35 year old with second degree burns: treated with hydrogel, Activon Tube, Actilite and Eclypse
Al-Kinidi Hospital Plastic Surgery & Burn Unit. Dr. Gabi Miriky (Sof. CPRE) Researcher: Dr.SH. Shalbaf
Background
The patient is female and 35 years old. She suffered burns when trying to rescue her family from her house when a gas heater exploded inside. The incident happened on December 21st 2009 and came to hospital no later than one hour after.
She has second degree burns to her face, anterior neck and covering both hands. She has both second and third degree burns on the posterior side of her both arms and forearms Also some to the anterior side of her arms and forearms, a little part on her right breast and smaller on her left breast.
Second degree burns on her posterior right shoulder and all her back with some small islands with unburnt skin.
Her respiratory system was clean and no abnormality found. Her burns were around 36% TBSA.
When the patient was brought to hospital due to edema escratomy were done in dorsal side for her hands.
Initial presentation
Right hand 12 hours after escharotomy
Blood exam result on admission
- WBC: 9200 ul
- Hg: 12.8 g/Dl
- Plt: 184000 ul
- BS: 121.2 mg/Dl
- Ur: 38 mg/Dl
- Cr: 0.60 mg/Dl
- Alb: 3.2 g/dl
- Na: 125.7 mmol/L
- K: 4.36 mmol/L
- Cl: 105.2 mmol/L
- Blood group: +A
First dressing
The wound was washed with normal saline solution, Activn honey and Actlite were applied with Eclypse as the secondary dressing.
Removed initial dressing after 5 days
Blood exam result on admission
- WBC: 6120 ul
- Hg: 8.8 g/Dl
- Plt: 190000 ul
- BS: 136 mg/Dl
- Ur: 10 mg/Dl
- Cr: 0.48 mg/Dl
- Alb: 3.0 g/dl
- Na: 132.6 mmol/L
- K: 3.71 mmol/L
- Cl: 95.4 mmol/L
Removal of second dressing
Fourth dressing - one week later
The wound was washed with normal saline fluid. Any dead tissue was removed. Activon Tube and Actilite were applied with Eclypse as the secondary dressing.
After 10 days
Blood exam result after 10 days
WBC: 5960 ul
Hg: 9.4 g/Dl
Plt: 262000 ul
BS: 113 mg/Dl
Ur: 27 mg/Dl
Cr: 0.52 mg/Dl
Alb: 3.1 g/dl
Na: 135.7 mmol/L
K: 4.12 mmol/L
Cl: 98.4 mmol/L
After 14 days
Seventh dressing change - 18 days after
The wound was washed with normal saline fluid. Anymore dead skin from left hand, arm and shoulder were removed. Activon Tube and Actilite were applied with Eclypse as the secondary dressing. Algivon was applied to her back and right hand with Eclypse to cover.
Blood exam result after 18 days
WBC: 4240 ul
Hg: 8.7 g/Dl
Plt: 279000 ul
BS: 134 mg/Dl
Ur: 16 mg/Dl
Cr: 0.5 mg/Dl
Alb: 3.1 g/dl
Na: 137.1 mmol/L
K: 3.72 mmol/L
Cl: 99.6 mmol/L
After 21 days
Ninth dressing change
After repeating this dressing treatment eight times, her back and most of her right hand treated had no further need for dressing.
The patient was discharged and came for a dressing change to be ready for skin graft.
Her left hand was washed by saline fluid, Activon Tube and Actilite were applied and covered with Eclypse.
After 25 days
Progress of treatment
On admission
40 days after admission
2 months after admission
On admission
40 days after admission
40 days after admission
Blood sample analysis
25
Results
From treating the affected area the majority of her burns were healing well in less than 20 days without the need for skin grafting. Only a small amount of skin grafting will be required at the third degree burn area that will need more attention. The patient was compliant with the treatment provided and found the dressings of a very acceptable pain level.
As blood analysis showed during the treatment her WBC decries and her Albumin rise to normal without need any Albumin injection. Haemoglobin is stable and came to normal.