Primary excision and prompt grafting as routine therapy for the treatment of thermal burns in children.

There is much evidence that the most important factor in the successful treatment of skin destruction after thermal injury is to remove dead tissue and promptly close the wound. While the exact methods employed to achieve this goal may vary, in the cases reported here three basic methods were used: (1) simple excision of burn eschar with immediate closure with autograft for small and medium-sized burns; (2) excision and immediate wound closure with autograft supplemented by allograft, with replacement of allograft by autograft before extensive allograft rejection, for large burns; and (3) immunosuppression and temporary skin transplantation for massive third degree burns. All have markedly decreased hospital stay and complications, and in large and massive burns mortality was substantially reduced.