Poster 45: Functional Outcome in a Patient with 92 Percent Total Body Surface Area Full-Thickness Burns: A Case Report

Abstract

Setting: Acute inpatient rehabilitation unit. Patient: 31-year-old man without medical history who sustained 92% full-thickness total body surface area (TBSA) burns secondary to flame-related injury. Case Description: The patient presented to the inpatient rehabilitation unit after surviving 92% TBSA full-thickness burns from a flame-related injury at work. During the patient's 4 month stay in the burn unit, he required pressor support and mechanical ventilation. He also underwent multiple skin grafts and debridements secondary to his severe burns. He was transferred to the acute inpatient rehabilitation unit 4 months after his original injury with a tracheostomy and percutaneous gastric tube. Assessment/Results: On admission to the rehabilitation unit, the patient was nonambulatory and was at a maximum assist level for transfers and self-care. He also remained nothing by mouth with bolus tube feeds. His wounds were aggressively managed and required dressing changes with each nursing shift. The patient was followed closely by all disciplines, including physical and occupational therapy, speech/language/pathology, psychology, wound care, and respiratory therapy. During his 57-day stay in the rehabilitation unit, the patient made significant progress. The patient was able to ambulate at a modified independent level within 4 weeks. Self-care skills improved slowly secondary to upper-extremity contractures. On discharge, the patient was minimum assist for upper-extremity dressing, set-up for feeding, and maximum assist for toileting and lower body dressing. Dysphagia improved and was upgraded to a mechanical soft diet with thin liquids on discharge to home. Conclusions: Survival rates for patients sustaining greater than 90% TBSA are low. According to the National Burn Repository Report of 2006, 74 cases in the 30 to 39 year-old age group were reported for full-thickness burns of 90% or greater, and of those 74 cases, 61 patients died. Current literature reveals that it is rare for a patient to sustain and survive greater than 90% TBSA full-thickness burn injury. Comprehensive inpatient rehabilitation is vital to burn-injured patients, providing a multi-disciplinary approach for patients to regain function and independence.