Improving survival in the burned patient.

Improving survival of burned patients has been reported by the majority of burn units over the past decade. Although many sophisticated studies have attempted to delineate the major factors responsible for this improvement, no single factor has emerged as being clearly dominant. On the MUSC burn service, increased survival has been particularly apparent in patients with burns involving 50-90% of the BSA. Little improvement in survival has yet been noted in patients with burns involving more than 90% of the BSA. We are convinced that general improvements in topical antimicrobials, antibiotics, techniques of critical care, improved wound care techniques and, very importantly, maintenance of the patient's nutritional status are all critical factors in improving survival in the burned patient. Attributing the increased survival of burned patients to any one of these factors alone currently does not seem to be clearly supported by data reported in the literature nor by our own experience. It is to be hoped that as the quality of skin substitutes and techniques of culturing skin improve, inroads into the extremely high mortality of burns involving more than 90% of the BSA can be made. The MUSC burn service is currently investigating the place of aggressive early burn wound excision and grafting with cultured epithelial autografts in achieving this goal.