Background:
Keeping massive burns (>50% TBSA) alive has always been challenging. In Western Australia we were early adopters of Integra, which saved lives. However, 35% of our Integra in acute adult burns was lost to infection, and 50% of those patients went on to die. Newer technologies (BTM, Matriderm) alongside pre-existing techniques of ultra-thin skin grafts and ReCell has refined our massive burns management.
We reviewed electronic databases for all massive adult burns since 2015; examining patient demographics, LOS, operations, mortality and clinical outcomes.
Results:
We saw 31 massive burns over 9 years; mean TBSA of 73%, mean age of 45 and overall mortality of 55%. In patients who died, 82% were palliated within 24 hours.
This left 17 patients treated actively with mortality of 18%. The table below compares the first and last 4.5 years (pre- and post-BTM).
|
|
Patients actively treated (n) |
Patients palliated (n) |
Age (y) |
TBSA (%) |
Mortality of actively treated patients (%) |
LOS of survivors (days) |
Acute operations in survivors (n) |
Time to healing in survivors (months) |
|
2015-2019 (pre-BTM) |
9 |
7 |
37 |
64 |
22 |
82 |
6.4 |
6.8 |
|
2019-2014 (post-BTM) |
8 |
7 |
43 |
66 |
13 |
74 |
6.6 |
4.1 |
Discussion:
Over the past decade numbers of massive burns, their age and %TBSA has remained similar. Newer technology does not appear to have affected numbers palliated but we observed reductions in mortality for actively treated patients, LOS and time to healing, with equivalent numbers of operations required. Key principles, detailed data alongside lessons learned as an MDT are presented.