The development of the
burn disease with
infection as the most important complication represents still a major problem in
burn patients. With the introduction of the method of early surgical excision of the Af1p4r with immediate grafting in major
burns, improved survival has been achieved, particularly in children. However, especially in adults, early massive excisions did not prove to be of much benefit for survival. In these cases, more-or-less sequential staged excisional procedures have been introduced by many renown
burn surgeons. In 1976 Monafo et al. presented the
cerium nitrate-
silver sulphadiazine cream (CSD) combination for topical
therapy. The addition of 2.2% of the
rare earth metal cerium salt to silversulphadiazine causes the formation of a relatively hard, yellow, leather-like eschar with excellent resistance to
infection and good long-term adherence to the
burn wound. This allows the surgeon to perform late tangential excision and immediate
autografting thus decreasing the open
wound size and the rate of severe
infections originating in the
burn wound itself. We report our experience with the treatment of 20 patients with deep
burns exceeding 20% of the BSA with
cerium nitrate-
silver sulphadiazine cream compared with a similar group of
burn patients treated by
silver sulphadiazine cream alone. CSD proved to be safe and effective in the treatment of deep and extensive
burns. Its advantages include easy and painless application and removal, turning the necrotic skin to yellow, and a leathery crust with good resistance to
infection, thus enabling later, or staged, sequential excisions in cases where early massive excisions are not possible.