White Cells in Burn Patients

Abstract

Advances in the surgical treatment of burns have markedly decreased mortality over the last 10 years. In the United States, the advent of 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. It is our prejudice that early excision of the burn wound within 24–72 h of the time of injury is absolutely essential in the very largest of third-degree burns, and the use of fresh cadaver skin as a temporary cover has become the standard of care. The physiologic and metabolic alterations following thermal injury continue despite these measures. We initially thought that if we excised and grafted the acute burn wound, the patients’ immunologic and hypermetabolic responses would return to normal. Unfortunately, this has not been the case. Essentially, a burn patient is one whose outer defense, the skin, has been damaged and whose inner defense mechanism is totally befuddled.