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Multidisciplinary management of extensive flame burns in a pediatric patient: a case report
Mohit Kakar 1, Liena Gasina 2, Timurs Zurmatai 1, Aleksandrs Mikitins 3, Arturs Viksne 3, Dzintars Ozols 1, Aigars Petersons 2
1 Rigas Stradins University & Children's Clinical University Hospital, Department of Pediatric Surgery
2 Rigas Stradins University
3 Children's Clinical University Hospital, Riga, Latvia
Introduction
Severe thermal injuries involving a high percentage of total body surface area (TBSA) in children are associated with significant morbidity and mortality. These cases require rapid resuscitation, complex surgical strategies, and long-term rehabilitation to optimize outcomes.
Case Presentation
We report the case of a 13 year old male admitted in critical condition with 55% TBSA (deep partial- and full-thickness), sustained following a flame injury. Affected regions included the thorax, abdomen, upper and lower extremities, and gluteal areas. The patient underwent immediate airway stabilization, mechanical ventilation, fluid resuscitation, and initiation of broad-spectrum antibiotics. Circumferential injuries to the limbs necessitated urgent fasciotomies to preserve distal perfusion. Serial necrectomies were performed, followed by staged allogeneic and autologous skin grafting. Limited donor site availability necessitated the repeated use of previously harvested areas. Postoperative management was complicated by massive fluid shifts, anemia requiring transfusions, and pleural effusion requiring thoracic drainage. To enhance epithelialization and manage chronic wound areas, platelet-rich fibrin (PRF) membranes and subdermal injections of autologous plasma were employed. Intensive rehabilitation included early mobilization, physiotherapy, and orthotic use. At four months post-injury, the patient demonstrated improved functional capacity despite persistent flexion contractures, hypertrophic/keloid scarring, and gait disturbances.
Conclusion
This case highlights the critical role of early surgical intervention, creative grafting strategies, and interdisciplinary care in the management of extensive pediatric burns. Adjunctive regenerative techniques such as PRF and autologous plasma therapy may be beneficial in managing difficult-to-heal wounds when donor sites are limited. Long-term rehabilitation remains essential for functional recovery and reintegration.