Infection in the burned upper extremity.

Infection invariably accompanies thermal injury. The degree to which a patient is jeopardized by infection is related to the size and depth of the burn, the density and virulence of the microorganisms colonizing the burn wound, and the competence of his immune defenses. The aim of topical therapy is to limit microbial colonization of the burn wound to levels below those associated with invasive infection of the viable tissue beneath the eschar. The use of effective topical and systemic antimicrobial agents has been associated with the emergence of other bacterial, fungal, and viral infections and a delay in separation of the eschar, presumably caused by the suppression of bacterial débribement of the burn wound. The treatment of fractures in thermally injured patients may require compromise to permit optimal wound care and alertness toward the development of osteomyelitis. Because of the frequency of suppurative thrombophlebitis in burned patients, particular care is needed in the management of intravenous cannulae. The treatment of burns is largely the control of infection. Awareness of the septic complications of thermal injury and constant vigilance against them is critical in successful burn management.