The use of topical negative pressure in a paediatric patient with extensive burns

Abstract

Over the last 50 years, the evolution of burn treatment has led to a major decrease in mortality. Recently, survival in children has improved to such an extent that the survival rate in children with burns involving 100% total body surface area (TBSA) is 50% [1]. Major advances have been made in early resuscitation, respiratory care, the treatment of inhalation injury, control of infection, modulation of the hypermetabolic response and nutritional support. The biggest impact on survival, however, has been the change in the approach to burn wound treatment. Years ago, burn wounds were allowed to separate by means of human and bacterial collagenases. Today, early tangential or fascial excision and grafting by various techniques makes it possible to remove all dead tissue. Before coverage of the burn, the patient remains immunosuppressed, hypermetabolic, susceptible to infection and in pain. Although the management of the burn wound is extremely challenging, a quick creation of a mechanical and biological barrier between the internal media and the environment is a wellaccepted therapeutic concept. The survival of the patient with major burns goes hand in hand with the survival of the skin grafts. The application of topical negative pressure (TNP) therapy or vacuum-assisted closure (VAC) device has demonstrated improved graft take [2]. The TNP therapy is a modified dressing, consisting of open-cell foam and suction tubing that is secured to the wound with an occlusive dressing. VAC wound closure exposes the wound bed to negative pressure by way of a closed system. Edema fluid is removed from extravascular space, thus eliminating an extrinsic cause of microcircula-