• Two case histories illustrate the surgical principles involved in the care of the severely burned child. A 5-year-old girl with extensive third-degree burns was carried through the initial period of shock by supportive treatment which included the administration of dextrose, electrolytes, serum albumin, and whole blood by venoclysis. Dressings were changed at four-to-six-day intervals under general anesthesia in the operating room. Wound infection was avoided, and sufficient skin for stamp-grafts was obtained from donor areas which, since healing, are covered by ordinary clothing. A 12-year-old girl, seven months after a similar burn, showed severe depletion and anemia, extensive infection, and pressure sores on both hips. Multiple transfusions were necessary to improve the general condition of the patient; antibiotics stopped the fever. Dressings were changed under general anesthesia, and subsequent graftings of skin were successful. An aggressive two-way plan of action is indicated in severe burns: general, systemic measures to combat infection and improve the patient's nutritional state, and specific, surgical measures to bring about the covering of the open wound with skin at the earliest possible moment. The skin coverage obtained by stamp-like grafts is permanent and in the experience of the author has proved to be of generally good functional quality.
Smith RS. SURGICAL MANAGEMENT OF THE SEVERELY BURNED CHILD. JAMA. 1957;164(5):511–516. doi:10.1001/jama.1957.02980050001001
Customize your JAMA Network experience by selecting one or more topics from the list below.
Create a personal account or sign in to: