Management of Major Burn Patients From the Kaohsiung Gas Explosion Disaster──Kaohsiung Chang Gung Experiences

Background: An unexpected underground explosion in downtown Kaohsiung resulted in massive casualties. For the patients admitted to the Kaohsiung Chang Gung Memorial Hospital (KCGMH) Burn Center, the burned surface area, wound depth, associated injuries, advanced hemodynamic monitoring, type of dressing and dermal substitute, and psychological sequelae after major trauma were recorded and analyzed. Materials and Methods: Ten major burn patients with 2nd- to 3rd-degree burns were admitted to the KCGMH Burn Intensive Care Unit (ICU) due to massive flame burns from August 1 to 3, 2014. Immediate intubation and escharotomy were performed due to inhalation injury and compartment syndrome, respectively. Resuscitation was performed based on the Parkland formula. Advanced hemodynamic monitoring was used on selected patients. Wound dressing and dermal substitutes were used as needed. Psychiatric consultations were available for patients once they were able to communicate. Results: All patients survived. The average burned surface area was 39.5% (range, 20-60%). Seven patients received immediate intubation. Four patients received immediate escharotomy and advanced hemodynamic monitoring. One patient developed acute respiratory distress syndrome. The average time of intubation and ICU stay were 7.1 days and 30.1 days, respectively. The average time to ambulation and hospital stay were 12.9 days and 55.8 days, respectively. Split-thickness skin graft was performed on 7 patients. Two patients received scar contracture release and full-thickness skin graft 4 months later. Associated injuries such as skull bone fracture with pneumocranium and bony fractures were observed in three patients. Eight patients were diagnosed with psychiatric disorders and received anxiolytic/anti-depressant medications. The mean follow-up period was 9 months. Conclusion: This unfortunate incident provided us with a rare opportunity to treat a large number of burn patients simultaneously. This unique experience is not only educational but also extremely valuable for the future treatment of major burn patients in batch. (J Taiwan Soc of Plast Surg 2016;25:1～11)