[Burns. Primary management and clinical therapy]

Following the saving of the patient in addition to the cool-water therapy an adequate infusion therapy with Ringerlactate should be initiated immediately. For the transport the wounds should only be covered sterile; in case of inhalation trauma early intubation. Adults with burns of more than 15% TBA (children already at 5%) as well as with burns of hands and face require an immediate transfer into a burncenter. After cleansing of the wounds in the hospital estimation of the burn depth and decision of treatment. Deep burns of hand and face should be necreted and covered within the first 72 hours if possible. For the remaining deep burns one should try a primary excision too or in case of a bad general condition a delayed primary excision after tanning. Up to the moment of operation one should choose between an open, half open or closed treatment. The covering of the necrectomized areas is done temporary with alloplastic material or xeogenic or allogenic skin respectively. Definitive covering can only be achieved by autogenic split skin or intermingled skin grafting. New possibilities are offered by "in vitro" grown keratinocytes.