Case report

Abstract

This case report describes the rehabilitation path of a man who sustained severe burns to his body and extremities as a result of a bushfire. The fingers of both hands were amputated except the thumbs and although he was a candidate for autologous transplant, declined this option for various reasons. Bilateral prostheses were made and resulted in a significant improvement in functional outcome without the need for surgery. Prostheses are practical alternatives to surgery and should be considered in selected patients. HistoryMr A. was a 51-year-old man who was severely burnt in a bushfire on the 1st January 1998 while a volunteer bushfighter. He sustained 60% partial and full thickness burns to the face, chest, arms, back and legs. Initially, he was admitted to an acute burns unit where he was an inpatient for three months. Treatment there involved emergency resuscitative care including vascular stabilisation with fluid replacement, airway provision, initial debridement and wound covering, pain relief and management of shock. Surgical amputation of the fingers of both hands excluding the thumbs was required, due to the initial burns, combined with extensive treatment for associated injuries. There were seven series of split skin grafts and his stay in the acute hospital was complicated by pneumonia, prostatitis, and wound infections with multiple-resistant Staphylococcus aureus. As well, he developed acute renal failure and sepsis which resolved with treatment.All correspondence to be addressed to Dr Brian Zeman, Senior Staff Specialist, Coorabel Unit, Royal Rehabilitation Centre, 59 Charles Street, Ryde, NSW 2112, Sydney, Australia.When his condition stabilised, he was offered reconstructive surgery with an autologous transplant from his toes to replace the absent fingers. This was offered as a staged procedure for each hand. For various reasons which included the loss of foot function and reluctance to have further surgery, he declined. By this stage, he was managed in a general rehabilitation ward. As no further major surgery was planned he was then transferred to the Royal Rehabilitation Centre, Sydney, six months after the injury, for further rehabilitation and to join his wife who had also been severely burnt.Before his injury, Mr A. was employed fulltime as a fibreglass moulder and also had a hobby stonefruit farm. He was trained as a fitter and turner and was left hand dominant. There were no previous significant injuries or medical problems. PresentationOn presentation to the rehabilitation centre, he was able to walk without assistance and had no functional problems with ambulation. Examination of his hands confirmed amputation of the fingers of both hands excluding the thumbs. On the left hand, he had amputation of the fifth digit at the proximal interphalangeal joint, and amputations of the second, third and fourth digits at the metacarpophalangeal joints. On the right hand, he had amputations of the third, fourth and fifth fingers at the metacarpophalangeal joint and amputation of the second ...