The West Australian surgical approach to massive burn injury

Massive burn injuries (>50% total body surface area) remain challenging for survival and reconstructive management. In Western Australia (WA), the dermal template used for massive burns was changed from Integra® to Novosorb® Biodegradable Temporising Matrix in 2019. Short-term outcomes in massive burns were examined in two groups before and after this change: 2015-2019 and 2020-2024. Comparison between these groups revealed that mortality of actively treated patients decreased in the latter group (from 22% to 14%), the mean length of stay reduced (from 82 days to 74 days) and the mean time to healing reduced dramatically (4.1 months compared to 6.8 months). A protocol-driven surgical approach to massive burns was developed in WA over the past decade which may have contributed to these improved outcomes along with the change in the dermal template used. Lessons learned over time and details of this surgical strategy are presented.