Wound Management Strategy for Burn Injuries During Pelvic External Fixation: A Case Report on the Practical Use of Negative Pressure Wound Therapy

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Burn management in patients requiring pelvic external fixation is extremely challenging due to restricted positioning and difficulty maintaining airtight negative pressure wound therapy (NPWT). Practical techniques to secure NPWT in this setting are rarely described. A 53-year-old man sustained 26% TBSA deep burns and an unstable pelvic fracture treated with external fixation. Circumferential trunk eschar excision was achieved by alternating lateral positions, as prone positioning was not feasible. Negative pressure wound therapy was applied for wound bed preparation and graft fixation. Airtight sealing was obtained using stoma paste around fixation pins and a belt-like silver-containing dressing on raw surfaces, reinforced with stoma paste to create a stable adhesion ridge. These methods enabled sustained negative pressure and stable graft take without regrafting. (1) Safe circumferential debridement achieved by alternating lateral positions. (2) Stoma paste effectively sealed difficult contours. (3) Silver dressing under stoma paste created an antimicrobial, sealable ridge for film adhesion. (4) "Double-sided film sealing" around pins maintained airtight NPWT. This case highlights practical NPWT sealing strategies enabling safe burn care under pelvic external fixation.