Patient 1: A 22-year-old male patient admitted to our hospital on May 1, 2000, with 92% TBSA burns (87% deep burns and 5% superficial), sparing the groin and both feet (Fig. 2A). This patient developed a severe inhalation injury subsequent to an explosion while working on a fuel tank and he was intubated on site.
The first days after the patient admission were marked by a severe hypovolemic shock requiring a resuscitation with 45 l of fluid within the first 24 h, which led to an abdominal compartment syndrome (ACS) followed by emergency decompressive laparotomy. He was also treated with large escharotomies on the whole body; the escharotomy on the abdominal wall was closed at day 3. Over the first month, the patient developed many episodes of systemic infection and septic shock (n = 11) with secondary acute respiratory distress syndrome (ARDS). Mechanical ventilation was maintained for 4.5 months and an open lung biopsy showed interstitial lung disease with bronchiolitis obliterans organizing pneumonia (BOOP). Deep burns of the hand necessitated secondary reconstruction, but distal phalangeal amputations were inevitable. The equivalent of 198% TBSA was debrided and we used temporary cover with 100% TBSA cadaver skin (glycerol preserved). Several reconstructive surgeries and skin grafts were performed on the body and face (nose, eyelids, ears, and lips). Overall, he had the equivalent of 101% TBSA grafted, including 75% TBSA of CEA, 18% of CDEA, and the rest with autologous skin grafting: total of 30 surgical interventions.
After spending 162 days in the intensive care unit (ICU), he was then transferred to the plastic surgery floor, where he received intensive physio- and ergo-therapy, and was finally discharged after a total of 18-month hospitalization.