Objectives
In extensive thermal injuries with posterior involvement early necrectomy and split thickness skin grafting of the back is notoriously 
difficult due to exposure of skin grafts to shear stress and pressure. An additional tool in the management of burn wounds is the air fluidized bed.
The aim of this retrospective study was to evaluate the impact of air fluidized support on the outcome of patients with posterior thermal injuries.
Methods
All patients with TBSA ≥15% admitted to the Burn Intensive Care Unit of the Division of Plastic and Reconstructive Surgery, Vienna General 
Hospital, between January 2003 and December 2014 were included in this retrospective study. Demographical data, ICU records and surgical 
records were collected, and statistically evaluated in respect of different treatment regimens (air-fluidized bed versus conventional pressure 
reducing mattresses).
Results
A total of 349 patients with TBSA ≥15% were admitted to ICU between 2003 and 2014, 24 (6.9%) died within the first 3 days. Of the remaining 
325 patients, 122 (37.5%) showed burn wounds of the back (IIb – III°); in 77 air fluidized therapy was applied.
Long-term survivors managed in the air fluidized bed had significant higher TBSA (median 50% vs. 25%), significant higher ABSI score 
(median 9.5 vs. 8) and delayed surgical therapy of the back (14 vs. 4 days after admittance) than patients managed with conventional 
pressure-reducing mattresses. However, survival rates did not differ between the two groups (29.9% vs. 31.1%). Severe infections due to 
late necrectomy were not observed.
Conclusion
The use of air-fluidized bed therapy in patients with severe burns and posterior involvement allows to postpone dorsal necrectomy in favour 
of early ventral or extremity surgical treatment, resulting in the survival of patients with higher ABSI scores as compared to patients managed 
with conventional pressure-reducing mattresses.

Impact of Air Fluidized Support on the Outcome of Patients with Posterior Thermal Injuries – the Viennese Experience