Living-Donor Allograft with Manual Grafting Technique for Extensive Pediatric Burns in Low-Resources Settings.

Abstract

Managing extensive pediatric burns is particularly challenging when patients present late with severe systemic complications and when surgical interventions face operational difficulties. Delayed referral increases the risk of sepsis, coagulopathy and metabolic disturbances, while limitations in essential equipment, such as dermatomes and mechanical meshers, further complicate treatment. Alternative techniques are needed to optimize wound coverage and improve outcomes in resource-limited settings. A 2-year-old female patient with 37.5% TBSA deep dermal to third-degree scald burns was referred nine days post-injury in critical condition with sepsis, thrombocytopenia, hypoalbuminemia and significantly elevated D-dimer levels. She underwent serial excisional debridement and multiple skin grafting procedures. Due to operational challenges in standard meshing, the fold-and-cut technique was used, allowing a 4.8-fold expansion of autologous grafts. A living-related allograft from her grandfather was applied as a temporary biological dressing to support epithelialization and reduce grafting needs. The autografts and allograft successfully integrated, leading to epithelialization, systemic stabilization, and functional recovery. At three months post-surgery, she had shown significant improvement, and one year post-discharge she could stand and attend school normally. This case highlights the ability to thrive despite limitations by adapting surgical techniques and leveraging available resources. The fold-and-cut technique and living-related allografts provided a feasible and cost-effective solution, proving that innovation and improvisation can yield favorable outcomes even in the most constrained environments. These findings demonstrate that similar low-resource settings can adopt and modify these techniques to improve burn care where access to advanced technology is limited.