Abstract
The surgical technique of early excision and grafting has revolutionized the care of severe burns but can be associated with major surgical bleeding. The use of tourniquet exsanguination to prepare limbs for the procedure and the use of topical thrombin and fibrin sealants on the excised area can provide an essentially bloodless field. Even on more difficult sites like the torso and on the graft donor sites, blood loss can be reduced dramatically with the use of topical sealants. Fibrin sealants also can be employed to facilitate graft adherence and thus improve graft survival and cosmetic results.