Multimodal management of more than 50% mixed deep dermal and full thickness burns in a child

• Published in: Polish Annals of Medicine
• Main Author: Subramaniam S.; Rodzaian W.S.; Yussof S.J.; Ibrahim S.; Hayati F.
• Format: Article
• Language: English
• Published: Collegium Medicum University of Warmia and Mazury 2023
• Online Access: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85187134724&doi=10.29089%2fpaom%2f162611&partnerID=40&md5=0127fb844eb702841ea9fe400f7b0975

Introduction: Early tangential excision and wound coverage by autologous skin grafting is the mainstay of treatment for deep dermal and full-thickness burns. They are challenging in children with major burns involving more than 50% of the body surface area. Aim: This article highlights a young boy who suffered from 52% mixed deep dermal and full-thickness burns after alleged thermal burns and we discuss his treatment strategies. Case study: A 10-year-old boy suffered 52% mixed deep dermal and full-thick-ness burns after alleged thermal burns. After initial resuscitation, pain relief and fluid replacement, he underwent an emergent escharotomy of bilateral lower limbs followed by a series of surgeries. His treatment was complicated by many hurdles such as graft failure, difficult intravenous access, nutritional support and local wound infection which were tackled aptly with a multidisciplinary approach. Results and discussion: A sequential excision of eschar tissue and advocation of multiple modalities of burn wound coverage, including glycerol-preserved cadaveric allograft (GPCA) and MEEK micrografting. GPCA decreases the bacterial load and helps to re-establish the skin barrier, normalise the physiological state and promote capillary ingrowth into the wound. MEEK micrografting allows better re--epithelization and has a shorter operation time. Conclusions: Various modalities can be used to achieve skin coverage such as GPCA and MEEK micrografting. Extensive burns need to be managed in a tertiary centre with a combination of skin coverage techniques such as GPCA and MEEK micrografting in order to overcome the unavailability of normal skin for conventional skin grafting. © 2023, Collegium Medicum University of Warmia and Mazury. All rights reserved.