Massive (>50% TBSA) burn injuries occur rarely in children and are associated with significant morbidity and mortality. We aimed to identify injury characteristics and reconstructive strategies consistent with survival.
An 18-year retrospective analysis of electronic records was performed for all massively burn injured paediatric patients referred since the NBC was established in 2006. We analysed survival, mechanism of injury, length of stay, operating room resource requirements, reconstructive techniques, donor site availability, and complications.
We identified 18 patients over the 18-year study period. Of these, 12 patients survived (mortality rate 33%). The most common age of injury was 2 years, with male gender and flame burns also occurring most commonly. Survivors had an average TBSA of 65%, total length of stay of 92 days and an ICU length of stay 28 days. As flame burn TBSA increased, the length of stay, operating time and number of operations also increased. During analysis, some statistical patterns were observed. In the 70-79% TBSA flame burn group, the total length of stay was approximately 2 days per TBSA with an ICU length of stay in days approximating half of TBSA. All patients with massive scald injuries survived and had a length of stay approximating one third of the TBSA injured. Flame burn complications were common and included loss of digits, central line associated bacteraemia (CLAB), and calvarial bone exposure. Scar contracture releases were required frequently during the acute phase.
Over the study period, surgical techniques have evolved and survivable TBSA in our unit has increased.