**11.1 Dermato-surgical considerations**

When excisional burn debridement is indicated, it is recommended that it be completed within the first 24–48 h after injury [208, 209]. Early debridement can help decrease the ongoing systemic response to inflammation stemming from the persistence of devitalized tissue [210, 211]. Removal of deep partial or fullthickness burn tissue with grafting and coverage with either permanent (preferred) or temporary graft can substantially decrease the daily rate of evaporative losses [212, 213]. Institution of aggressive operative management of burns, combined with optimization of non-surgical aspects of burn care, can result in a significant decline in mortality rates. More recent developments in this particular area include the introduction of selective enzymatic debridement agent designed specifically for burn wounds [214].
