Survival from an 87% total body surface area burn: a case report and literature review

Abstract

The presented case examines the survival of a 22-year-old male with 87% total body surface area (TBSA) burns from a diesel tank explosion with rare and life-threatening injury with historically high mortality. We analyze critical interventions, complications and outcomes while reviewing literature on extensive burn management. A 20-year-old male presented with 87% TBSA superficial second and third degree burns from a diesel tank explosion. Initial assessment revealed hypertension (134/89 mmHg), respiratory rate of 47 bpm.  Emergency management included intubation, fluid resuscitation (Ringer’s lactate), escharotomies, and vasopressor support. ICU admission was complicated by disseminated intravascular coagulation (DIC), sepsis, and multi-organ dysfunction. The patient received resuscitation with 4 liters of crystalloids over 24 hours, guided by urine output to maintain levels above 0.6 mL/kg/hr. Patient was intubated. Surgical interventions included serial debridement, split-thickness skin grafting, and a tracheostomy performed on day 11. Infection control measures involved the use of colistin and a combination of meropenem and caspofungin, which were later adjusted in response to gram-negative sepsis. Supportive care consisted of mechanical ventilation, fresh frozen plasma transfusions, and careful management of electrolytes. The patient stabilized after 8 months, with gradual improvement in organ function. Discharge included specialist surgical (hand/plastic surgery clinics) follow-up. Survival in >87% TBSA burns remains rare but achievable with aggressive resuscitation, early excision, infection control, and multidisciplinary care. This case highlights evolving burn management strategies, though long-term disability and ethical considerations persist.