Successful treatment of a case of extensive radiation burns with multiple organ dysfunction syndrome.
A patient sustained acute third-degree radiation burns over 41% of his body surface. The burns were due to occupational injury caused by an electron accelerator. Most of his wounds appeared and spread gradually during the 10th week after the radiation burn. Subsequently, severe wound infection with methicillin-resistant Staphylococcus aureus, severe pneumonia, respiratory failure, systemic inflammatory response syndrome, nephropathy, and hypoproteinemia had developed 3 months after the radiation injury. Most of the skin grafts could neither survive nor spread on the fresh wound after removing the necrotic tissue. This phenomenon resulted in many more wounds after operations, increasing the risk of wound infection. Parenteral nutrition, respiratory support with a ventilator, antibiotics for methicillin-resistant Staphylococcus aureus, steroid therapeutics for nephropathy, deeper debridement for wounds, and skin grafting were applied for treatment of this patient. The patient recovered gradually and was discharged from the hospital in good condition after 18 months. The authors suggest that deeper excision of necrotic tissue and skin grafting as well as appropriate antibiotics are principal measures to counteract systemic inflammatory response syndrome. Sufficient albumen by vein and steroid should be administered for treatment against nephropathy and for control of infection. Functions of organs should be carefully monitored to fine-tune the therapeutic programs and to minimize complications of organs.
Department of Burns and Plastic Surgery, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China. yeyanglee@hotmail.com
Yeyang
Y
Li
Jinlun
J
Wang
Gang
G
Li
Weihua
W
Lin
Xiaojian
X
Li
Renlian
R
Tong
D000062:Accidents, Occupational; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002056:Burns / Q000209:etiology / Q000628:therapy*; D003131:Combined Modality Therapy; D003646:Debridement; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D009102:Multiple Organ Failure / Q000209:etiology / Q000628:therapy*; D010288:Parenteral Nutrition; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000209:etiology / Q000628:therapy*; D012121:Respiration, Artificial; D016038:Skin Transplantation; D013203:Staphylococcal Infections / Q000382:microbiology; D013256:Steroids / Q000627:therapeutic use; D014946:Wound Infection / Q000382:microbiology
D000900:Anti-Bacterial Agents; D013256:Steroids