Treatment of a patient with massive unhealed wound accompanied by wound sepsis in late stage after burn injury / 中华烧伤杂志

ABSTRACT

This article analyzed the medical records of a patient with 90% TBSA unhealed wound accompanied with wound sepsis 50 days post burn (PBD) and to discuss the ideal strategies of treatment for such patients in such condition. This was a 24-year-old male patient suffering from flame burn with 95% TBSA wound and severe inhalation injury. Meek skin grafting with autologous scalp was performed once to the thoracic and abdominal regions; intermingled skin grafting of autologous scalp microskin and large sheet of allograft was performed twice to the limbs within PBD 31. The patient was transferred to our hospital on PBD 50 with 90% TBSA wound unhealed, leaving a vast amount of necrotic tissue and allografts. Furthermore, he was complicated by sepsis, pulmonary infection, and gastric ulcer. Debridement and allogenic skin grafting were performed on the first day after hospitalization. When the condition of wounds was improved, transplantation of a large sheet of allogenic skin with inlaid small pieces of autologous skin, intermingled skin grafting of autologous and allogenic skin, and small pieces of autologous skin grafting were performed. Because of the shortage of donor area, the exposed wounds were temporarily covered with allogeneic skin. Epidermal growth factor was used to promote the healing of autologous skin donor site and deep partial-thickness burn wound. Autologous skin grafting was performed whenever source of healthy skin was available. Systemic use of effective antibiotics, nutritional support and therapy, and other comprehensive measures also contributed to the success of treatment of this patient suffering from wound sepsis. The patient was cured and discharged on PBD 145.