The use of homograft compared to topical antimicrobial therapy in the treatment of second-degree burns of more than 40% total body surface area

The traditional approach for the treatment of partial-thickness burns has been the application of topical antimicrobial therapy to control bacterial colonization, avoid progression to invasive infection, and allow healing of the underlying burn wound. Infection is associated with apparent conversion of a second-degree burn to full-thickness injury that requires autografting, to say nothing of a source of sepsis, which has been associated with multiorgan failure and death. We postulated that early debridement and coverage of large partial-thickness burns (>40% total body surface area) with homograft would preserve underlying tissue, improves healing, and decreases morbidity. We present data obtained in 16 patients treated with the application of homograft compared to 13 patients treated with the traditional approach consisting of twice daily applications of silver sulfadiazine. The treatment of massive second-degree burns with homograft reduced hospital length of stay (P<0.01). We thus conclude that in patients with >40% total body surface area burns, early debridement and wound coverage with homograft is an alternative method to the conservative non-operative approach with topical antimicrobial therapy.