Excision and Skin Grafting of Thermal Burns.

A 45-year-old man was rescued from his burning house. Firefighters removed his smoldering clothes and initiated intravenous access, pulse oximetry, and electrocardiographic monitoring. An endotracheal tube was inserted, and ventilation with 100% oxygen was initiated for presumed airway instability and inhalation injury. He was taken to a local emergency department with both superficial and deep dermal burns involving his torso and arms; the burns covered 42% of his total body-surface area. Intravenous fluid resuscitation was initiated. He was then transferred to a burn center for definitive treatment. Tube feeding was initiated through a nasogastric tube. The burns were cleansed and a slow-release silver dressing was applied. On day 3 after the injury, he is clinically stable. The clinicians are now deciding whether to excise the burns and how to cover the open wounds.