There are reports, including a collaborative study of 78 burn center patients the majority of whom were children, that these patients exhibit elements of a compartment syndrome, with clearly elevated measured compartment pressures. It was felt that this was important, allowing for early intervention to hopefully limit the level of amputation.
Other options include:
- allografting (use of cadaver skin)
- autografting (using the patient's own skin)
- or leaving the wound open and treating it with dressing techniques
All of these options have their advocates, but the truth of the matter is that the decision to autograft is based on the availability of donor sites. In the patient just presented, there was extensive disease with very little uninvolved skin to use for primary repair. Therefore, you are really stuck with other alternatives - leaving it open and treating it with dressings, using negative pressure dressings or allografts.
The central issue in terms of care is the decision on trying to limit the level of amputation. Since this is a common finding, seen in over 90% of these patients, what you would like to do is do this in consultation with orthopedics to maintain some of the length of long bones to preserve the growth plates.
Mortality is high, in the 20-40% range, and complications are frequent, near 90%. Central nervous system complications, including stroke and seizures, occur in 20% of the patients, 40% are left with some component of chronic lung disease and 95% of the patients will have an amputation of either a digit or an extremity.