Dr John Greenwood

Royal Adelaide Hospital

Immediate burn excision (within 24 hours of injury) confers an extensive range of advantages to both patient and surgeon. In order to ensure early survival, facilitate the surgical course and deliver an optimal outcome, it is essential to exploit several ‘physiological windows’. These windows are open early after injury, but briefly. They include wound, anaesthetic, haemodynamic and cellular/serum health windows. The timely exploitation of these brief physiological hiatuses is synergistically coupled with the significant benefits of immediate eschar removal, which include the abolition of the Allgöwer effects, a reduction in resuscitation fluid requirements, negating the need for escharotomy and decontaminating the wound surface. Additionally, an “early start means an early finish”. At daily costs incurred on a Specialist Burns Unit approaching $3,000, any reduction in the duration of inpatient stay can save thousands of dollars. This fact is lost on neither administrators, nor governments.