R. B. Lindberg1, John A. Moncrief1, Alex Mason1
1U.S. Army Surgical Research Unit Fort Sam Houston, Texas
Tóm tắt
Discussion and SummaryThe successful control of burn wound sepsis by use of Sulfamylon burn cream has greatly altered the management of the burn wound and its prognosis. The character of the healing wound has altered, with persistence of eschar now seen, due to suppression of microbial debriding action. This problem has been resolved by discontinuing therapy and applying dressings if necessary to hasten eschar separation. The use of a water soluble base, which is 62% water, has resulted in a decrease in evaporative water loss, with a consequent reduction in the metabolic load on the patient. This is evident in the reduction of weight loss in the post‐burn period. The control of local sepsis appears to add to this gain, since it too represents a decrease in metabolic demand. The survival of epithelial islands in deep dermal burns which had previously been converted to full‐thickness injury by infection has resulted in healing of such injuries without resort to skin grafting. The hydrotherapy procedures permit a daily gentle debridement of matured eschar, and a consequent reduction in the frequency of surgical debridement has occurred. The reduction in the need for general anaesthetic has simplified wound management and minimized weight loss due to cancelled meals.The drug is simple to compound and to apply. Areas housing many burn patients are now odorless, in striking contrast to the environment previously existing.The elimination of burn wound sepsis has, however, increased the magnitude of other clinical problems in burn management. The most prominent of these are the pulmonary complications, specifically a diffuse pneumonia. This is not a hematogenous Pseudomonas pneumonia, which was formerly a common complication of burn wound sepsis, but a bronchopneumonia, often associated with patches of atalectasis.The mortality statistics show a consistent reduction of 50% in death rate; most of the change has occurred in burns of less than 50% of body surface. There has been no improvement in death rate of burns of over 60%, although the cause of death has changed from one of wound infection to pneumonia. Burn wound sepsis has been relegated to a minor role in burn mortality by the use of topical Sulfamylon therapy.
