Challenges in the Management of Large Burns

Early excision and coverage of the large burns improves the survival and prevents infections. However, it is important to understand and treat the complex pathophysiological derangements associated with large burn injury for a successful outcome. Nutrition and infection prevention are two main pillars of the supportive treatment. Skin coverage should be achieved as early as possible. Alternative skin grafting methods and donor sites are valuable tools for this purpose. If the wound cannot be covered soon, temporary dressings and skin substitutes can provide a physiologic environment to facilitate wound healing and can be used as a bridge to definitive coverage. For patients with high Baux scores, palliative care consultation should be considered early in the hospital course. Palliative care is not synonymous with withdrawal of care. On the contrary, it improves the comfort of the patients and families during their often, lengthy hospital stay.