ABSTRACT
Definitive wound closure in patients with massive burns can be a frustrating and elusive goal. In some patients, cultured materials can provide some element of definitive closure. Hopefully this will become a more practical reality in a few years. For most patients with massive deep injuries, multiple thin reharvests of available donor sites provide the bulk of definitive coverage. However, no donor site can be harvested indefinitely and, in some patients, changing the initial objective from complete to 95% definitive closure allows for a period of rehabilitation and strengthening near the end of the acute stay, prior to embarking on efforts to close the last difficult 5% of their wound. This judgment should me made on a case-by-case basis.
