Objectives:
A major burn more than 80% TBSA was used to relate with high mortality rate and prolonged hospitalization. Precise acute resuscitation and early wound reconstruction not only decrease the mortality rate and hospitalization course, but also avoid major complications during the treatment course.
Methods:
This is a case series study which included 5 cases. The patients with burn injuries more than 80% between January, 2018 and October, 2021 in National Taiwan University Hospital are included. All the hospitalization course and data are retrospectively recorded.
Results:
Among the 5 cases presented, the last 2 cases achieved early goal in post-burn 30 hours, and tangential burn wound excision were performed in 48 hours. The concept of reconstruction mapping was applied because of limited donor site. Under the combination of cadaveric skin graft and Biobrane dressing, the burn area decreased 40% (case 4) and 54% (case 5) in the first operation. The onset of sepsis in case 4 was post-burn day 35, while no sepsis episode showed in case 5 (p<0.01). The ICU hospitalization was 75 days in case 4 and 43 days in case 5 (p<0.01). The involvement of rehabilitation was day 12 in case 4, and day 5 in case 5 (p<0.01).
Conclusion:
Speed is the key in treatment of major burn patients more than 80%, which included early achievement of early goal, effective reconstructive plan, and early involvement of rehabilitation. The course of hospitalization, the onset of sepsis, and the functional evaluation showed significantly improvement than previous cases.