Update on burn care in France

Excerpt

Care of burn patients in France, as in many European countries, has long been neglected; this was a field which afforded little satisfaction and did not arouse much medical interest. It was only after the Second World War that attitudes really began to change; awareness of the need for multidisciplinary specialized management led to the opening of Burn Departments 50 years ago. Burns are in fact a specific pathology involving intense pathophysiological reactions which require particular treatment both local and general, as the course of the two is closely linked. Burn care requires teamwork within autonomous structures providing overall therapy in which intensive anesthetic management, surgical intensive care, and plastic and repair surgery all have a role to play. While intensive care techniques made it possible to maintain the major vital functions, adversely affected during the early postburn period and to combat immediate complications, there has been decisive progress in surgical skin-cover techniques. The first basic principle of the treatment of burn patients states that if burns are extensive, only rapid healing can save the patient's life, as any delay may lead to a chronic wound, with the risk of local and general complications. A burn is not just a particular kind of wound, and early excision is required, associated in varying degrees with coverage techniques (e.g., dermoepidermal autograft, total skin graft, skin expansion, microsurgical transfer techniques, skin substitutes such as Integra). However, healing alone is not enough; it is the surgeon's task to choose the best technique for restoring the functional character of the scar and preventing hypertrophic or keloid scars, contractures, etc. That is the second principle of burn care. Function must be considered. The third and last principle is that repair must always be as esthetic as possible, since a scar of good cosmetic appearance is a guarantee of the patient's later quality of life, the ultimate goal of the whole chain of care. …