Dr De Silva Dinuksha1
1St George Plastic And Reconstructive Surgery Department, Sydney, Australia
Burn wound debridement is an integral step in managing burn injuries. Timely debridement serves to prevent infection, optimise quality of life and cosmesis, and improve overall survival. Surgical management of burns has evolved over time: beginning with Sushruta, who first described free-hand skin harvesting in 600BC, a hallowed procession of surgical pioneers has refined techniques and developed a smorgasbord of instruments with which we debride burns today. We present a history of these advancements.
European surgeons Ambroise Pare and Wilhelm Fabry were some of the first to describe early excision of burn wounds during the 16th Century. They were ahead of their time however; a lack of antiseptic technique meant high infection rates and blood loss, so excision was abandoned for centuries. 1865 saw Lister successfully sterilise surgical instruments using phenol, and post-operative infections significantly decreased.
World War 2 generated a huge number of burn victims – this was met with a wave of innovation. Enzymatic debridement techniques were introduced in the form of plant or bacterial agents. In the 1940s early excision and skin grafting was increasingly utilised. Sharp excision tools evolved concurrently thanks to Humby, Watson, Goullian and others. Their blades remain in popular use today. In the early 1970s Janzekovic revolutionised burns treatment with her technique of tangential burn wound excision. Several advancements have been made since then including the introduction of hydrosurgery, which aims to preserve dermis, reduce theatre time/blood loss, and improve scar outcomes.
1. Lee KC, Joory K & Moiemen NS 2014. ‘History of burns: the past, present and the future’. Burn Trauma, vol.2;pp169–180.
2. Cope O, et al. 1947. ‘Expeditious Care of Full-Thickness Burn Wounds by Surgical Excision and Grafting’. Ann Surg, vol.125;no.1;pp1-22.
3. Janzekovic Z 1970. A new concept in the early excision and immediate grafting of burns. J Trauma, vol.10;pp1103–1108.
Dinuksha is a plastic surgery registrar at St George Hospital, Sydney.