Moyens de recouvrement du brûlé grave : réflexions sur leur application aux lésions radiologiques

H. CARSIN (1), J. STÉPHANAZZI (1), F. LAMBERT (2) , P.-M. CURET (3) and P. GOURMELON (4) (1) Centre de traitement de brûlés et (2) Service de chirurgie plastique, HIA Percy, 92140 Clamart, France; (3) Service de protection radiologique des armées, rue Lt. R. Batamy, 92140 Clamart, France ; (4) IRSN Radioprotection 2002, Vol. 37, n° 1, pages 13 à 25, in French.

Covering techniques for severe burn treatment: lessons for radiological burn accidents. After a severe burn, the injured person is weakened by a risk of infection and a general inflammation. The necrotic tissues have to be removed because they are toxic for the organism. The injured person also needs to be covered by a cutaneous envelope, which has to be done by a treatment centre for burned people. The different techniques are the following: - autografts on limited burned areas; - cutaneous substitutes to cover temporary extended burned areas. among them: natural substitutes like xenografts (pork skin, sheep skin,..) or allografts (human skin), treated natural substitutes which only maintain the extracellular matrix. Artificial skins belong to this category and allow the development of high quality scars, cell cultures in the laboratory: multiplying the individual cells and grafting them onto the patient. This technique is not common but allows one to heal severely injured patients. X-ray burns are still a problem. Their characteristics are analysed: intensive, permanent, antalgic resistant pain. They are difficult to compare with heat burns. In spite of a small number of known cases, we can give some comments and guidance on radio necrosis cures: the importance of the patient's comfort, of ending the pain, of preventing infection, and nutritional balance. At the level of epidermic inflammation and phlyctens (skin blisters), the treatment may be completed by the use of growth factors. At the level of necrosis, after a temporary cover, an autograft can be considered only if a healthy basis is guaranteed. The use of cellular cultures in order to obtain harmonious growth factors can be argued.