[Principles of the local treatment: Surgical processing].

The deep burns require a surgical treatment. The third degree circular burns require escharotomies and sometimes fasciotomies to avoid vascular compression. Early burn wound excision permits to remove the necrotic tissue that produce toxins and encourage infection. Wound coverage by an autologous split-thickness skin grafting, meshed or not, usually leads to a correct scar quality. In severe burns, when donor's sites are limited, the homografts permit to pass a critical stage even though they are rejected secondarily. The keratinocytes culture remains a difficult and exceptional technique for very severe burns permitting to save their life but with poor cosmetic results. Artificial dermal substitute could sometimes permit to replace the homograft and to improve the cosmetic results of the grafts by a better reconstitution of skin. If early burn wound excision with autologous split-thickness skin grafting remains the gold standard, the tissue-engineering will be a future way for the surgical treatment of the burns.