烧伤后期特大未愈创面伴脓毒症患者的救治

Treatment of a patient with massive unhealed wound ac- companied by wound sepsis in late stage after burn injury

1病历摘要 患者男，24岁。于2010年4月24日因高温锅炉爆炸，面颈、躯干、四肢和会阴部大部分皮肤被火焰烧伤，总面积95．0％TBSA，深度为深Ⅱ～Ⅲ度，伴有重度吸入性损伤。

This article analyzed the medical records of a patient with 90% TBSA unhealed wound accompanied with wound sepsis 50 days post burn （PBD） and to discuss the ideal strategies of treatment for such patients in such condition. This was a 24-year-old male patient suffering from flame burn with 95% TBSA wound and severe inhalation injury. Meek skin grafting with autologous scalp was performed once to the thoracie and abdominal regions; intermingled skin grafting of autologous scalp microskin and large sheet of allograft was performed twice to the limhs within PBD 31. The patient was transferred to our hospital on PBD 50 with 90% TBSA wound unhealed, leaving a vast amount of necrotic tissue and allografts. Furthermore, he was complicated by sepsis, puhnonary infection, and gastric： ul- ver. Debridement and aliogenie skin grafting were performed on the first clay after hospitalization. When the condition of wounds was improved, transplantation of a large sheet of allogenic skin with inlaid small pieces of autologous skin, intermingled skin grafting of autologous and allogenic skin, and small pieces of au- tologous skin grafting were perfnrmed. Beeause of the shortage of donor area, the exposed wounds were temporarily covered with allogeneic skin. Epidermal growth factor was used to promote the healing of autologous skin donor site and deep partial-thickness burn wound. Autologous skin grafting was performed whenever source of healthy skin was available. Systemic use of effective antibiotics, nutritional support and therapy, and other compre- hensive measures also contributed to the success of treatment of this patient suffering from wound sepsis. The patient was cured and discharged on PBD 145.