 In the management of burns, before any attempt is made to care for the burn wounds, systemic therapy must be instituted. An accurate appraisal of the burns must be made. Intensive adequate supportive therapy must be initiated and a judicious use of colloids and electrolytes continued. The patient's emotional factors must also be considered and his general condition stabilized. Then definitive local care should be instituted. Every effort should be made to minimize contamination. If the burns are minimal to moderate in size, they can be initially debrided in a well-equipped dressing room. If the burn is extensive, an operating room is preferable. In either dressing room or operating room, analgesia is preferable to general anesthesia. In the dressing room, burned areas should be cleansed and all debris detached to epidermis and greases or ointments that have been previously applied are gently removed. Alcoholic soaps and scrubbing brushes are to be avoided because they cause unnecessary trauma to the remaining viable epithelium. The areas are cleansed with a planned detergent soap and warm water. The soap should be removed by irrigation with sterile warm water or saline. Generally, debriedmont is advisable. Break all blisters and remove all de-vitalized epithelium. This non-viable tissue may act as a nutrient for bacteria if it is not adequately debrided. Now a decision must be made as to the type of further local care to be given. The aims of the local care of burned wounds may be achieved by two methods, by occlusive dressings or by exposure to the air. In certain instances, it is desirable to treat some areas by exposure and other areas in the same patient by occlusive dressings. They are techniques that may be used to complement each other. Both methods have advantages and disadvantages, but there are certain types of burns that would be better treated by dressings and others by exposure. Outpatients and patients who must be transported should have occlusive dressings applied. Third-degree burns of the hand are dressed so that the position of function can be maintained. Circumferential burns, which cannot be exposed to the air, must be dressed. Burns of the face or the perineum are difficult to dress adequately. They do better if left exposed. Burns of one side of the body respond better if exposed. Second-degree burns of the hands and extensive circumferential burns are best treated by exposure if they are turned frequently on a striker frame. Burn cases treated on an outpatient basis should be dressed frequently to guard against cracking the protective covering. There is a patient who will be treated by both the exposure and occlusive dressing techniques. The right hand and arm have sustained circumferential burns. The hand is essentially second-degree, as is the forearm. However, over the medial aspect of the elbow and upper arm, third-degree involvement is present, characterized by a yellowish discoloration. Burns of the trunk and head are present. To expose them adequately to the air, the patient must be turned every two hours on a striker frame. This method of alternately exposing first one side and then the other side allows the exudate over the partial thickness burn to dry and form a crust. The ascar, or dead tissue of the full thickness burn, does not become macerated and remains dry. After clean pads and a foam rubber mattress have been placed over the patient's back, the second part of the striker frame is applied and fastened into place at each end. The frame is turned quickly so that the patient is now lying on his back. The second foam rubber mattress is removed. Then the soiled pads are gently freed from the burned anterior surface. The patient is again exposed to the air. At this time, all the burn areas, previously unexposed, can be given an opportunity to dry out rapidly. The circumferential burns can be seen over the front and back of the thighs. Again, the whitish third degree areas are noted immediately. The remainder of the burn seems to be second degree in depth. The abdomen and chest are covered with a mixed burn, most of which is second degree in depth. The face is burned only over the lower half. The areas over the chin and neck are all second degree. Four days post burn, dry, firm, crusts and escars can be seen to be well formed. They will act as a protective covering over the arm and hand. By turning the patient and elevating the hand and arm, the circumferential burns become adequately exposed to the air and maceration is prevented. The anterior surface of the trunk is also well dried. The second degree burn has formed an excellent covering. Although contaminating microorganisms may be present in abundance on the burn's surface, their proliferation is curtailed by the dryness of the crust. The face and neck are already beginning to heal, and the crust formed over the second degree area is flaking away, leaving regenerated epithelium. Circumferential burns are best treated by occlusive dressings if the burns cannot be kept dry by frequent turning of the patient on a striker frame. The dressings are changed in the operating room approximately every three days. At this time, the wounds are approximately two weeks post burn. Separation of escar has begun. Swab cultures are taken at each dressing change so that the physician may know the type and antibiotic sensitivity of the bacteria colonizing the wound surfaces. The escar can be removed by cutting the fibrous collagenous bands that hold the necrotic tissue to the underlying viable base. As much escar as possible is removed without opening vascular channels for invasive infection. The legs are then lifted by the attendants and the remaining burned areas are treated in a similar manner. The soil dressings are discarded. The operative field is redraped. The legs are cleansed to remove surface bacteria. Darrel water or saline is used to gently irrigate the wounds and to remove all remaining loose debris. Then the burned surfaces are dried. Fresh gauze impregnated with a light layer of petrol atom is then applied. Chemical and enzymatic debrising agents are not used routinely. Antibiotic ointments are seldom applied at this stage of debrising. The legs are dressed in large single dressings which have been previously prepared. These dressing packs are cut to various sizes so that an entire leg or arm or part of a leg or arm can be covered with a single dressing. They are temporarily held in place by towel clamps until the outer wrapping can be applied. The outer wrapping is a thin semi-elastic fine mesh gauze roll. The towel clamps are removed as the outer wrapping is applied. Even resilient compression is obtained by wrapping the dressings with the proper amount of tension. Date of the dressing change is then recorded on a strip of adhesive tape which is also used to secure the dressing. With the onset of bacterial autolisis beneath the burned surface, wet dressings are resorted to to hasten the removal of crust and eschar. The burned surface is gently cleansed and irrigated. Then saline compresses are applied. These in turn are covered with a moist five-yard roll of coarse mesh gauze. The wet dressing is finally covered with a sterile pad. This wet dressing program is continued every four to six hours until the burned surfaces are clean and ready for skin grafting. These then, in summary, are the primary aims of local care in the management of burns, cleanse the wound, and produce unfavorable environment for bacteria by exposure to air or by wet dressings to enhance bacterial autolisis. If these principles are followed, partial thickness burns will epithelialize to form normal skin protection. In full thickness burns, however, this protection will be accomplished only when the burned surfaces are able to accept skin grafts by the final step in local care, skin grafting.