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Streamlining Burn Care: A Comprehensive Algorithm for Lower Extremity Burn Management
Mare G. Kaulakis, BS; Christopher J. Fedor, MS; Alexis M. Henderson, MPH; Hilary Y. Liu, BS; José A. Arellano, MD; Garth Elias, MD; Guy M. Stofman, MD; Alain C. Corcos, MD, FACS; Jenny A. Ziembicki, MD; Franceso M. Egro, MD, MSc, MRCS
University of Pittsburgh Medical Center (UPMC), University of Pittsburgh School of Medicine
2025-01-13
Presenter: Mare G. Kaulakis
Affidavit:
I agree.
Director Name: Vu T. Nguyen
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background: Lower extremity (LE) burns pose significant challenges, often leading to morbidity and long-term functional impairment despite advancements in burn care. This study aims to develop a standardized treatment algorithm to improve LE burn outcomes.
Methods: A retrospective analysis of LE burn patients at a single ABA-verified burn center (2012-2023) included demographics, burn characteristics and treatment. Logistic regression evaluated associations between burn demographics and surgical intervention.
Results: The study included 558 patients (64.87% male, 35.13% female; mean age 38.62±24.25 years; mean BMI 26.64±8.12). Common burn etiologies were flame (48.57%; n=271), scald (34.59%; n=193), chemical (3.23%; n=18), and electrical (1.26%; n=7), with a mean total body surface area (TBSA) of 10.51±14.41 and LE BSA of 3.06±0.85.
300 (53.76%) patients received surgical intervention; 13 (4.33%) had superficial partial-thickness, 111 (37%) deep partial-thickness, and 176 (58.67%) full-thickness burns to the LEs. Common procedures included excision plus autograft (43.33%; n=130) and two-stage operation (cadaveric allograft followed by autograft) (36%; n=108). Each 1% TBSA increase raised likelihood of surgical intervention by 4% (OR=1.04, p=0.0115) and excision plus cadaveric allograft by 5% (OR=1.05, p=0.0027), while decreasing likelihood of excision plus autograft by 6% (OR=0.94, p=0.0025). Deep partial-thickness burns increased surgical likelihood by 13.23 times (OR=13.23, p=0.0000) while full-thickness increased it by 64.55 times (OR=64.55, p=0.0000).
Conclusion: A standardized treatment algorithm for LE burns is crucial for improving outcomes. This study demonstrates TBSA and burn depth significantly influence surgical decisions, with larger, deeper burns often requiring surgical intervention due to patient instability or limited healthy skin.
