[Basic comments on differential surgical therapy of severe burns]. / Grundsätzliche Bemerkungen zur differenzierten chirurgischen Therapie von schweren Brandverletzungen.

The life of severely burned patients nowadays is endangered especially by infections and septic complications deriving from the wounds. This danger can be obviated only by early excision of all deep necrotic areas and immediate wound closure, ideally with autografts. The correct estimation of the depth of burn is decisive for effective local surgical therapy, which is guided mainly by visible criteria. Conservative treatment is employed for first-degree and superficial second-degree burns, while operative therapy is needed for deep second-degree and third-degree burns. The required immediate wound closure with autografts is problematic after necrectomy of burns larger than 40% TBSA. To extend the limited skin reserves, autografts are meshed or combined with homografts. Defects can be covered temporarily with vital or non-vital homografts until donor sites for split-thickness skin grafts are healed. Cultured epithelial autografts at present are not suitable for routine use. After deep burns, no matter what kind of operative treatment is used, scars are left. The scars raise difficulties with regard to aesthetics and function. Permanent pressure in the early stages of aftercare is an effective method of accelerating the maturation of scars and improving their appearance.

[Initial management of severely burned patients from the surgical viewpoint]. / Die Erstversorgung des schwerbrandverletzten Patienten aus chirurgischer Sicht.

Of all the surgical steps in the therapy of severely burned patients, the first procedure has a decisive influence on the outcome. Current surgical emergency care-diagnosis and treatment of burns in our special-care units for burned children and adults is presented and discussed.

[Treatment of severe concomitant injuries in severely burned patients]. / Die Behandlung schwerer Begleitverletzungen beim Verbrennungspatienten.

Over a period of almost 6 years, 18 out of 320 burn patients treated in the burn centre had sustained additional severe trauma; for the most part the trauma was due to a motor vehicle accident or a fall. The risk of overlooking such additional injuries can be minimized by systematic examination and a team approach, the same as in normal multiple-trauma patients. Apart from the burn, life-threatening complications such as intra-abdominal bleeding or haemopneumothoracic injuries are to be treated immediately. In order to facilitate appropriate burn wound care and optimize mobilization, early internal or external fixation of unstable orthopaedic injuries should be performed as soon as possible. In our experience, operations carried out within 48 h after the injury have neither led to complications in wound healing nor to osteomyelitis.

[In vitro and in vivo studies of a temporary absorbable dressing]. / In-vitro- und in-vivo-Untersuchungen einer absorbierbaren temporären Wundabdeckung.

The major advantage of biodegradable synthetic wound dressings compared to other synthetic materials and biological tissue derivatives is avoidance of the necessity to change the dressing. The copolymer films used in this study were made of lactic and caproic acid. They pose no problems concerning immunology or transmission of diseases. Moreover, the substances released by degradation may possibly influence the process of wound healing. The material proved to be non-toxic and was used successfully as a carrier for cell culture with keratinocytes. The permeability for bacteria is determined by degradation. Evaluation of the bacteriological studies indicates secure protection against secondary contamination of the films for at least 15 days, however. Concerning application, dressing properties, wound healing and wound retraction, no disadvantages were found in comparison with the results of the competition's film Opsite. Based on these findings, the films are now used in a clinical study as a wound dressing for split-skin donor sites.

[The severe burn from the viewpoint of the patient]. / Die schwere Brandverletzung aus Sicht des Patienten.

A patient reports a severe burn injury. At the time of the accident, the patient was 42 years old. He tells his story: how the accident occurred, the therapy following, and the long-drawn-out rehabilitation period of three years. He suffered a third-degree burn of 45% TBSA by a high-voltage arc. Injured were the upper extremities, the trunk, and both thighs.

[Treatment of calcaneus and mid-foot fractures using closed reposition and fixation with the Ilisarov fixator]. / Die Frakturbehandlung des Kalkaneus und des Mittelfusses mittels geschlossener Reposition und Fixation im Ilisarow-Fixateur.

Sixteen fractures of the calcaneus involving the subtalar joint were treated by closed reduction and external fixation using the Ilisarov apparatus. Except for four cases in which temporary arthrodesis of the subtalar or ankle joint was used, fixation was usually only used for the calcaneus. The operative technique is described precisely. Initial follow-up examinations (on average after 1 year) show advantages over conservative treatment, e.g. better anatomical reduction. In addition, early mobilization of the joint and early weight-bearing result in less pain from disuse osteoporosis. Furthermore, several case reports demonstrate the efficiency of this method in tarsal and metatarsal fracture-dislocations.