Annals ofBurns and Fire Disasters - vol. IX - n. 2 - June 1996

HISTORY OF THE PRAGUE BURN CENTRE

K6nigovA R.

Prague Burn Centre, Prague, Czech Republic

SUMMARY. An interesting account is given of the development of burn care and plastic surgery in ex-Czechoslovakia. Much of the credit for the progress achieved is due to Francis Burian, who in 1938 won the first Chair of Plastic Surgery to be established at Charles University. He understood that mortality and morbidity were related to absence of asepsis and to non-use of grafting. Wartime experience led to his creation of a specialized bum unit, providing total, continual burn care in a separate building, not just in existing plastic surgery facilities. The staffing of the present-day Prague Burn Centre is described, along with current trends in treatment. The psychological aspect is also given its due importance.

It may be of interest to readers to know something of the memorable events related to burn care and plastic surgery in ex-Czechoslovakia. The development of the two disciplines was a matter of utmost concern for our late professor, Francis Burian. In 1938, Charles University in Prague established the first Chair of Plastic Surgery and Burian was appointed professor for this area of specialization. Before the Second World War burn patients were already being treated in surgical wards, but in Central Europe they remained within the domain of dermatology even after the War. Bacterial colonization of burns was considered inevitable, and septic complications were not regarded as unusual. Owing to the putrification which developed in patients who survived, formidable cosmetic and functional sequelae became the domain of plastic surgeons. Burian considered that the cause of the poor results in both mortality and morbidity was the non-existence of asepsis and the non-existence of grafting.
After the war, Burian resumed all his previous activities and made the first attempts to found a specialized bum facility, drawing on his son's experience in the treatment of casualties in the United Kingdom during the war. His concept was to provide total, continual bum care not within existing plastic surgery wards but in a separate building.
He pointed out the arguments in favour of the centralization of burn care. There are requirements of high expertise in both medical and nursing staff, attained by constant exposure to manifold problems. The staff must also understand the psychological state of burned patients, in order to prevent possible sequelae which may even include suicide. This design was unique on the Continent.
In 1953 Burian opened the first Burn Centre serving the entire western part of ex-Czechoslovakia (7 million inhabitants). Apart from clinical work, it was accredited as a teaching centre, and in 1965 it initiated experimental work in the Research Laboratory. The first Chief was Helena Peskovi, followed by Mdrio DobrIcovsky. At present, the Prague Burn Centre has a total of 60 beds, onethird in the paediatric ward and 14 in the Intensive Care Unit. Six of these are air-fluidized. Annually, an average of 500 patients are admitted and operated on. Ten thousand are treated as out-patients. With the adoption of the early excision technique in major burns a skin bank was considered essential. Since 1973 pig skin delivered to the skin bank has been used for harvesting split-skin xenografts. In 1988, in cooperation with the Institute of Molecular Genetics, then belonging to the Czechoslovak Academy of Science, keratinocyte culture became available to the Prague Burn Centre. Advances in medical technology and practices have secured total care provided by an interdisciplinary burn team. These advances have been associated with improved patient outcome, but at the same time manifold ethical problems have arisen due to the withholding and withdrawal of life-support systems.
The interdisciplinary burn team is composed of nine surgeons, five of whom are qualified in plastic surgery, one paediatrician, one internist physician, one psychologist, one cell-biologist, one skin-bank specialist, one neurologist, three physiotherapists and two teachers. All doc~ tors, including the two anaesthetists, are permanent members of the burn team.
As a teaching centre the team has provided lectures and practical training for medical students and fostered preparedness for surgeons in burn disasters.
Burian's concept of burn care included reconstruction of the severely deformed and disfigured, performed by the same team. The psychological background of these patients is one of the many problems whose solution lies in close cooperation between the burn surgeon and the psychologist. It is their duty to try, as far as is humanly possible, to re-establish the life of the victim in all reasonable ways. This calls for staff with a spirit dedicated to the patients, who - particularly if they have facial disfig- they usually become sure that there is a meaning in their urements - may feel lonely. In the burn centre however struggle for future life.

RESUME. L'auteur présente une intéressante description du développement de la thérapie des brûlures et de la chirurgie plastique dans l'ex-Tchécoslovaquie. Une bonne partie du mérite des progrès réalisés doit être attribuée à Francis Burian, qui a gagné la première chaire de chirurgie plastique créée à l'Université Charles. a compris que la mortalité et la morbidité dépendaient de l'absence de l'asepsie et du non-emploi des greffes. Les expériences de guerre l'ont amené à créer un service spécialisé des brûlures qui fournissait des soins continuels et totaux dans un service particulier et non seulement chez les structures existantes de chirurgie plastique. L'organigramme actuel du Centre des Brûlés de Prague est décrit, comme aussi les tendances thérapeutiques. L'importance de l'aspect psychologique est aussi soulign6e.