10-year review of paediatric patients with massive burn injury at the New Zealand National Burn Centre
Victoria Lo1, Paul Baker1, Lindsay Damkat-Thomas1, Richard Wong She1, 1Te Whatu Ora – Counties Manukau, Auckland New Zealand
Abstract
The National Burn Centre (NBC) of New Zealand provides care for both adult and paediatric burn injured patients. We admit approximately 20 paediatric patients per annum with TBSA >10%.
We conducted a 10-review review of massive (>70% TBSA) paediatric burn injured patients referred to the NBC. Of the five patients who were referred, one was palliated and four were admitted for active management.
The mean age of the actively managed group was 1 year 9 months. The average TBSA was 77.5%. All patients were male. Mean number of acute operations was 40. Available useful donor sites were limited in all cases, however scalp and buttocks were most frequently utilised. Reconstructive strategies have evolved over the years. Temporary wound cover with allograft was initially exclusively used, however Biodegradable Temporising Matrix has been a more recent addition to wound temporisation. Definitive skin closure has progressed from rounds of widely meshed autografting with allograft overlay to BTM combined with Meek grafting.
Scar contracture releases occurred during the acute phase of care in all cases due to the prolonged admission times. Complications will be discussed including common themes such as loss of digits and documented central line associated bacteraemia in three cases. The limit of what is deemed to be a survivable TBSA in our unit has increased and lessons learned from this challenging patient group will be discussed
Biography
Clinical Lead for Burns at the New Zealand National Burn Centre