Background: Burns injury causes serious morbidity among the pediatric population all around the globe. Childhood burn creates lifelong ailments. Aims and Objective: Epidemiological data on pediatric burns can provide vital information for developing prevention strategies. Material and Methods: A prospective observational study was conducted in the department of burns, plastic, and maxillofacial Surgery between April 2021 and August 2022. All pediatric patients up to the age of 12 years presenting to our casualty with electric burns were included in this study. The demographic details, mode and mechanism of injury, and burn assessment as per the Lund and Browder chart were recorded based on the information provided by the parent/guardian. Data were entered in an MS Excel spreadsheet and analysed using SPSS version 21.0. Result: Children above 6 years were more prone to electrical burn injuries in our study. Male: female ratio in our study was 2.4:1. Majority of the patients suffered electrical burn injuries at the terrace. Most of the patients suffered 70% burns expired. Conclusion: We conclude that electrical injuries due to high voltage electric current are on the rise in the pediatric population which is due to the transmitting wires passing in proximity to the dwelling houses and due to increasing urbanization with high-rise buildings becoming the norm. A large-scale multicentric study is required to ascertain the rise in the incidence of high-voltage burns.
Context: Local wound care is a crucial aspect in burn care of patients. Prevention of infection plays an important role in reducing mortality and morbidity. The efficacy of topical medication and its toxicities are well documented. Silver sulfadiazine (SSD) is cheaper and has good wound healing properties and plays a role in the prevention of infection. This study deals with the efficacy of SSD on burn wound healing in partial-thickness burn injuries at a remarkably reduced cost. Aims: This study is focused to evaluate the efficacy, safety, cost-effectiveness, and tolerance of SSD in burn wound care (a) To study the efficacy and safety of SSD on partial-thickness burns (b). The efficacy of SSD on wound healing and prevention of infection and (c). To assess the cost reduction achieved using SSD. Settings and Design: Tertiary care hospital, urban setting, and cross-sectional study. Subjects and Methods: (a) The study was done from January 2020 to March 2022 (b) 35 patients with thermal burns were included. (c) The patients were admitted/SSD was used for topical application and the wound was covered with dressings (d) Dressings were changed once in 48 h and the progress in wound healing was assessed. (e) Wound swabs were taken once in 72 h. (f) The patients were followed up at the outpatient department following their discharge till complete wound healing and rehabilitation. Statistical Analysis Used: Chi-square test and nonparametric Mann–Whitney U-test were used. P ≤ 0.05 was considered statistically significant. Results: (a) The wound healing was within the specified time without delay or onset of infection and patients had no toxicity related to SSD. (b) The cost was considerably reduced compared to the latest dressing materials available in the market. (c) Quality of life, rehabilitation, and the scar quality indices were within the normal parameters. Conclusions: Serum lactate levels can help to monitor the adequacy of fluid resuscitation in burns. Serum lactate and urine output should be taken into consideration to determine the end point of resuscitation. The minor differences in antibacterial activity between SSD and the new products did not seem to have any influence on the rate of wound healing. Rapid wound closure is essential to obtain an optimal functional and esthetic outcome. It was concluded from the results of this systemic review that the standard use of SSD in the conservative treatment of burn wounds may be limited to superficial with total body surface area of up to 20%.
Ear reconstruction for microtia is an intriguing surgery in terms of clinical skill and dexterity for plastic and reconstructive surgeons. Apart from proper ratios and detailed carving of cartilage framework, the overlying skin is utmost important for the final outcome of reconstruction. A good outcome needs adherence of the skin flap and cartilaginous framework, for which purpose suction drains are used during the surgery. By creating a negative pressure, suction drains promote adherence of skin flap and cartilage framework and removes the seroma and hematoma. Usually surgeons put two drains through the infra auricular skin one behind and other beneath the cartilaginous framework. Herein, we put forward our idea of putting the drains through the hair bearing areas of the scalp so as to avoid visible postoperative visible scars.
Introduction: Traditional burn management involves early excision and grafting, which often necessitate extensive donor sites, leading to increased morbidity and longer recovery times. Autologous skin cell suspension has emerged as an innovative technique for addressing these challenges, offering a promising alternative for extensive burns by enhancing wound healing and reducing donor site requirements. This study presents a novel, cost-effective method for preparing autologous skin cell suspension using lipoaspirate. Methodology: A 42-year-old male with 45% thermal burns due to a gas cylinder explosion was treated with surgical excision. Liposuction was carried out and the fat graft was processed via centrifugation. A 5 cm × 5 cm full-thickness skin graft was harvested from the same site, derma-abraded, and combined with the processed lipoaspirate to create an autologous skin cell suspension. This suspension was sprayed onto the excised wound bed. Results: The indigenous method demonstrated the potential to effectively manage extensive burn injuries with minimal donor site morbidity. Adipose-derived stem cells within the lipoaspirate exhibited regenerative properties which enhanced wound healing. This approach synergized the benefits of lipoaspirate and epidermal cell suspension. Compared to commercial systems like RECELL, this method proved to be significantly more cost-effective and feasible in resource-limited settings. Conclusion: The innovative preparation of autologous skin cell suspension using lipoaspirate represents a practical and economical alternative for burn wound management.
Artificial intelligence (AI) is expanding its footprints across all our activities. The main tools of AI include machine learning, artificial neural networks, natural language processing, and computer vision. It has been used across various medical specialties, and there are numerous studies that have investigated and validated various tools of AI in clinical practice. Plastic surgery and its subspecialties like burns have always been in the forefront of surgical innovations. We discuss the various articles that have used AI tools for burn management. AI tools have been successfully used to calculate the TBSA and depth of burns from burn photographs. AI algorithms have been used in clinical decision-making in burn critical care like early recognition of sepsis and acute kidney injury and also prediction of need for ventilation. Artificial neural networks have looked at optimum serum concentrations of antibiotics in severe burn patients. There are tools incorporating AI to surgical robotics and surgical decision-making. AI has been extensively used in the prediction of burn mortality and length of stay calculations. The unique nature of injury in burn patients and the developments of AI till now in this field leave burn management in an exceptionally good position to harness the next phases of innovations in AI.
Background: Burn injuries are among the most devastating of all injuries and a major global public health crisis. To understand the incidence and magnitude of the problem and its preventive aspects, it is important to undertake epidemiological studies in a particular location. Objective: The objective of this study was to study the prevalence of burns and its distribution according to age, gender, socioeconomic status, cause of injuries, mode of injuries in various communities, and depth of burns by detailed clinical examination. Materials and Methods: The present study was conducted in our hospital with 200 patients including all major and minor burns. All data were collected from patients and relatives with proper consent. Data analysis was done in both Microsoft Excel Spreadsheet ver. 2013 (Microsoft Corporation, Redmond, Washington, USA) and SPSS Statistics for Windows, Version XX (IBM Corp., Armonk, NY, USA) of significance used was the Chi-square test; P = 0.05 or less was considered statistically significant. Results: Burn injuries were more common among males, although no significant association was found between age and gender. A majority of patients (69.5%) were Hindus, and the Manipuri Meitei tribe was most frequently affected (69.5%). Most belonged to the lower-middle socioeconomic class (46.5%), and 56.5% were married. Flame burns (49%) were the most common type, while scald burns were slightly higher (53%) and more frequent in females (83.3%). Kerosene was the leading cause of flame burns (20%). Accidental burns were most prevalent, though suicidal and assault-related burns were more common in females. Most injuries occurred at home, particularly between 4 PM–8 PM and 8 AM–12 PM. The majority of cases involved single individuals. Second-degree burns were the most frequently observed depth of injury. Conclusion: The prevalence of burns varies according to socioeconomic status, lifestyle, environment, habit, and gender. Burns are more common among males in our study.
Opening a closed ostium as a result of postburn scarring presents a daunting task. In case of oral cavity, prime functions of nutrition and speech are hampered, and early restoration without risk of recurrence is important. Neglected cases of perioral burns may present with severe microstomia, for which Starplasty can be used as a simple and effective method of release. It has minimal chances of recurrence without any need for postoperative splintage.
Background: Perineal burns are uncommon and devastating with a negative effect on quality of life. Isolated perineal burns are uncommon and indicate a suspicious act. These are of prime medicolegal importance. These burns mandate admission and management. This study is aimed at studying the incidence and outcome of perineal burns at our center. Methods: All patients being treated at Government Kilpauk Medical College Hospital, Chennai, from July 2023 to December 2023 with perineal burns were considered for the study. The data were collected and analyzed based on the inclusion and exclusion criteria. The study was conducted both as an observational and as a retrospective study. Results: A total of 12 patients had sustained perineal burns. Majority of them belonged to the age group of <20 years with equivocal gender distribution. Most of the perineal burn injuries were due to accidental scald injuries involving a total body surface area of <41%, with majority of the patients presenting within five days of the injury for treatment. Conclusion: Perineal burn injuries pose a negative effect on the quality of life hence prevention is always better than cure. Early intervention avoids morbidity. The concept of wholesome care plays an important role in the management of perineal burns. It is equally important to view the situation from a medico-legal standpoint.
Cutaneous horn in a postburn scar is an unusual occurrence. We present a case of cutaneous horn in a 55-year-old male patient on the ulnar aspect of the forearm. The unique feature of this case report is the lesion causing an indentation on the underlying ulna bone making it the only case reported. Histopathology report is a hyperkeratotic horn without any evidence of malignancy.
Hot dye burns are a rare but potentially serious form of thermal and chemical injuries that can result from contact with hot dye substances. We present the case report of a 45-year-old male who sustained hot dye burns to his body following an accidental spillage of boiling dye during a textile manufacturing process. The patient presented to the emergency department with extensive burns and was managed with prompt cooling, wound care, and surgical intervention later on. Regular cleaning and dressing was done on alternate days under all aseptic precautions, eventually the dye was cleared from the skin. Approximately 3%–4% of the total body surface area burn was not healed and required STSG, which was healed as well.
Burns are the leading complication with the use of electrosurgery. Burns at the site of the grounding pad are due to a lack of knowledge, training, and negligence that have medicolegal implications. The aim of this case series is to promote awareness among the surgeons and medical staff regarding the causes that can lead to burns due to grounding pads and to prevent such injuries.
Background: Chronic pruritus in pediatric burn patients is a distressing and often overlooked complication that can significantly impact quality of life. Understanding the epidemiology, predictors, and clinical course of pruritus in this population is essential for effective management. Materials and Methods: We conducted a retrospective cohort study to evaluate pruritus in pediatric burn survivors. Data were collected from medical records, including demographic information, burn characteristics, and pruritus severity scores. Statistical analyses were performed to identify the predictors of prolonged pruritus and define its clinical course. Results: Among 150 pediatric burn patients included in the study, 65% experienced prolonged pruritus following burn injury. Factors associated with prolonged pruritus included age at burn injury (P < 0.001), total body surface area burned (P = 0.023), and presence of inhalation injury (P = 0.045). Pruritus severity, measured using a Visual Analog Scale (VAS), was significantly higher in patients with prolonged pruritus compared to those with transient pruritus (mean VAS score: 7.8 vs. 4.2, P < 0.001). In addition, the clinical course of pruritus in pediatric burn survivors was characterized by persistent symptoms in 80% of cases, with a median duration of 12 months (interquartile range: 6–18 months). Conclusions: Pruritus is a common and often persistent issue in pediatric burn survivors. Our findings highlight the importance of early recognition and the management of pruritus to improve outcomes in this vulnerable population.
Severe burn contractures of the knee and elbow are debilitating deformities. The shortened musculotendinous units and neurovascular structures stand out as bowstrings and damage to these structures is possible when attempted to straighten it forcefully. However, with proper planning and tissue selection and replacement, desirable results can be achieved. This single-stage radical release has been described for non-burn contractures such as cerebral palsy and other spastic disorders, but the literature for post-burn contractures is scant, especially for severe elbow and knee contractures. In this article, we discuss the excellent outcomes offered by radical release and reconstruction of severe burn flexion contractures of the knee and elbow through three representative cases.
Aims and Objectives: This study aimed at assessing the role of ultrasound in postburn contracture evaluation of extremities. It correlated preoperative ultrasound with intraoperative findings to determine its usefulness in treatment planning. Materials and Methods: In this observational study, 51 patients aged 12 years and above with postburn contracture of the extremities were observed. A total of 92 contractures were studied, and B-mode ultrasound was used to determine the thickness of the scar and its relation with deeper structures. Statistical Analysis: A diagnostic test was used to calculate sensitivity and specificity. Inter-rater kappa agreement was used to assess the strength of agreement between ultrasound and intraoperative findings. P < 0.05 was considered significant. The data were entered into Microsoft EXCEL spreadsheet and analysis was done using Statistical Package for the Social Sciences (SPSS) version 21.0. Results: Electrical burns showed deeper structure involvement in 62.5% of cases, and thermal burns showed contractures in 17.3% of cases based on preoperative ultrasound sonography (USG). Overall, USG and intraoperative findings were the same in all cases except one. Based on USG findings, surgical planning was better defined, and the need for flap cover was decided before surgery in all cases, resulting in better surgical decision-making. Conclusion: Ultrasound plays a role in assessing PBC involvement in deeper planes and tissues and in prognosticating correction of deformity and functional restoration. With advances in ultrasound technology, there will be a definitive change in diagnosing and managing PBC in a more objective way.
Cutaneous warts, caused by human papillomavirus (HPV), are commonly treated with various systemic and topical therapies, including acid-based solutions. However, misuse of caustic agents like formic acid can result in serious complications. We report a case of a 44-year-old male who developed a third-degree chemical burn on the dorsal aspect of the right second finger after improper use of an over-the-counter 85% formic acid solution for wart treatment. Despite the product’s recommendation for limited weekly use, the patient applied it twice daily. A necrotic wound developed, necessitating surgical debridement and eventual reconstruction with two local rotational Yin-Yang flaps. Full functional recovery was achieved, with a QuickDASH score improving from 61.4 preoperatively to 0 at 13 months postoperatively. Although acid-based treatments like formic acid are effective for wart removal, unsupervised use can lead to chemical burns and deep tissue damage. Management involves debridement and appropriate reconstructive techniques based on wound depth and location. For dorsal finger defects, local flap options such as Yin-Yang flaps are advantageous, offering single-stage closure without donor site morbidity. This case highlights the importance of medical supervision when using caustic wart treatments and highlights effective surgical strategies for managing resultant injuries.
Introduction: Burns remains one of the most frequent public health concerns associated with significant mortality and morbidity. This study aims to determine the epidemiological profile and mortality among infants admitted to a tertiary burns care center over the past 10 years. Materials and Methods: A retrospective study was conducted to review infants admitted to a tertiary burns care center from January 2012 to December 2021. The epidemiological data were studied, including age, gender, cause, total body surface area burnt, depth, localization, cause of death, and length of hospital stay, among others. Results: A total of 335 burn infants were studied. The most common etiology of burn was scald burns (79.1%), followed by flame burns (10.7%). 209 (62.3%) of the patients were male and the remaining 126 patients (37.6%) were female, with a male: female ratio of 1.6:1. The duration of hospitalization stay was 8 days on an average. Most cases had combined depth burns (59.1%), followed by second-degree deep burns (14.3%). The most frequent areas burnt were on the trunk and upper limbs. The mortality rate was 17.9%, sepsis with multiorgan failure being the major causes. Conclusion: This study provides an overview of demographic features and mortality rates of infants admitted to a tertiary burns care center. Infants are at significant risk of burns, usually caused by hazards in home environment. Better parental and education prevention are important to decrease incidence of infant burns.
Background and Objective: Patients with severe burns have coagulation abnormalities that are similar to those seen in sepsis or acute trauma patients. Patients with severe burns who experience coagulopathy exhibit abnormalities in procoagulants as well as compromised fibrinolytic and endogenous anticoagulation mechanisms. The objective is to monitor coagulant and hematological changes that take place during the admission of burn patients. Materials and Methods: Fifty consecutive admitting burn patients with different percentages of burn were subjected to the study. Types of pretested questionnaires were used to gather sociodemographic data, and for coagulant changes, 6.5 mL of blood was taken; 4.5 mL to sodium citrate tube for prothrombin time, partial thromboplastin time test manually done, and 2 mL in ethylenediaminetetraacetic acid tube for hemoglobin, platelet (PLT) count test by Medonic coulter. Results: From 50 participant patients, age (27.5 ± 15.15) years, female: male (1.94:1), severely burned (52%), mainly by kersosin burn (70%), with urban (52%) more than a rural area, and morality (22%), there was a significant difference of prothrombin time, partial thromboplastin time, and hemoglobin level between 1st, 7th day of admission P value of all < 0.05, also significantly difference in Prothrombin time with high percentage burn than low percentage in the 1st, 7th day, and in partial thromboplastin time in day 7, while no changes in PLT count in both 1st and 7th day of admission. Conclusions: Although burn-related coagulopathies are now recognized, despite their potential benefits in predicting thromboembolic events and assisting in timely clinical decision-making on treatment and prognosis, there are currently no guidelines for managing them.
The bones over the posterior aspect of elbow joint are subcutaneous, and can easily get exposed following complications of bursitis, degenerative joint disease and burns.Because of the difficulty in treating these wounds a variety of local muscle, musculocutaneous, fasciocutaneous, distant, and free flaps have been described. Fasciocutaneous flaps have the advantage of using regional tissue in a single stage. But the donor defects need to be skin grafted, producing an additional wound at the graft harvest site. We hearby present our experience of using a sensate bilobed flap innervated by branches of medial brachial cutaneous nerve for coverage of post electric burn defect over posterior aspect of elbow joint, where donor defect was amenable to primary closure.
Background: Electricity dictates modern life. High-voltage (>1000 volts) electrical burns are fatal when the contact site is a vital body part such as the neck, which may occur due to open high-tension wires, which is common in developing countries. The contact burns in the neck may result in the exposure of vessels, trachea, cervical spine, or any other important structures. Materials and Methods: This was a retrospective descriptive study carried out in a tertiary burns center from November 2020 to March 2023. Five patients with electric contact burns in the neck were included in the study. All patients were resuscitated as per the department protocol. Regular assessment of wounds was done, and patients were managed with intravenous fluids, antibiotics and daily dressings. Investigations deemed necessary as per the standard of care in electric burn injuries were done. Contrast-enhanced magnetic resonance imaging neck or contrast-enhanced computed tomography neck was undertaken to assess the underlying vital structures. Flap coverage for neck defects was done with either deltopectoral (DP) or pectoralis major myocutaneous (PMMC) flaps. Results: Out of five patients, three patients underwent reconstruction using PMMC flap and in two patients, the reconstruction of neck was done using DP flap. In one patient, there was necrosis of the distal edge of the PMMC flap, which was managed with debridement and resuturing and there was minor skin graft loss. All other flaps settled well. Conclusion: The workhorse PMMC flap and DP flaps are consistent and reliable in managing the large soft-tissue defects following high voltage electric contact burns of the neck.
Introduction: While obesity is conventionally recognized as a risk factor for increased mortality and morbidity among trauma patients, a growing body of evidence suggests the existence of an intriguing phenomenon known as the “obesity paradox.” It is worth noting that current medical literature contains limited data concerning the impact of body mass index (BMI) on individuals who have suffered severe burn injuries. Burn injuries remain a significant challenge in developing countries, despite remarkable advancements in their management. Aims and Objectives: The primary objective was inhospital mortality. Secondary objectives were hospital stay and wound infections. Materials and Methods: This was a prospective study from June 2022 to November 2022 in the Department of Burns, Plastic, and Reconstructive Surgery, Kilpauk Medical College and Hospital. Results: Difference in hospital stay did not reach statistical significance (P = 0.26). Wound infection in this study (P = 0.87) was not significant. BMI in this study was 27.01 ± 4.76. Mortality in BMI group >30 kg/m2 was more than <30 kg/m2; P = 0.03 which was significant (Fischer’s exact test calculator). Conclusion: Our findings reveal a notable increase in mortality rates among obese patients, with a discernible “inflection point” when their BMI surpasses 30 (kg/m2). This particular insight bears significant relevance for burn care teams, prompting them to refine their approaches and minimize adverse outcomes in this patient group.
