholar
  13. 13.
    Brownson EG, Pham TN, Chung KK. How to recognize a failed burn resuscitation. Crit Care Clin. 2016;32:567–75.CrossRefPubMedGoogle Scholar
  14. 14.
    Smith DL, et al. Effect of inhalation injury, burn size, and age on mortality—a study of 1447 consecutive burn patients. J Trauma. 1994;37:655–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Bennett JE, Lewis E. Operative decompression of constricting burns. Surgery. 1958;43:949–55.PubMedGoogle Scholar
  16. 16.
    Kaplan I, White W. Incisional decompression of circumferential burns. Plast Reconstr Surg. 1961;28:609–18.CrossRefGoogle Scholar
  17. 17.
    Pruitt BA, Dowling JA, Moncrief JA. Escharotomy in early burn care. Arch Surg. 1968;96:502–7.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Fox CL Jr. Silver sulfadiazine—a new topical therapy for Pseudomonas in burns. Arch Surg. 1968;96:184–8.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Stanford W, Rappole BW, Fox CL Jr. Clinical experience with silver sulfadiazine, a new topical agent for control of Pseudomonas infections in burns. J Trauma. 1969;9:377–88.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Fox CL Jr, Modak SM. Mechanism of silver sulfadiazine action on burn wound infections. Antimicrob Agents Chemother. 1974;5:582–8.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    White MG, Asch MJ. Acid-base effects of topical mafenide acetate in the burned patient. N Engl J Med. 1971;284:1281–6.CrossRefPubMedGoogle Scholar
  22. 22.
    Harrison HN, Bales H, Jacoby F. The behavior of mafenide acetate as a basis for its clinical use. Arch Surg. 1971;103:449–53.CrossRefPubMedGoogle Scholar
  23. 23.
    Klasen HJ. A historical review of the use of silver in the treatment of burns. II. Renewed interest for silver. Burns. 2000;26:131–8.CrossRefPubMedGoogle Scholar
  24. 24.
    Lindberg RB, Moncrief JA, Switzer WE, Order SE, Mills W Jr. The successful control of burn wound sepsis. J Trauma. 1965;5:601–16.CrossRefPubMedGoogle Scholar
  25. 25.
    Moyer CA, Brentano L, Gravens DL, Margraf HW, Monafo WW Jr. Treatment of large burns with 0.5% silver nitrate solution. Arch Surg. 1965;90:812–67.CrossRefPubMedGoogle Scholar
  26. 26.
    Pruitt BA Jr. The diagnosis and treatment of infection in the burn patient. Burns. 1984;11:79–83.CrossRefGoogle Scholar
  27. 27.
    Brown TP, Cancio LC, McManus AT, Mason AD Jr. Survival benefit conferred by topical antimicrobial preparations in burn patients: a historical perspective. J Trauma. 2004;56:863–6.CrossRefPubMedGoogle Scholar
  28. 28.
    Mayhall GC. The epidemiology of burn wound infections: then and now. Clin Infect Dis. 2003;37:543–50.CrossRefPubMedGoogle Scholar
  29. 29.
    Richard P, et al. Pseudomonas aeruginosa outbreak in a burn unit—role of antimicrobials in the emergence of multiply resistant strains. J Infect Dis. 1994;170:377–83.CrossRefPubMedGoogle Scholar
  30. 30.
    Pruitt BA, et al. Burn wound infections: current status. World J Surg. 1998;22:135–45.CrossRefPubMedGoogle Scholar
  31. 31.
    Pruitt BA Jr, O’Neill JA Jr, Moncrief JA, Lindberg RB. Successful control of burn-wound sepsis. JAMA. 1968;203:1054–6.CrossRefPubMedGoogle Scholar
  32. 32.
    Shirani KZ, et al. The influence of inhalation injury and pneumonia on burn mortality. Ann Surg. 1987;205:82–7.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    van Duin D, Jones SW, Dibiase L, et al. Reduction in central line-associated bloodstream infections in patients with burns. Infect Control Hosp Epidemiol. 2014;35(8):1066–8. Epub 2014 Jun 20CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    O’Mara MS, Reed NL, Palmieri TL, Greenhalgh DG. Central venous catheter infections in burn patients with scheduled catheter exchange and replacement. J Surg Res. 2007;142(2):341–50.CrossRefPubMedGoogle Scholar
  35. 35.
    King B, Schulman CI, Pepe A, Pappas P, Varas R, Namias N. Timing of central venous catheter exchange and frequency of bacteremia in burn patients. J Burn Care Res. 2007;28(6):859–60.CrossRefPubMedGoogle Scholar
  36. 36.
    Purdue GF, Hunt JL. Chondritis of the burned ear: a preventable complication. Am J Surg. 1986;152:257–9.CrossRefPubMedGoogle Scholar
  37. 37.
    Baruchin AM, Schraf S, Rosenberg L, Sagi AA. Hot bitumen burns: 92 hospitalized patients. Burns. 1997;23:438–41.CrossRefPubMedGoogle Scholar
  38. 38.
    Carta T, Gawaziuk J, Liu S, Logsetty S. Use of mineral oil Fleet enema for the removal of a large tar burn: a case report. Burns. 2015;41(2):e11–4. Epub 2014 Oct 11CrossRefPubMedGoogle Scholar
  39. 39.
    Buja Z, Arifi H, Hoxha E. Electrical burn injuries. An eight-year review. Ann Burns Fire Disasters. 2010;23(1):4–7.PubMedPubMedCentralGoogle Scholar
  40. 40.
    Simmons R. Emergency management of electrical burns. J Emerg Nurs. 1977;3(2):13–5.PubMedGoogle Scholar
  41. 41.
    Burd A. Hydrofluoric acid burns: rational treatment. J Burn Care Res. 2009;30:908.CrossRefPubMedGoogle Scholar
  42. 42.
    Dalamaga M, Karmaniolas K, Nikolaidou A, et al. Hypocalcemia, hypomagnesemia, and hypokalemia following hydrofluoric acid chemical injury. J Burn Care Res. 2008;29:541–3.CrossRefPubMedGoogle Scholar
  43. 43.
    Lin TM, Lee SS, Lai CS, et al. Phenol burn. Burns. 2006;32:517–21.CrossRefPubMedGoogle Scholar
  44. 44.
    Parikh TJ. Acute concentrated phenol dermal burns: complications and management. Indian J Crit Care Med. 2015;19(5):280–2.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Davis KG. Acute management of white phosphorus burn. Mil Med. 2002;167:83–4.CrossRefPubMedGoogle Scholar
  46. 46.
    Barillo DJ, Cancio LC, Goodwin CW. Treatment of white phosphorus and other chemical burn injuries at one burn center over a 51-year period. Burns. 2004;30:448–52.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Director of Emergency General SurgeryUniversity of MichiganAnn ArborUSA

Personalised recommendations