Patient 2: A 39-year-old male patient admitted to our hospital on July 27, 2017 with 90% TBSA deep and intermediate burns after an explosion of solvents in his workshop. The burns were mainly of the face and neck sparing the groin and both feet as for patient 1 (Fig. 2B). On site, he was stable with no signs of respiratory distress but was intubated because of perioral burns.
For resuscitation, he received 16 l of fluid within the first 24 h. Multiple escharotomies were performed on the trunk and the four limbs; closure of the escharotomies on the trunk occurred on days 17 and 24.
At day 8, the patient developed an acute renal failure KDIGO III with a normal intrabdominal pressure and no finding on the computed tomographic scan. Continuous renal replacement therapy was needed until day 46, followed by intermittent dialysis until day 63. Although there was no inhalation injury on bronchoscopy, the patient remained intubated for 30 days. He had five infection events (three cutaneous and two pneumonia). His wounds were debrided, followed by skin grafting without requiring any amputation. The same surgical debridement technique was used as for patient 1, using a Weck's blade, a Watson's blade, and curettage. As often as possible, a tourniquet for the limbs was employed. Wounds were injected with saline adrenalized solution before debridement, to minimize blood loss (as a standard procedure). As for patient 1, timing of debridement started at day 3 post traumatism, with a maximum of 15% to 20% TBSA debridement per surgery, and the mean interval between debridement was 48 h until the burned tissues were fully accomplished. The equivalent of 110% TBSA was debrided, 189% TBSA was covered with Biological Bandages based on progenitor cells and used as temporary cover, and 7% TBSA was covered with glycerol-preserved cadaver skin. Overall, the patient had 85% TBSA grafted (80% TBSA of CEA and the rest with autologous skin graft), with a total of 15 surgical interventions. The final evaluation of deep burns was evaluated at 75% TBSA versus 81% TBSA at admission (Fig. 2B), because several body zones of second intermediate burns (chest, abdomen, back, thighs, and legs) healed by themselves. These zones received the application of Biological Bandages (Fig. 3), which when compared to past experience were thought to stimulate these intermediate-degree burns toward a spontaneous healing of particular body regions (Fig. 4).
After spending 76 days in the ICU, he was transferred to the Plastic Surgery floor, then to a rehabilitation center, where he received intensive physio- and ergo-therapy. He was finally discharged after a total of 9.5-month hospitalization.
The data for both patients regarding their burn injury and the received medical treatments are summarized in Table 1. A summary over time of the main surgical interventions and the corresponding body regions is shown for both patients in Fig. 3.