Ćertić B, Jovanović M, Karamarković M, Živković M
University Clinical Centre of Serbia Clinic for Burns, Plastic and Reconstructive Surgery, Belgrade, Serbia.
School of Medicine University of Belgrade, Belgrade, Serbia.
Ann Burns Fire Disasters. 2023 Sep 30;36(3):209-213. eCollection 2023 Sep.
Here we present a case report of a young female patient with severe burn injury inflicting 27% of total body surface area (TBSA) associated with COVID-19 infection. Upon admission, . (sensitive only to ) was isolated from the wound swabs of the right arm, hand and thorax. On the fifth day after admission, a surgical excision was performed and 12% of TBSA was covered with homotransplants. The following day the patient had a sudden drop in oxygen saturation with hypotension (85/45 mmHg). Additionally, agitation, visual and auditory hallucinations were noticed. We found a massive pleural effusion on the left side and pneumonic foci on the right side. On the thirteenth day after admission the final surgical excision and homotransplantation of the skin were performed. In the following days, debridement of all necrotic tissue and covering of all the burned areas with homotransplants were done. Hemodynamic instability of the patient progressed along with the finding on the chest radiography, despite the local finding including adherent homotransplants with no signs of lysis or local infection at the wound beds. Due to low oxygen saturation, the patient was intubated on the fourteenth day after admission. Despite the measures taken, the lethal outcome occurred on the twenty-fifth day after admission to our Clinic. A decision on the right timing for surgical treatment in severely burned COVID-19 patients needs to be investigated in order to enable surgeons to make evidence-based decisions during the pandemic.
在此，我们报告一例年轻女性严重烧伤患者的病例，其烧伤面积达全身表面积的27%，并伴有新型冠状病毒肺炎（COVID-19）感染。入院时，从右臂、手部和胸部的伤口拭子中分离出（仅对敏感）。入院后第5天，进行了手术切除，12%的体表面积覆盖了同种异体移植皮片。次日，患者血氧饱和度突然下降并伴有低血压（85/45 mmHg）。此外，还出现了烦躁不安、视幻觉和听幻觉。我们发现左侧有大量胸腔积液，右侧有肺炎病灶。入院后第13天，进行了最终的皮肤手术切除和同种异体移植。在接下来的几天里，对所有坏死组织进行了清创，并使用同种异体移植皮片覆盖了所有烧伤区域。尽管局部情况包括同种异体移植皮片粘连，创面床无溶解或局部感染迹象，但患者的血流动力学不稳定状况仍随着胸部X线检查结果而进展。由于血氧饱和度低，患者在入院后第14天进行了插管。尽管采取了各种措施，但患者在入住我们诊所后的第25天死亡。为使外科医生在疫情期间能够做出基于证据的决策，需要对重度烧伤COVID-19患者手术治疗的正确时机进行研究。
