The role of negative pressure wound therapy in the treatment of fourth-degree burns. Trends and new horizons.

The term "fourth-degree burn" is not very often found in the literature because it is often associated with lethal injury. These injuries are characterized by exposure of viable tissue such as tendon or bone and are associated with challenging wound closure. The goal of reconstruction is to provide adequate soft tissue coverage and restoration of function. Several treatment modalities have been used to serve this purpose. We present four male patients with fourth-degree burns of the extremities, treated with negative pressure wound therapy. The patients' age ranged from 15 to 49 yr (mean, 28 yr). The total body surface area burned ranged from 3 to 60% (mean, 34.25%). Negative pressure wound therapy was applied for 16-30 days (mean, 23.75 days). Three split-thickness skin grafts and one bipedicled local flap were performed. Wound closure was completed in 28 to 50 days. The results were satisfactory for both physicians and patients. Our longest follow-up was three years. The results achieved in this group of patients revealed the negative pressure wound therapy was a reliable alternative method in the treatment of fourthdegree burns.