Early removal of the eschar in upper extremity burns.

The rationale behind early removal of the burn is sound, but the techniques presently available to accomplish this are limited. In patients with large area burns, massive excision should be considered only in burn centers prepared to provide the enormous amount of supportive care required. Carefully selected, localized burns of the upper extremity may benefit from timely surgical excision. Final function, particularly in the hand, depends more on the depth of initial injury and involvement of deep structures than on the choice between excision and topical chemotherapy. Enzymatic débridement, though an attractive concept, is presently in the development stage and should be viewed with caution. The success of any procedure for early removal of the eschar depends on prompt and complete wound coverage with skin grafts.