The hypermetabolism of major thermal burn: Implications for infections

Abstract

The decade of the 1980s saw a tremendous diminution of mortality in major thermal burn injuries. Early massive excision and grafting of burns has increased the LD50 to 98% total body surface area (TBSA) burn in referral pediatric burn centers such as the Shriners Burns Institute-Galveston Unit. We believe that early excision of the burn wound, within 72h of the time of injury, is absolutely essential in the very largest of 3rd degree burns, and we advocate, as a standard of care, the use of fresh cadaver skin as a temporary cover. We initially thought that excising and grafting the acute burn wound would return the patients’ immunologic and hypermetabolic responses to normal. Surprisingly, this has not been the case; the physiologic and metabolic alterations following thermal injury continue despite these measures. Essentially, a burn patient is one whose outer defense, the skin, is breached and whose inner defense mechanism is deranged.