A 29-year-old man was admitted to our institution 10 days after he had undergone an urgent exploratory laparotomy at a local army hospital after a terrorist bombing attack. On admission, deep second-degree and third-degree burns involving 25% of the upper and lower extremities were present, together with a 25 x 10-cm abdominal full-thickness blast injury defect on the left side, an infected eviscerated midline incision, and a colostomy on the right side of the abdomen. The patient underwent a second laparotomy, at which time the intraabdominal abscess was drained, and the abdominal cavity was irrigated with saline. A jejunal perforation was found and sutured. The abdominal cavity was left open and covered with a Bogota bag for temporary closure. On postburn day 18, the patient underwent débridment and grafting of the third-degree burns to the left and right arm and right lower extremities. After several débridment sessions (postburn days 16, 18, 20, 22, and 24), an abdominal skin release and reapproximation were performed (postburn day 26). On postburn day 36, split-thickness skin grafts were placed directly on the granulated tissue of the intestines and on a defect in the left flank and iliac regions. Postoperatively, the patient did well. He was discharged on postburn day 78 with all wounds well healed. In our opinion, temporary closure followed by direct application of meshed split-thickness skin grafts to exposed abdominal viscera represents a simple method of reconstruction that can be safely performed, with minimal risk, on critically ill patients.

译文

:一名29岁的男子在恐怖炸弹袭击后在当地一家军队医院接受紧急探索性剖腹手术10天后被送进我们的机构。入院时出现上,下肢深部烧伤,累及上肢和下肢的25%,左侧有25 x 10-cm的腹部全层爆炸伤缺损,被感染的内脏中线切口,在腹部右侧进行结肠造口术。患者进行了第二次剖腹手术,此时排空了腹腔内脓肿,并用生理盐水冲洗了腹腔。发现并缝合了空肠穿孔。腹腔保持开放并用Bogota袋覆盖以暂时关闭。烧伤后第18天,患者进行了清创术,并在左右臂和右下肢进行了三度烧伤。经过几次清创术后(烧伤后第16、18、20、22和24天),进行了腹部皮肤的释放和重新逼近(烧伤后第26天)。在烧伤后第36天,将切开厚度的皮肤移植物直接放在肠的肉芽组织上以及左侧腹和骨区域的缺损处。术后病人表现良好。烧伤后第78天他已出院,所有伤口均得到了良好治愈。在我们看来,暂时闭合然后直接将网状劈开厚度的皮肤移植物应用于暴露的腹腔内脏代表了一种简单的重建方法,可以对重症患者进行安全且风险最小的重建。

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