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Section I.   HISTORICAL OVERVIEW

Prior to the late 20^th century, wounds were felt to heal better if exposed under a "scab". This process produced surface desiccation and eschar formation now known to deepen the wound, but was felt to protect the wound. The thinking may have been correct given the fact that no antibacterial agents were available to treat an infection.

The most detailed descriptions were found in medical books from Ancient Greece. Although the initial ingredients first applied to the burn and other wounds varied considerably, wound dryness was always sought.

The description of the healing process leading to scar as the normal endpoint would indicate that outcomes were less than ideal.

This concept remained popular for wound care until the mid-20^th century (and even longer for the burn wound). One exception was a report in the early 19^th century where burns and wounds were managed with the wound immersed under water, with good healing results. This concept was not accepted however as a standard of care.

Allen and Koch in 1942 popularized a petrolatum gauze and dressing closure method which decreased the surface drying. The primary death from burns was at that time and remained so, septicemia from burn infection and therefore there were many who returned to exposure, especially with the advent of a topical antibiotic cream by Fox 1969 (silver sulfadiazine) and Moncrief 1971 (sulfamylon). The introduction of silver nitrate soaks by Moyer in 1965 required an occlusive dressing and was the first use of a moist wound healing method in burns. However, the main concept in burn care was not wet or dry, but rather control of infection by topical antibiotics.

These topical antibiotics can control infection but do also retard healing, especially re-epithelialization.

The following graphic describes the interesting conceptual diversion of non-burn wound, burn wound care in the 1960’s as to optimum management. This difference in management persists today. Although the availability of a sulfamylon solution may alter this difference.

Superficial Burns an exception

Example of exposure approach with dry eschar

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