Fourth-degree burns to the lower extremity with exposed tendon and bone: a ten-year experience

Fourth-degree extremity burns involve muscle, tendon, and bone, often leading to amputation or significant functional impairment. We report our 10-year experience (1995-2004) at an urban burn center with fourth-degree burns to the lower extremity to characterize treatments and outcomes. Twenty-one p...

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Bibliographic Details
Published in:Journal of burn care & research 2006-01, Vol.27 (1), p.34-39
Main Authors: Parrett, Brian M, Pomahac, Bohdan, Demling, Robert H, Orgill, Dennis P
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Amputation - statistics & numerical data
Atmospheric Pressure
Bacteremia - etiology
Burn Units
Burns - classification
Burns - complications
Burns - surgery
Cellulitis - etiology
Debridement
Female
Granulation Tissue - growth & development
Humans
Length of Stay
Limb Salvage - methods
Limb Salvage - statistics & numerical data
Lower Extremity - injuries
Lower Extremity - surgery
Male
Middle Aged
Retrospective Studies
Surgical Flaps
Treatment Outcome
Urban Health Services
Vacuum
Venous Thrombosis - etiology
Wound Healing
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Summary:Fourth-degree extremity burns involve muscle, tendon, and bone, often leading to amputation or significant functional impairment. We report our 10-year experience (1995-2004) at an urban burn center with fourth-degree burns to the lower extremity to characterize treatments and outcomes. Twenty-one patients (40 limbs), mean age of 45 years, were treated for fourth-degree lower-extremity burns with the average extremity burn size of 24% TBSA (range, 2-36%) and a mean fourth-degree burn size of 9% TBSA (range, 2-18%). A mean of eight operations were required for limb salvage. Six free-tissue transfers, 2 fillet flaps, 14 local flaps, and multiple skin grafts were performed. Five patients underwent tibial burring for granulation tissue stimulation, and the subatmospheric pressure device was used in eight patients. Seven limb amputations (18%) were required in four patients, and 76% of patients were ambulatory on follow-up. The mean hospital stay was 76 days with high rates of cellulitis, deep vein thrombosis, and bacteremia. Patients treated with flap closure had a significant decrease in the number of operations required for limb salvage. Fourth-degree lower-extremity burns require multistage reconstructive procedures using multiple levels of the reconstructive ladder but limb salvage is possible in a majority of cases.
ISSN:1559-047X
DOI:10.1097/01.bcr.0000192265.20514.c5