![]() ![]() The burns were subsequently debrided in theatre with the Versajet II (hydrosurgery system), before being autografted. Despite the wounds having been previously assessed as superficial partial thickness, it was apparent that the burns had failed to improve and would not heal without surgical intervention (see Figs. He was swabbed for microbiology, then commenced on intravenous antibiotics. On examination, he had sloughy, infected burn wounds on the face, neck, hands, and arms. Once comfortable, he was discharged home to have dressings in the community and for clinic follow-up within an expectation, his wounds would heal within the 3-week target.įive days later, the patient re-presented to the emergency department feeling feverish and complaining of general malaise. The patient was admitted for 48 h for analgesia and to establish a dressing plan and face care protocol on the ward. Remarkably, all of the flash burns from the welding accident had affected previously grafted or scarred skin. The patient was known to the VABS as he had sustained a 40% TBSA burn 12 years previously, following a fire while cooking with hot oil. The epidermal layer had blistered and been removed, but the underlying dermis remained sensate and with a brisk capillary refill. His burns were clinically assessed as 5% TBSA and mainly of superficial partial thickness. His immediate first aid was to jump into a swimming pool of cold water. The patient sustained burns to the face, neck, hands, and arms. Here, we report the case of a patient who did not conform to our usual treatment algorithm due to a previous burn injury.Ī 33-year-old male was brought to the emergency department by ambulance having been exposed to an explosive flash burn from a nitrous compressor while welding. On review in clinic, these smaller, more superficial burns invariably heal within the 3-week time frame. Superficial partial thickness burns covering less than 5% TBSA may be debrided and dressed as required. In our practice, superficial partial thickness burns covering an area greater than 5% total body surface area (TBSA) and presenting within 48 h post burn may be considered for surgical scrubbing of the wounds and application of Biobrane. Laser Doppler scanning is utilised as an adjunct assessment in partial thickness burns which are borderline superficial partial thickness and likely to heal or deep partial thickness that will likely need surgical intervention. Burn depth is assessed as superficial, partial thickness or full thickness based largely on clinical assessment. In our practice at the Victorian Adult Burns Service (VABS), we admit on average 400 burns patients per year and aim to have their wounds healed within a strict 3-week time frame in order to reduce the long-term burn sequelae of scarring and contractures. Conclusionsīurns sustained in areas of previous burn scars and grafts may behave differently to normal patterns of healing, requiring more aggressive management and surgical intervention at an early stage. Initially assessed as superficial partial thickness in depth, the wounds were treated conservatively with dressings however, they failed to heal and became infected requiring surgical management. Our patient was a 33-year-old man who presented with a 5% TBSA burn on skin scarred by a previous 40% total body surface area (TBSA) burn and skin grafts. We discuss the potential implications when managing a case like this and suggest potential biological reasons why the skin may behave differently. We report on an unusual case of a patient sustaining a secondary large burn to areas previously injured by a burn from a different mechanism. ![]() Patients presenting with large surface area burns are common in our practice however, patients with a secondary large burn on pre-existing burn scars and grafts are rare and not reported. ![]()
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