Acute 40% TBSA Flame Burns with Early Tangential Excision and STSG

Patient Information

• Age: 29 years
• Gender: Male
• Diagnosis: 40% total body surface area mixed partial- and full-thickness flame burns involving trunk and both upper extremities

Procedure

Parkland-guided resuscitation, escharotomy of circumferential chest burns, staged tangential excision, and autologous STSG.

Findings

Inhalation injury ruled out by bronchoscopy; carboxyhaemoglobin normal. Full-thickness areas estimated 22% TBSA. Circumferential chest eschar with compromised ventilation mechanics—escharotomy performed at admission. Lactate and urine output guided fluid titration.

Surgical Technique

First operative session (day 2 post-burn): tangential excision of chest and anterior abdomen full-thickness areas with Watson knife to viable bleeding dermis; STSG from thighs meshed 1:3 applied with staples. Second session (day 4): bilateral arm excision and grafting. Biological temporising dressing not required after adequate autograft availability. Thermoregulation, analgesia, and high-protein nutrition protocol maintained throughout.

Outcome

Overall graft take >90%. No sepsis-related mortality; inpatient stay 28 days. Commenced pressure garments and scar massage at 3 weeks post-graft. At 6 months, hypertrophic scarring over anterior chest managed with silicone and intralesional triamcinolone where indicated; ROM of shoulders improving with physiotherapy.

Clinical Notes

Early excision and grafting reduced hospital stay compared with historical delayed excision at this centre. Case suitable for illustrative resuscitation and operative images when available.