British Burn Association

Following first aid, the acute management of the burn patient requires assessment according to recognized protocols of trauma resuscitation with specific attention to accurate recognition of the depth and the extent of the burn wound. Surgical management will be required when the burn wound is either extensive, deep in nature or complex in its presentation. Frequently, burn wounds present with these three attributes, making surgery unavoidable. Extensive burn wounds may require surgery to ensure patient comfort and appropriate wound management irrespective of their depth. Deep burn wounds will always require surgery due to their inability for self-healing and their potential for abnormal scarring with subsequent impact on function and cosmetic appearance. Complexity is present when the injury is both deep and extensive or when the burn wound is associated with trauma or deranged physiology that compromises survival. The pillars of burn surgery are early debridement and prompt soft tissue cover. These need to be supported by multidisciplinary team involvement to ensure successful outcomes, appropriate rehabilitation, and the return to society as an active member of the burns survivor. The extended competencies of the burn surgeon also involve airway management by providing surgical aids to ventilation, escharotomy if indicated, control of the different variables of the hypermetabolic response to burn injury such as temperature, infection, blood loss, nutrition and pharmacological modulation and further secondary procedures for contracture release, scar management and burns reconstruction.