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Introduction: Early removal of burn eschar is a cornerstone of burn care. The most commonly practiced eschar removal technique for deep burns in modern burn care is surgical debridement but this technique is associated with surgical burden and leads to unnecessary excision of viable tissue., Goals: To review 30 years of research and development of an enzymatic debridement agent for burns., Methods: Studies performed during the last 30 years are reviewed in this manuscript., Results: Patients who underwent enzymatic debridement had a significantly shorter time to complete debridement, the surgical burden was significantly lower, hand burns did not necessitate escharotomy, and the long term results were favorable., Discussion: Early enzymatic debridement leads to an efficient debridement, preservation of viable tissue, a reduction in surgical burden and favorable long term results., Conclusion: We believe early enzymatic debridement will lead to better care for burn victims and perhaps, even to a paradigm shift in the treatment of burns.

Mastectomy in 16 consecutive patients with carcinoma of the breast was immediately followed by reconstruction with a transverse abdominal, myocutaneous flap. Surgery was performed simultaneously by a team of general surgeons and a team of plastic surgeons. The final cosmetic result was considered very good by most patients. Complications were only minor and were treated conservatively. We consider breast reconstruction by this method, after mastectomy for breast carcinoma, to be the method of choice.

The technique of immediate breast reconstruction, using the tissue expander and replacing it with a permanent silicone prosthesis, has been applied with increasing frequency during the past several years. We chose this technique for immediate breast reconstruction because of its simplicity, rapidity when combined with mastectomy, and good esthetic results. We have performed 29 immediate breast reconstructions in the past 1.5 years in patients ranging from 22 to 72 years (mean 47). The insertion of the tissue expander added only 20-30 minutes of operating time for the mastectomy, and did not prolong hospitalization. Before we began to replace the expander with a permanent silicone prosthesis there were complications in 4 patients (14%). These included development of a seroma in 3, 1 of which became infected 40 days after insertion of the tissue expander, and capsular contraction in a patient who had previously had radiotherapy to her breast. The case with the infection was the only failure and the expander had to be removed. Immediate reconstruction of the breast is easily performed and can be of tremendous psychological benefit to mastectomy patients. Chemotherapy or radiotherapy are not contraindications to this type of reconstruction.