Multimodal management of more than 50% mixed deep dermal and full thickness burns in a child
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Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
Department of Surgery, Queen Elizabeth Hospital, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia
Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
Department of Plastic and Reconstructive Surgery, Sungai Buloh Hospital, Selangor, Malaysia
Submission date: 2022-11-28
Final revision date: 2023-03-25
Acceptance date: 2023-03-25
Online publication date: 2023-10-20
Corresponding author
Firdaus Hayati   

Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, 88450 Kota Kinabalu, Sabah, Malaysia
Pol. Ann. Med. 2023;30(2):144-148
Early tangential excision and wound coverage by autologous skin grafting is the mainstay of treatment for deep dermal and full-thickness burns. They are challenging in children with major burns involving more than 50% of the body surface area.

This article highlights a young boy who suffered from 52% mixed deep dermal and full-thickness burns after alleged thermal burns and we discuss his treatment strategies.

Case study:
A 10-year-old boy suffered 52% mixed deep dermal and full-thickness burns after alleged thermal burns. After initial resuscitation, pain relief and fluid replacement, he underwent an emergent escharotomy of bilateral lower limbs followed by a series of surgeries. His treatment was complicated by many hurdles such as graft failure, difficult intravenous access, nutritional support and local wound infection which were tackled aptly with a multidisciplinary approach.

Results and discussion:
A sequential excision of eschar tissue and advocation of multiple modalities of burn wound coverage, including glycerol-preserved cadaveric allograft (GPCA) and MEEK micrografting. GPCA decreases the bacterial load and helps to re-establish the skin barrier, normalise the physiological state and promote capillary ingrowth into the wound. MEEK micrografting allows better re-epithelization and has a shorter operation time.

Various modalities can be used to achieve skin coverage such as GPCA and MEEK micrografting. Extensive burns need to be managed in a tertiary centre with a combination of skin coverage techniques such as GPCA and MEEK micrografting in order to overcome the unavailability of normal skin for conventional skin grafting.

We would like to thank the Director-General of the Ministry of Health Malaysia for giving us the opportunity to publish this interesting case. We also thank those who were directly or indirectly involved in managing this case throughout her treatment course.
None declared.
The authors declare that there are no conflicts of interest.
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