Overall, burns are smaller than 20 years ago, but even small burns can leave patients with debilitating scars. The management of the burn wound and resultant scarring requires the integration of multiple disciplines. Despite our best efforts, the evaluation and treatment of burn wounds and burn scars has not been completely elucidated. The purpose of this work is to describe the state of knowledge regarding wound healing, both what is known and what is not known, and to recap the priorities set by the breakout sessions of the Burn State of the Science: Research meeting. Wound challenges in 2007 include wound coverage for patients with extensive full-thickness burns, management of donor sites and partial-thickness burns, and reduction of long-term morbidity from burn scars. Early excision and grafting of the burn wound have indisputably impacted burn survival more than any other intervention during the past 30 years.1 Removing the burn wound has been reported to decrease infection, shorten hospital length of stay, reduce the need for reconstructive surgery, and return patients to their premorbid level of function sooner.2 These clinical advances have created a standard of care that emphasizes use of sheet skin grafts whenever possible with meshed grafts recommended for coverage of burns in patients with larger full-thickness wounds.3,4 Larger wounds may benefit from coverage with skin substitutes. Existing skin substitutes include both dermal replacement templates and epidermal cultures.5 Dermal substitutes, such as Integra (Integra Life Sciences Corp., Plainsboro, NJ), replace the cutaneous connective tissue and provide a template for ingrowth of indigenous cells from the wound bed.6,7 Dermal substitutes have been reported to reduce scar formation and improve wound pliability. Keratinocyte grafts restore the epidermal layer and restore the cutaneous barrier to infection and fluid loss. Cultured epidermal allografts, which have gained popularity for treatment of nonhealing chronic wounds, have limited applicability in definitive burn treatment because of rejection. Reports of successful treatment of large burns with cultured dermal–epidermal autografts8,–12 have not yet progressed to multicenter trials because of their expense and complexity of fabrication.13 Whereas development of these products has advanced the field, time of preparation and expense limit their availability for treatment of patients with extensive burn injuries.