Challenges in surgery of deep burns

Abstract

Introduction. Full-thickness burns pose a significant challenge in terms of surgical management, particularly when concurrent trauma of other organs is involved. Traditional treatment of deep burns includes early excision or debridement of necrotic tissue, followed by skin grafting or flap reconstruction. There are numerous challenges such as poor overall general condition, polytrauma, questionable wound bed viability, limited donor sites. Thus, we have to consider skin substitutes. INTEGRAR is an acellular dermal substitute which creates a native dermis. The aim of this case was to share our experience of the treatment by skin substitutes in a polytraumatized burn patient. Case outline. We present a case report of a 46-year-old man with severe work-related contact burn wounds associated with multiple rib and vertebral fractures, as well as lungs contusion with localized bilateral hemothorax. Patient suffered from third-degree burns to the lower extremities, extending to scrotal and gluteal area, which included 15% of the total body surface area. The patient underwent early excision of necrotic tissues with subsequent skin autografting on the right leg; however, due to partial failure of autografts, we had to perform allografting followed by autografting because of limited local donor sites and poor general condition. Successive debridement and partial osteotomy resulted in the left knee defect with exposed patella. Therefore, in order to reconstruct the consequent defect and prevent joint contracture, the defect was finally covered by INTEGRAR. Conclusion. Our experience has highlighted that INTEGRAR prevents functional disability and furthermore, it leads to optimal aesthetic results.

Keywords

• integrar
• full-thickness burns
• exposed bone
• skin grafts
• reconstruction