The importance of closure –the use of skin and skin substitutes in the acute burn wound.

John G. Harvey

Head, Burns Unit

The Children’s Hospital at Westmead

Early surgical or chemical debridement of the acute burn wound within 48 hours has been shown to have a profound effect on the modulation of the systemic inflammatory response in major burns. Recent evidence suggests that this aggressive approach has led to a significant reduction in long term survival in children with greater that 80% burns.

Such a massive excision creates an open surgical wound which must be closed. Autologous skin grafts are not possible due to lack of available donor sites in major burns and furthermore their use creates a further open wound and amplifies the inflammatory response . The use in this situation of autologous epidermal cells grown in culture, has great potential; however the fragility of such grafts have led to the use of human allografts and dermal substitutes such as “Integra” as a temporary wound cover whilst epidermal cells are grown in culture and later grafted on to a well prepared recipient site.

This paper will present current practice in the management of the acute burn wound using autografts, cultured epidermal autografts, allografts and skin substitutes.