About 3000 years ago, grass, leaves, sea-salt, egg- yolk and etc were common materials topically applied on burns. For thousands of years, the explanation for the pathological processes of burns was based on the classical Greek humoral theory. It was until 18th century there were fundamental structural changes in burns management. In 1965, harden silver nitrate emerged for removing granulation tissue and its antibacterial action at 0.5% solution, these were followed by the introduction of silver sulfadiazine in recent decades. In the 19th century, researches on the classification of burns, pathogenesis, operative treatments, causes of death and mortality risk factors grew. Burns were distinguished into the irritation phase (0-48 hours post-burn), the inflammation phase (3-8 days), the suppuration phase and the exhaustion phase. One symptom or one presumed cause of death was the general thought. Although incision on deep burns was the first surgical intervention in 16th century for pus drainage, it only after 200 years that early removal of eschars became common. The first skin grafting (< 5mm in diameter) was in 1869. Early excision and skin grafting was first reported in 1901, to prevent infection (1905), to improve cosmetic and functional results (1905, 1927), to prevent or to treat toxaemia (1925). However, in the mid 20th century, most surgeon still preferred not performing skin grafting until granulation tissue had formed (3-4 weeks post-burns). It was around the Second World War, allograft was used to covered the granulations until autografting, while immediate excision and grafting was limited on patients with small burns (<3% TBSA, 1947). In fact, the timing of excision was debatable. Specialized center developed in the late 60s and 70s with great advances in general aspects of care including nutrition, biological dressings and various graft expansion technique. Early tangential excision and grafting leading to lower mortality became widely accepted, and cultured keratinocytes was introduced for speeding up wound healing. In 1980, The Chinese reported remarkable results in treating very large burns with intermingled grafting. In the course of evolution in recent decades, from 2000 to 2020, we developed strategies in treating deep dermal and full thickness burns ≧ 70%. The techniques in various aspects of treatments will be discussed.

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