Dr John Greenwood
Royal Adelaide Hospital
Once the burn eschar has been excised, thoughts turn to definitive closure. In the patient with extensive burns, this usually means early commencement of serial skin grafting. An alternative strategy is wound ‘temporisation’. This can be ‘active’, where the temporising agent not only buys time for the surgeon but also improves the wound bed by neo-dermal creation. The application of such temporisers reduces the early iatrogenic trauma and physiological insult inflicted on burns patients by early donor site creation at the time when the patient is already maximally traumatised, especially in view of the closing ‘windows’ mentioned earlier. Active temporisation facilitates the development of additional donor sites, as superficial areas of burn heal. A neo-dermis changes the way that meshed graft takes, since interstitial healing by secondary intention is unnecessary and, if skin graft is required, ‘converts’ split grafts to full thickness grafts, affording heightened suppleness and elasticity. Finally, allowing time for the growth and production of cultured composite skin equivalents can negate the need for the skin graft, and its donor wounds and subsequent scars, altogether; this is aided by improvement of the wound bed to better accept graft/composite cultured skin as definitive closure. Active temporisation, thus, opens a logical door to cultured composite skin technology.