A 40-year-old patient, with no morbid history, suffered electrical burns due to high voltage contact with a high voltage cable, which caused a fall in the right hand in 5 meters, followed by a height fall.
Located to the Emergency Department of HUAP.
He was admitted intubated in Glasgow 7, with normal sinus tachycardia.
You have partial thickness burns in head, face and chest with an extension greater than 9% of total body surface (TSC) and deep in neck, right hand and hypogastrium of 5.5% Garcés with a severity index of 74.5.
In the midline, there is evidence of infraumbilical thickening of the abdominal wall, in addition to thickening of the small intestine segment with secondary fixation to a cleft palate.
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In the secondary evaluation, there was also evidence of dislocation of the elbow, which was reduced and orthopedically treated and blunt traumatic brain injury (TBI), which was evaluated by Neurosurgery, with no alterations in the computed tomography CT scan.
Among the tests performed at the time of hospital admission, there is a high creatine kinase with a maximum value of 14,000 IU/L on the third day, with no impact on renal function.
During evolution, the patient presents coagulation dysfunction and elevated transient hepatic transaminases.
There were no cardiovascular alterations.
On the day of admission we performed scarectomy of the abdominal lesion, which showed a small bowel segment compromise, because we practiced exploratory laparotomy.
The initial inspection revealed a 30 cm segment of ileum with necrotic appearance at 1 m from the ileocecal valve, and a second lesion at 60 cm proximal to the ileocecal valve, where two necrotic areas were seen.
We resected both lesions with wide vital margins and performed two ileoileal end-to-end anastomosis.
In addition, we observed a necrotic lesion in the anterior wall of the bladder, which we also resected, ending with a flat closure.
We then resected devitalized tissues of the abdominal wall and medial thirds of both rectus abdominis muscles with their aponeurotic sheaths.
We decided to close the abdominal wall with biculcated flaps of the residual rectus abdominis muscles on the peritoneum and conduct a confrontation of skin edges at the ends of the injury.
We covered everything with cure and controlled central aspiration.
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We also performed scarectomy and loop removal of the right hand.
On the fifth postoperative day, we performed a new surgical silhouette in which we found vital tissues with no evidence of nastomotic leakage, so we chose to cover the skin defect with porcine heteroinjection.
We also performed cervical fixation scarectomy, resecting stenosis, both gentlemastoid muscles partially and the right external jugular vein.
We also covered porcine heteroinjectors.
The ninth article deals with open abdominal and cervical areas with autologous epidermal grafts, expanded 3 x 1 in the abdominal area and with fenestrated plate in the neck.
The donor area of the grafts was the left thigh in its anterior and lateral faces (5% SCT).
The patient had no postoperative complications.
She was early supported with parenteral nutrition and started enteral feeding on the seventh postoperative day, with good tolerance and effective intestinal transit.
She was discharged after 71 days of hospitalization.
