TREATMENT OF A SEVERE ALKALI BURN

The case history of a 20-year-old male patient who sustained an 85 per cent total body surface area alkali burn to his skin, after falling i nto a caustic lime pit, is reported. Considerable problems regarding t he correct estimate of burn wound depth, predominant location of the d eepest burn on the posterior half of the body, appropriate wound cover age, and lack of sufficient skin graft donor sites required a complex treatment plan. Excisions to fascia and intradermal debridement were r equired to achieve an appropriate bed for wound closure. Five per cent mafenide acetate solution (Sulfamylon) was applied to prevent burn wo und sepsis. Human allografts and Biobrane were used extensively to ach ieve temporary wound closure, to provide mechanical protection of fres hly autografted wounds, and to prevent desiccation following applicati on of cultured epidermal autografts on to debrided wounds and split th ickness skin grafted donor sites. The case illustrates a number of pro blems associated with the evaluation and treatment of patients sufferi ng severe alkali burns and demonstrates the implementation of both est ablished and evolving technologies in the management of these injuries .