Volume 20 - Issue 4 - April, 2008

Work. Finish. Publish.

Results unpublished are little better than those never achieved.”
                                 –Logan Wilson1

The excitement of being notified that all your hard work in preparing your abstract or poster paid off is fading. The memory of the meeting and the pride and adulation that came from your presentation or your poster are satisfying memories. Is what you have accomplished enough or is there more t



Advances in Burn Care

When considering what to put in the “Advances in Burn Care” section this time, I was hard pressed to find enough that was new in burn care to fill an entire issue. I decided instead to devote this issue of WOUNDS to the history of burn care. This way, we all can remember from whence we came in burn care.

Two articles are written by Chester Paul, MD. I asked Dr. Paul to write a review of the history of burn grafting. He believed that the topic was too large in scope for one review, and decided to write one article on skin grafting and another on the use of skin s



History of Metabolic Treatments in Burn Care

Throughout the latter portion of the 20th century, major developments and advances within the specialty of burn care have been made. Several interventions and developments in reducing energy demands following burns have played a role in attenuating the metabolic response and reducing energy requirements. As a result, long-term function and prognosis have greatly improved. These interventions include early burn excision and wound closure with skin grafts or substitutes, early and aggressive enteral feeding, elevating environmental temperature to thermal neutrality, and pharmacological therapie



Topical Antimicrobials in Burn Wound Care: A Recent History

It is nearly 100 years since antisepsis came to dominate the treatment of burns. All that has been accomplished, as far as we can see from the data available, has been to offset the good that sound physiological and surgical principles and modern aseptic technique should have afforded.”1
—Carl A. Moyer, MD, 1954

The topical therapy of burn wounds dates back to the beginnings of civilization. Throughout history, a number of famous philosophers, physicians, and scientists have contributed to the knowledge of burn wound management, inc



Skin Grafting in Burns

The definitive history of the transplantation of human tissues, or animal tissues for that matter, is shrouded in the mists of antiquity. Numerous authors referred to tissue transplantation centuries before the birth of Christ. Fata writes that the earliest recorded plastic surgery operation was done by a surgeon named Sushruta (or Susruta) in India perhaps as early as 700 years B.C.1–3 Sushruta is considered the father of plastic surgery in India and is credited by some as being simply “the father of surgery.” There is some evidence that reconstruction of the nos



Skin Substitutes in Burn Care

Large surface area burns continue to be one of the most difficult and deadly problems the medical community faces today. Although major strides have been made in burn care throughout the years, many difficulties remain. Historically, some rather bizarre and egregious concoctions, at least by modern standards, have been applied to burns to promote healing. Barbara Ravage, author of Burn Unit, records and describes fascinating unguents and emollients that include using calf dung and black mud as topical burn treatments, as recorded in the Ebers Papyrus from the 1500s BC.1



July 2008

Military Endorses New Dressing Compound

Woundstat™ is a newly developed lightweight and granular dressing compound from Virginia Commonwealth University (Richmond, Va) and TraumaCure Inc (Bethesda, Md). The compound received endorsement from the Department of Defense Joint Committee on Tactical Combat Casualty Care for widespread military use.

The Woundstat is not only moldable, but adheres to irregular wound shapes while quickly stemming high-pressure bleeding in moderate to severe wounds.

The technology is the result of more than 3 years of research and dev



July 2008

International Best Practices Introduced for V.A.C.® Therapy

The first comprehensive publication of international best practices for the use of KCI’s V.A.C.® Therapy (KCI, San Antonio, Tex) was introduced at the Third Congress of the World Union of Wound Healing Societies in Toronto, Canada.

Entitled, Principles for Best Practice—Vacuum Assisted Closure: Recommendations for Use, A Consensus Document, the document was developed by an international expert working group to provide guidance on the successful integration of the V.A.C. into clinical practice for



From Cholera to “Fluid Creep”: A Historical Review of Fluid Resuscitation of the Burn Trauma Patient

Resuscitation of a patient with a traumatic burn presents unique and dynamic challenges, which often involve the critical care management of multiple physiological derangements. It is well known that a major burn injury can lead to burn shock and involve multiple organ systems. Burn shock has been described as the outcome of a combination of multiple factors, including hypovolemia, microcirculatory injury and dysfunction, and the release of local and systemic inflammatory mediators, which result in the body’s inability to adequately meet cellular needs.1,2 After initial stabi



A Brief Historical Review of Flaps and Burn Reconstruction

We are like dwarfs sitting on the shoulders of giants. We see more, and things that are more distant, than they did, not because our sight is superior or because we are taller than they, but because they raise us up, and by their great stature add to ours.”

                         —John of Salisbury, 1159 AD

Classic Examples of Flap and Burn Reconstruction

Perhaps one of the earliest and most notable fla