Complete intracranial autolysis after thermal injury

A 41-year-old male electrician presented to our Burn Center after being rescued from the bottom of a manhole where a fire broke out as he was laying cables. Investigators did not believe the fire was electrical in origin and may have been related to a flammable gas leak. He had no past medical or surgical history, had no allergies, and took no prescription medications. He had no history of tobacco or illegal drug use, although he did socially use alcohol. Upon arrival at our institution, he was awake, alert, and communicative with a Glasgow Coma Score of 15. There was no loss of consciousness. He was hemodynamically stable, but in respiratory distress. The trauma evaluation revealed no additional injuries other than the burn wounds. Evaluation of his thermal injuries revealed a 51% total body surface area involvement, including the entire anterior torso, face, bilateral arms, and the back of one leg. The majority of these burn wounds were deep partial and full-thickness. The patient was immediately intubated and resuscitated. Over the next several days, the patient underwent escharotomy of his upper extremity near-circumferential wounds, tracheostomy, and tangential excision and splitthickness autografting of his extremity wounds, as well as tangential excision of the thoracic burn.