Abstract:
Introduction. Burns are underestimated, life-threatening injuries that are difficult to manage, because of
systemic inflammatory response, fluid loss, large scale infections. An ideal burn wound dressing should
have good antiseptic properties, reduce epithelization period, absorb exudate provide moisturization and
pain relief. Injuries caused by frequent dressing, also, represents an important issue. One of the main
problems is improvement of surgical treatment methods, directed towards a debridement and adequate
plastic cover. Enzymatic debridement, autodermoplasty, allografts, xenografts, flaps, semisynthetic skin
substitutes, cell therapy, tissue expansion – choosing an optimal treatment method, will lead to both
shortening the hospitalization period and avoiding sequelae.
Aim of study. To underline the particularities of burns management by studying the scientific articles, for
the elaboration of the recommendations for choosing the best treatment option.
Methods and materials. It was done a literature review, by searching the scientific articles on Google
Scholar, PubMed, Elsevier, Cochrane, published last 5 years, using keywords "burns surgical
management", "burns dressing", "burns grafting".
Results. Among the substances widespread in burn dressing, povidone-iodine is an antiseptic with wideaction
spectrum, reduces epithelization period, when compared to chlorhexidine. Chlorhexidine in a
concentration greater than 2% is more effective than silver sulfadiazine. Sulfadiazine is quite widespread,
notwithstanding that it is associated with poor healing results, the need for frequent dressings and the pain
associated with this. Regarding surgical treatment, early wound debridement decreases the rate of infections
and length of hospitalization. Defects reconstruction and coverage should be performed as soon as possible
after debridement to decrease fluid loss and infection. It can be done temporary covering with allograft or
synthetic skin substitutes, or permanent, with autologous split skin grafts, this depends on burned area of
the skin and availability of the donor sites.
Conclusion. Burns injuries are common, the majority requiring only dressings. A proper wound dressing
will protect against infection, reduce epithelization period, absorb exudate, provide moisturization and pain
relief. In massive burns – dressing is not sufficient, and wound closure requires excisions of burnt skin and
donor grafting, to generate skin synthesis and angiogenesis. Although, in our practice, autografts are not
always available because of the lack of skin donors and the severity of the injuries. In such cases, it is used
allografts, xenografts, semisynthetic skin substitutes, cell therapy, tissue expansion, flaps. The disponible
plasty methods can be crucial in optimizing outcomes.
