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岁的男子在恐怖爆炸袭击后在当地一家军队医院接受紧急剖腹探查术10天后被送入我们的机构。入院时,出现了涉及上下肢25% 的深二度和三度烧伤,左侧有25x10 cm的腹部全层爆炸伤缺损,感染的内脏中线切口,以及腹部右侧的结肠造口术。患者接受了第二次剖腹手术,此时引流了腹腔内脓肿,并用盐水冲洗了腹腔。发现空肠穿孔并缝合。腹腔保持开放状态,并用波哥大袋覆盖,以暂时关闭。在烧伤后第18天,患者接受了三度烧伤的移植,并将其移植到左,右臂和右下肢。经过几次缓解 (烧伤后第16、18、20、22和24天) 后,进行了腹部皮肤释放和重新逼近 (烧伤后第26天)。在烧伤后的第36天,将厚度分开的皮肤移植物直接放置在肠的颗粒状组织以及左侧和ili区的缺损处。术后,患者表现良好。他在烧伤后第78天出院,所有伤口均愈合良好。在我们看来,暂时封闭,然后直接将网状厚度的皮肤移植物应用到暴露的腹部内脏上,代表了一种简单的重建方法,可以对危重病人安全地进行,风险最小。

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