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Histological and clinical studies have been made on comparable burn wounds covered with either boiled potato peels affixed to gauze bandages or gauze dressings alone; both dressings were applied over a thin layer of 5 per cent silver sulphadiazine. Compared with treatment with plain gauze dressings, the application of the potato peel dressing reduced or eliminated dessication, permitted the survival of superficial skin cells and hastened epithelial regeneration. Bacteriological studies showed that the potato peels had no intrinsic antibacterial activity, the wounds beneath both dressings showing either no growth or, on most occasions, the same bacterial species. The easy availability of potato peels and gauze bandages on to which they can be affixed, the simplicity of the preparation of this dressing, the ease of sterilization and its low cost of production make this the dressing of choice for burn wounds in our developing country.

Deep burns affecting the dorsum of the hand have been treated by tangential excision of the eschar in 156 patients involving 208 hands. From our 10-year experience we have concluded that: If the patient's general condition permits it all hands with deep partial and full thickness skin loss burns are suitable for early tangential excision of the eschar. The best time for the operation is within the first week after injury. If the burn is of limited extent and the requirement for autograft skin is small the operation may be carried out under nerve block anaesthesia. When the burn is more extensive (i.e. involving both hands) intravenous ketamine anaesthesia is recommended. During tangential excision sequential layers of tissue must be removed until the base of the burn appears porcelain white in colour, has a lustrous appearance with many small bleeding points and is firm in consistency. If there are deep burns of the finger webs they are incised or excised and then grafted. Postoperatively an absence of fever, pain or exudation from the wound indicates that inspection of the wound can be delayed for about 2 weeks. By this time the wound is usually healed and functional rehabilitation and physiotherapy can commence.

Silver sulphadiazine has been applied to the burn wounds of 509 patients during the past 10 years. Eleven patients with burns covering more than 20 per cent of the body surface showed silver deposits in the mucosa of the lips, gingiva and cheeks. The colour of the burn wound was also slightly darker than in patients not treated with silver compounds. This darker colour spontaneously disappeared during the year following discharge from hospital. The pathogenesis of silver deposition has been discussed in relation to other published studies.

This report contains our experience gained over 13 years of the tangential excision of burned tissue in 627 patients. We have discussed the indications for and timing of tangential excision, methods of determining the margin between viable and non-viable tissue using histological studies in some patients and the problem of wound coverage after tangential excision.

The treatment of injuries inflicted on hands and occasionally forearms by crushing between hot rigid surfaces (thermal crush injury) is usually complex because of the possibility of fractures, nerve and tendon injuries, as well as heat destruction of the skin which also may be macerated. A review of the treatment of 60 patients with thermal crush injuries has defined the more important aspects of treatment including the choice of materials for wound coverage (split thickness skin or tube pedicle tissue graft) and the optimal time for surgical repair of the injury.

Twenty-six patients were evaluated with regard to CPK values in week 1 post-burn. Patients were allocated into two groups based on the severity of burn injury. Group 1 included patients with minor electrical or thermal injury, and Group 2 those patients with deep thermal injury and objective evidence of muscle necrosis. With the exception of day 5 post-burn, Group 2 had significantly increased CPK levels as compared to Group 1. This indicates that CPK levels, especially with electrical and deep thermal burns, are sensitive tests in evaluating the depth of burn injury such that an appropriate pre-operative strategy for debriding and grafting is possible.

Arguably one of the oldest recorded methods of treating burns is still recommended today, namely prompt cooling of the injured part, usually in cold water. Such therapy was recommended by Galen (AD 129-199) and Rhazes (AD 852-923) Earle (1799) and by Sorensen (1967). As a first aid measure it has numerous advocates in the 1970s and 1980s. Almost certainly subjective considerations initiated this form of treatment and only within recent times have objective studies confirmed the beneficial effects of a more rapid reduction in tissue temperature and thus severity of injury.

Candida infection has become an important cause of morbidity and death in burned or immunosuppressed patients. Two patients with extensive burn complicated with Candida infection are presented, along with the risk factors, diagnostic procedures, and current methods of treatment.

Histopathological studies were made on samples of liver and spleen tissue taken post mortem from 59 patients with severe burns. Samples from 8 patients were also studied using the transmission electron microscope. The main pathological findings were degeneration and necrosis of hepatic cells and proliferation of Kupffer cells showing active phagocytosis. Their causes in relation to the time of death after burning and severity of injury have been discussed. The proliferation of Kupffer cells may be a compensatory reaction to the severe splenic injury seen in the patients.

From the results in 110 patients, in whom 207 red cell volume estimations were made at various times after burning using either (51)Cr-, (32)P-, or Group NN-labelled cells, and 17 plasma volume estimations on the same patients using either T-1824-or (131)I-labelled albumin, it is concluded that: [List: see text]