[Basic comments on differential surgical therapy of severe burns]

The life of severely burned patients nowadays is endangered especially by infections and septic complications deriving from the wounds. This danger can be obviated only by early excision of all deep necrotic areas and immediate wound closure, ideally with autografts. The correct estimation of the depth of burn is decisive for effective local surgical therapy, which is guided mainly by visible criteria. Conservative treatment is employed for first-degree and superficial second-degree burns, while operative therapy is needed for deep second-degree and third-degree burns. The required immediate wound closure with autografts is problematic after necrectomy of burns larger than 40% TBSA. To extend the limited skin reserves, autografts are meshed or combined with homografts. Defects can be covered temporarily with vital or non-vital homografts until donor sites for split-thickness skin grafts are healed. Cultured epithelial autografts at present are not suitable for routine use. After deep burns, no matter what kind of operative treatment is used, scars are left. The scars raise difficulties with regard to aesthetics and function. Permanent pressure in the early stages of aftercare is an effective method of accelerating the maturation of scars and improving their appearance.