Challenges in surgery of deep burns

Introduction. Full thickness burns pose a significant challenge in terms of surgical management, particularly when concurrent trauma of other organs is involved. Traditional treatment of deep burns includes early excision or debridement of necrotic tissue, followed by skin grafting or flap reconstruction. There are numerous challenges such as poor overall general condition, polytrauma, questionable wound bed viability, limited donor sites. Thus, we have to consider skin substitutes. INTEGRAR is a acellular dermal substitute which create a native dermis. The aim of this case was to share our experience of the treatment by skin substitutes in the polytraumatized burn patient. Case outline. We present the case report of a 46-year-old man with the severe work-related contact burn wounds associated with multiple rib and vertebral fractures as well as lungs contusion with localized bilateral hemothorax. Patient suffered from third-degree burns to the lower extremities, extending to scrotal and gluteal area, which included 15% of total body surface area. Patient underwent early excision of necrotic tissues with subsequently skin autografting on right leg, however, due to partial failure of autografts we had to perform allografting followed by autografting because of limited local donor sites and poor general condition. Successive debridement and partial osteotomy resulted in left knee defect with exposed patella. Therefore, in order to reconstruct consequent defect and prevention of joint contracture, defect was finally covered by INTEGRAR. Conclusion. Our experience has highlighted that INTEGRAR prevents functional disability and furthermore, it leads to optimal aesthetic results.