A new technique in the clinical assessment of burns.

Abstract

iTCOMEsasa great relief these days to find that with the passage of time the classification of certain diseases becomes simpler rather than more complex. Thus the modern classification of burns into partial skin loss and whole skin loss cuts clean through the more traditional and even more confusing earlier descriptions of burn depth. This new classification has the additional advantage that it not only describes the lesion accurately but also indicates the correct line of treatment. Partial skin loss implies the presence of sufficient epithelial cells in the dermis, hair follicles and sweat glands to resurface the area, whereas whole skin loss implies complete destruction of all epithelial elements so that healing can only occur by migration from the periphery or contracture of the bed of the wound. Thus theoretically all partial thickness burns should heal provided they are properly cared for, whereas the ideal treatment for full thickness burns should be excision and closure of the wound, either by suture or skin graft. In practice, the value of early excision of full thickness burns has been amply confirmed by several workers but there are three very significant limitations to this therapeutic procedure: 1. Biological. The skin is the largest single organ of the human body, and there would appear to be limits to its destruction by burning or excision beyond which survival of the patient is impossible. 2. Technical. In the excision of major burns, particularly in the very young and the aged, there are very real problems of blood loss including its estimation and replacement before, during and after operation; dangers of