By P. Avogadro. Montana Tech.

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If the axillary area is excised purchase 60 caps diabecon with visa, the grafts or skin substitutes are secured with bolsters. Wounds are dressed with petrolatum-impregnated fine-mesh gauze and burn dressings (large padded cotton-based dressings). As an alternative, the wounds may be covered with Acticoat, a nanocrystalline silver nitrate dressing (petrola- tum-impregnated fine-mesh gauze should then not be applied directly to the wound). It is normally necessary to change the outer burn dressings at 48–72 h because of oozing and exudates from the wound (burn wound edema). Splints are fabricated in the operating room before the patient is fully dressed. Patient may benefit from an air-fluidized bed if their back has been grafted or harvested. The postoperative surgical plan differs depending on the wound closure strategy utilized: Integra: Patients return 2–3 weeks following the first operation to start Integra grafting with super-thin (6/1000 inch) split-thickness skin auto- grafts. Autografts: Patients return at weekly intervals (for further autografting and change of homografts) until complete wound closure has been achieved. When patients’ wounds are fully covered, an aggressive rehabilitation program is started (in the meantime, patients benefit from active and passive therapy between operations). SERIAL OR SEQUENTIAL EARLY BURN WOUND EXCISION Serial or sequential excision is less aggressive but its goal is to excise the whole burn wound within a week before colonization of burn wound by gram-negative bacteria has occurred. Burn patients are resuscitated and burn wounds are treated with the applica- tion of silver sulfadiazine or cerium nitrate–silver sulfadiazine dressings for 252 Barret 48–72 h. Two to three days after the injury, patients–undergo surgical excision and closure of the wound. The burn wound is serially excised in sessions of up to 20–25% total body surface area burned. The patient returns then at 48 h intervals for further surgery until the whole burn has been excised.