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Successful treatment of a patient with an extraordinarily large deep burn.

Li HY, Xiao SC, Zhu SH, Wang GY, Wang GQ, Ji SZ, Xia ZF - Med. Sci. Monit. (2011)

Bottom Line: Treatment of extraordinarily large deep burns remains a huge clinical challenge.This article is a summary of our experience with the treatment of a patient with an extraordinarily large deep burn (99.5% TBSA and 23% fourth degree burn) by using the "microskin autografting and alloskin repeated grafting" method to close the deep burn wound because of scarcity of skin sources of the patient.The patient has been observed for 2 years, and is able to face the reality of life peacefully with the support of his family.

View Article: PubMed Central - PubMed

Affiliation: Department of Burn Surgery, Changhai Hospital, 2nd Military Medical University, Shanghai, PR of China.

ABSTRACT

Background: Treatment of extraordinarily large deep burns remains a huge clinical challenge.

Case report: This article is a summary of our experience with the treatment of a patient with an extraordinarily large deep burn (99.5% TBSA and 23% fourth degree burn) by using the "microskin autografting and alloskin repeated grafting" method to close the deep burn wound because of scarcity of skin sources of the patient.

Conclusions: The patient has been observed for 2 years, and is able to face the reality of life peacefully with the support of his family.

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Related in: MedlinePlus

Muscular necrosis are seen in right calf (A); after repeated debridement and removal of necrosed muscular tissue, the tibia is exposed, which is covered with alloskin for protection (B); holes are drilled on the tibia, and the wound is closed with autoskin after granulation tissue formation (C).
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f3-medscimonit-17-4-cs47: Muscular necrosis are seen in right calf (A); after repeated debridement and removal of necrosed muscular tissue, the tibia is exposed, which is covered with alloskin for protection (B); holes are drilled on the tibia, and the wound is closed with autoskin after granulation tissue formation (C).

Mentions: As the 4 extremities of the patient sustained large areas of fourth degree burns with muscular necrosis and liquification, infection was likely to occur. In addition, myoglobin produced by decomposition of the necrosed muscle was liable to impair renal function and seriously threaten the patient’s life. On the basis of careful intra-operative observation, those definitely necrosed tissues were resected without delay by incising the deep fascia and sarcolemma, and the exposed deep tissues were covered with alloskin. After multiple debridements, granulation tissue formed. The wound was closed with stamp-like autoskin grafts. As the muscle of the left upper arm was seriously necrosed, amputation was performed on the 10th day after the injury. As large amounts of muscle of both calves were necrosed, the tibia was exposed after clearing the necrosed tissue. As we were not able to cover it with flaps, holes were drilled on the exposed tibia to penetrate the cortex and reach the medulla for the sake of promoting granulation formation in the spaces created by the holes. When the formed granulation tissue covered the exposed tibia in about 4 months, stamp-like autoskin grafting was performed to close the wound of the right calf (Figure 3). Although the left tibia was covered by granulation tissue, bone marrow infection occurred in the long course of dressing changes. In addition, the left ankle completely lost its function, and the left foot was deformed due to scar contraction. The lower leg and 1/3 of the upper leg had to be amputated. The fingers and toes of the patient were also affected by deep burns, for which exposure therapy was used to keep the eschar dry. In about 3 months the eschar was lysed and fell off. Finger and toe amputations were performed after the necrosed margins became clear.


Successful treatment of a patient with an extraordinarily large deep burn.

Li HY, Xiao SC, Zhu SH, Wang GY, Wang GQ, Ji SZ, Xia ZF - Med. Sci. Monit. (2011)

Muscular necrosis are seen in right calf (A); after repeated debridement and removal of necrosed muscular tissue, the tibia is exposed, which is covered with alloskin for protection (B); holes are drilled on the tibia, and the wound is closed with autoskin after granulation tissue formation (C).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3539531&req=5

f3-medscimonit-17-4-cs47: Muscular necrosis are seen in right calf (A); after repeated debridement and removal of necrosed muscular tissue, the tibia is exposed, which is covered with alloskin for protection (B); holes are drilled on the tibia, and the wound is closed with autoskin after granulation tissue formation (C).
Mentions: As the 4 extremities of the patient sustained large areas of fourth degree burns with muscular necrosis and liquification, infection was likely to occur. In addition, myoglobin produced by decomposition of the necrosed muscle was liable to impair renal function and seriously threaten the patient’s life. On the basis of careful intra-operative observation, those definitely necrosed tissues were resected without delay by incising the deep fascia and sarcolemma, and the exposed deep tissues were covered with alloskin. After multiple debridements, granulation tissue formed. The wound was closed with stamp-like autoskin grafts. As the muscle of the left upper arm was seriously necrosed, amputation was performed on the 10th day after the injury. As large amounts of muscle of both calves were necrosed, the tibia was exposed after clearing the necrosed tissue. As we were not able to cover it with flaps, holes were drilled on the exposed tibia to penetrate the cortex and reach the medulla for the sake of promoting granulation formation in the spaces created by the holes. When the formed granulation tissue covered the exposed tibia in about 4 months, stamp-like autoskin grafting was performed to close the wound of the right calf (Figure 3). Although the left tibia was covered by granulation tissue, bone marrow infection occurred in the long course of dressing changes. In addition, the left ankle completely lost its function, and the left foot was deformed due to scar contraction. The lower leg and 1/3 of the upper leg had to be amputated. The fingers and toes of the patient were also affected by deep burns, for which exposure therapy was used to keep the eschar dry. In about 3 months the eschar was lysed and fell off. Finger and toe amputations were performed after the necrosed margins became clear.

Bottom Line: Treatment of extraordinarily large deep burns remains a huge clinical challenge.This article is a summary of our experience with the treatment of a patient with an extraordinarily large deep burn (99.5% TBSA and 23% fourth degree burn) by using the "microskin autografting and alloskin repeated grafting" method to close the deep burn wound because of scarcity of skin sources of the patient.The patient has been observed for 2 years, and is able to face the reality of life peacefully with the support of his family.

View Article: PubMed Central - PubMed

Affiliation: Department of Burn Surgery, Changhai Hospital, 2nd Military Medical University, Shanghai, PR of China.

ABSTRACT

Background: Treatment of extraordinarily large deep burns remains a huge clinical challenge.

Case report: This article is a summary of our experience with the treatment of a patient with an extraordinarily large deep burn (99.5% TBSA and 23% fourth degree burn) by using the "microskin autografting and alloskin repeated grafting" method to close the deep burn wound because of scarcity of skin sources of the patient.

Conclusions: The patient has been observed for 2 years, and is able to face the reality of life peacefully with the support of his family.

Show MeSH
Related in: MedlinePlus