Nitrogen balance after thermal burns. Effect of early eschar excision.

Introduction The formation of a tough eschar which is permeable to water vapor and which eventually separates spontaneously or is surgically removed from the burn wound is characteristic of full-thickness dermal death due to heat. The entire course and management of full-thickness thermal burns is governed by the eschar and its pathophysiology and by the presence or absence of enough normal skin to obtain wound closure. The part played by the eschar in the metabolic response to thermal trauma has been largely ignored, except as a possible source of "burn toxins." However, the total energy requirements placed upon the recipient by a full-thickness thermal injury are directly related to the transwound vaporizational heat loss. Since eschar permeability to water vapor varies greatly from the time of burning until eschar separation, the natural or iatrogenic evolution of the eschar should affect energy requirements. This study investigates the metabolic effect of early