A 75-year-old male with a history of hypertension, type 2 diabetes mellitus, transient ischemic attack, autoimmune hypothyroidism and mild cognitive impairment.
She suffered from total bodily burns caused by flame inflammation in her clothes when she lived with gas oil flame, which resulted in deep and subdermal skin lesions 20% in both lower extremities prescribed, with a surface
Burns were deep dermal on the posterior surface of both thighs and circumferential burns on both thighs and on a plate of subdermal affectation on the anterior surface of the left thighs.
Resuscitation in the first hours after the accident took place in a hospital in another region, from which he was transferred to the Intensive Care Unit of our hospital to continue the treatment of the injuries.
On the day of admission, we performed emergency scarotomies in both pathologies and completed the initial resuscitation.
During the first 3 weeks of admission, 4 sessions of serial debridement of the post-operative area were performed. The coverage was achieved with self-injection of the meshed partial skin of the anterior thighs in the superficial burns.
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In a new surgical session, we performed debridement of the left pretibial area, with persistence under the fixation device, which had not been removed during previous surgeries.
After adequate elimination of this entity, a 20 cm long pretibial defect is observed, with exposure of the tibia.
Scoping of the entire exposed periosteum and initiation of vacuum therapy were performed on the resulting defect.
We applied vacuum therapy with VAC® (KCI Clinic Spain SL) device continuously at 125 mmHg.
Cures were performed every 72 hours with chlorhexidine soap.
No new debridement processes were necessary in the operating room.
After 45 days of vacuum therapy, we checked the complete coverage of bone by granulation tissue and performed definitive treatment with partial skin autoinjectors taken from the glulites, after which we achieved complete wound closure.
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During the treatment period, microbiological cultures of the underlying granulation tissue were positive for multiresistant Pseudomonas aeruginosa, which the patient had previously also presented in urine.
Systemic treatment was established with Imipenem and Cilastatina, and partial debridement of the most superficial and hypertrophic granulation tissue was performed during dressing changes in the room.
After completing vacuum therapy and injecting the defect, the patient did not show signs of graft infection.
At 100 days of admission, the patient was discharged from the hospital with difficulty walking and outpatient rehabilitation treatment.
