Abstract

Background – In elderly patients burns are not only frequent but comorbidities are commonly present in patients over 65 and negatively influence both morbidity and mortality. Moreover, they strongly influence the decision-making process on therapeutic strategies. Case report – We present the case of a 78-year-old woman who contracted full thickness burns to the elbow joint at the level of the ulnar sulcus and Guyon’s canal, after experiencing cardiac syncope while cooking. The burns covered 3% of total body surface area (ABSI score 8). Due to numerous comorbidities and an unstable cardiovascular status we were compelled to adopt a two-stage surgical procedure, i.e., instead of covering the defects with free microvascular tissue transfers we opted to use local flaps. The defect over the wrist was covered with a distally based adipofascio- cutaneous radial artery perforator flap under regional anaesthesia, while the elbow defect was covered with a distally based lateral arm flap. Postoperatively the patient developed a residual defect over the radial epicondyle of the humerus, which required an additional surgical procedure. The patient was hospitalised for four weeks and aftercare was continued for an additional twelve weeks in our outpatient clinic. At the end of this period all wounds had completely healed, movement and sensation were restored to normal and the patient successfully resumed everyday life. Conclusion – In this patient population extended hospitalisation times must be accepted. Despite the limitations on therapy mentioned above, this case report points to the possibility of restitutio ad integrum and thus complete reintegration into everyday life.