Experience in the management of severe burn patients with third degree burn area more than 90% TBSA

Objective To summarize the experiences in the treatment of severely burned patients with third degree burn area over 90% TBSA.Methods Forty-eight patients with third degree burn area over 90% TBSA during 1966 to 2002 were enrolled in this study.The primary treatment included immediate and optimal fluid resuscitation.Early tracheotomy was applied to those patients with moderate or severe inhalation injury,so as to keep smooth airway.To support the systematic defense power and to deal with the wounds correctly.Antibiotics were employed reasonably.Disinfection and isolation rules were obeyed strictly.Burn infection and internal organ complications were prevented and treated.The principle of the management of third degree burn wounds:debridement of necrotic tissue as early as possible and coverage of the burn wound in time and completely.The coverage of the burn wound could be accomplished by the intermingled grafting of autoskin and alloskin,by that small pieces of autoskin were inlayed in the open holes in the large sheet of alloskin and by microskin grafting,by skin plasma grafting with large sheet alloskin coverage.In addition, enteral nutrition support and physical therapy were also adopted.Results Sixteen patients out of the 48 were rescued with 7 of them minding their own life.Conclusions Correct and in time fluid resuscitation were the basis of rescuing.Faithful wound coverage was key point of the rescuing.Infection control and in- ternal organ complication management were carried out throughout the whole process.