Surgical management of burn wound sepsis.

Twenty-two burned pediatric patients were diagnosed as having wound sepsis confirmed histologically and microbiologically. The availability of histologic and quantitative microbiologic data based upon biopsy data has permitted an early, accurate method of detecting burn wound sepsis. The histologic data have been of greatest value because of their prompt availability and accuracy. All patients underwent tangential debridement or surgical excision to fascia based upon the assessment of the wound by the surgeon. Two patients died at two and five days postoperatively of sepsis attributable to the burn wound. A third patient died at 56 days of sepsis originating at a site other than the burn wound. Thus, the over-all mortality, including the third patient, was 14 per cent. Children surviving the septic episodes showed a marked improvement in the clinical course shortly after undergoing therapeutic surgical excision. Since initiation of surgical intervention in burn wound sepsis, the over-all mortality has decreased from an average annual rate of 11.2 to 2.8 per cent.