Osteotomies and autografted artificial dermal substitute over bone marrow in a bone-deep burn in an elder patient: An alternative to amputation

In this report, we describe the case of an elder patient who suffered a third-degree fire burn with extensive bone affection and exposure of both tibias. The usual treatment strategy for this type of case would have been amputation, or the performance of a multiple free flap surgery. Notwithstanding taking into account the age and the functional objectives for this patient, the multiple free flap option was disregarded. Therefore, we performed an original limb salvage procedure which consisted in bilateral anterior tibial cortex osteotomies and direct grafting over bone marrow, applying skin grafts over a monolayer artificial dermal substitute (Integra®), covered by a negative pressure therapy device. The wound was successfully and early covered, preventing the patient from the long hospital stay and derived complications that other coverage strategies would have carried.

Level of Evidence: Level V, therapeutic study.