Editing Burns (section)

== Operative principles ==

* Spend no more than 2 hours operating, excise no more than 20% TBSA, and lose no more than 2 units of blood.
* Good to cover posterior trunk and buttocks early, to allow supine positioning later in recovery
* Coverage generally proceeds proximal to distal when future amputation is a possibility
* Aim to graft dorsal and digits within first three weeks
* Tangential excision - remove skin layer by layer until viable tissue is reached, followed by immediate application of STSG
* STSG harvested with powered dermatome at 0.008 to 0.01 inch (0.1 to 0.2mm)
* Meshing the graft can allow haematoma/seroma to drain. If haematoma/seroma forms under an un-meshed graft, use a needle to remove the fluid. Meshing also expands the graft.
* Use cadaver allografts when limited by amount of skin available for autograft. One practice is to use widely expanded autografts coered with cadaver allografts. The 4:1 autografts heals in about 3 weeks, and the cadaver skin falls off.