42 Year Old Patient with Deep Thermal Forearm and Hand Burn

An adult (42 years), white male, was admitted as an emergency in a hospital in South Africa with an accidental burn sustained to the right upper extremity, including hand after falling into an uncontrolled fire. First-aid therapy at home included immersion of the arm in cold water because of the extreme open fire burn and severity of pain.

Emergency room care and early treatment by a multidisciplinary medical team consisting of general and plastic surgeons included hospitalization, pain medication, antibiotics, burn resuscitation to prevent burn related shock and hypovolemia.

Emergency clinical assessment using established burn parameters confirmed a 5% Total Body Surface Area (TBSA) burn, deep thermal  burn involving the right upper extremity (forearm) and hand, left hand and two fingers with volar surface involvement.

Anatomically, the burn involved the cutaneous innervation regions on the dorsum represented by the medial, lateral and posterior cutaneous nerves of the forearm. Both radial and dorsal innervation areas were affected on the posterior aspect of the right hand. 

The burn surfaces included the flexor and extensor forearm surfaces,and the burn on the right-extremity was larger than on the left side. On the right-volar surface, the burn infringed on the medial and lateral cutaneous nerve regions of the forearms, all being terminal-branches of the brachial-plexus. These surfaces were in the distribution of C6, 7 and 8 cutaneous dermatomes of the right upper extremity.

The depth, type, and grading together with the “The Rule of Nine” parameters helped establish burn severity scoring prior to surgical burn-wound debridement. The conservative principles of burn wound treatment and care were applied including the use of moist wound-dressings.

Tangential excision or skin grafting was not indicated and the wounds were initially dressed with in-hospital, silver impregnated dressings before intentional conversion to L-Mesitran Hydro  after hospital discharge.

Twice-weekly burn dressings, after hospital discharge were supervised by a medical-specialist, over a period of 60 days on an out-patient basis. L -Mesitran Hydro – (hydro-active antibacterial barrier dressing) was used as the dressing of choice.

Smaller areas were managed thereafter with topical application of a L-Mesitran Ointment in conjunction with hydro-application to facilitate burn-wound healing. Before and after burn dressing treatment with the L-Mesitran, the clinical outcome in this patient, are reflected in 

Satisfactory wound healing and burn epithelialization was complete in 60 days, and the rehabilitation at home was successful and facilitated by strict sepsis surveillance and nutritional support.