Staged limb salvage after an infected full-thickness shoulder-girdle flame burn with osteoarticular exposure in an elderly patient: A case report with 3.5-year follow-up.
Nguyen Ngoc-Huyen, Nguyen The-Hoang, Nguyen Quang-Vinh et al.
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Case in brief
A 73-year-old woman with diabetes, hypertension, and cachexia presented about 3 weeks after a flame burn with an extensive infected wound from the neck base to the distal left arm. The fourth-degree injury exposed the shoulder capsule, rotator cuff, proximal humerus, scapula, and shoulder joints; cultures grew Escherichia coli and Acinetobacter baumannii. The brachial plexus and major vessels were intact. After optimization, culture-directed antibiotics, serial debridement, and negative-pressure therapy controlled the infection. A pedicled latissimus dorsi flap and skin grafting achieved durable coverage. At 3.5 years the wound remained healed, with near-preserved distal function and independence despite markedly limited active shoulder motion.
What made this case unusual
The case illustrates staged limb salvage despite extensive infected destruction of the shoulder in a frail older patient, with preserved distal neurovascular function informing the decision to reconstruct rather than abandon the limb.
Diagnostic / clinical pearl
In severe shoulder-girdle burns, assess distal neurovascular integrity and realistic residual-limb utility alongside the extent of tissue destruction when considering salvage.