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   Table of Contents - Current issue
January-December 2020
Volume 28 | Issue 1
Page Nos. 1-114

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Burn management during COVID-19 era: An overview p. 1
Vijay Kumar
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Tips in the management of burns p. 4
Shalabh Kumar
Burns is a serious health problem in our country. Burn management is a complex and resource intensive process and requires a dedicated multidisciplinary team working in coordination in all the aspects of burn care simultaneously. Most burn patients get treated by the general practitioner primarily and then referred to higher centers. Specialized burn centers are few in number, and affordable care is hard to find other than government run institutions. A lot of research has been done in the fields of burn resuscitation, nutrition, synthetic and biologic dressings, and surgical management of burn wounds, etc., and several advances have been made, but most institutes managing burns are restricted by their availability of resources and high patient load and hence adopt their own protocols based on their patient characteristics, resources, and experience in treating burns. Here, I have shared a few tips and wisdom I have gained in the management of burns based on my experience of almost 30 years in treating burns at a government run tertiary burn care center. Despite all efforts, severe burns are still associated with very high morbidity and mortality and so a concerted effort needs to be made at the national as well as grass root level to raise the awareness and education regarding burns safety and prevention of burns.
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Understanding the role of serum lactate as an end point in burn resuscitation p. 7
Nita Trina D'souza, Abha Rani Kujur, D Rajeswari
Context: Fluid resuscitation plays a significant role in burns treatment. Inappropriate resuscitation impacts morbidity and mortality. Urine output (UO), the current gold standard, alone, is not an adequate end point of fluid resuscitation in burns. Hence, we studied the utility of serum lactate levels as a reliable marker and end point of resuscitation. Aims: (a) To understand the role of serum lactate levels in burns as end point in acute burn resuscitation and (b) To assess its sensitivity and specificity. Settings and Design: Tertiary care hospital, urban setting, and cross-sectional study. Subjects and Methods: The study was done from September 2015 to July 2017. Sixty-four patients with thermal burns were included. Serum lactate levels were recorded at arrival, 8 h, 16 h, 24 h, and 48 h interval postburn incident. Hourly UO heart rate and mean arterial pressure were recorded for the outcome measures. Statistical Analysis Used: Chi-square test and nonparametric Mann–Whitney U-test. P ≤ 0.05 was considered statistically significant. Results: (a) The initial serum lactate levels at presentation were directly proportional to:
  1. The total body surface area and percent deep component of burns sustained
  2. Delay in starting resuscitation.
b. Time taken for serum lactate levels to normalize is directly proportional to initial serum lactate level. At 16 h, serum lactate showed (94%) specificity, (53%) sensitivity, and at 48 h (85%) sensitivity, (44%) specificity. Conclusions: Serum lactate levels can help to monitor the adequacy of fluid resuscitation in burns. Serum lactate and UO, both, should be taken into consideration to determine the end point of resuscitation.
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Epidemiological analysis of chemical burns: Does it reflect any change in trends? Highly accessed article p. 13
Sunil Sharma, Piyush K Thayal, Praveen Kumar Arumugam
Introduction: Chemical burns constitute small proportion of cases among the total admissions due to burn injuries. The spectrum of severity of illness can vary from mild injuries to life-threatening trauma. In the Indian scenario, the incidence of chemical burns has been reported to be 2.25%–2.4% of total burn admissions. We decided to analyze the epidemiological trends in a tertiary care center from 2013 to 2018 and observe if there has been any shift in the trends. Materials and Methods: A retrospective chart review of all burn victims who attended our burns casualty in V. M. M. C and Safdarjung Hospital, New Delhi, India, between January 2013 and December 2018, was carried out. Results: During the study period of 6 calendar years from 2013 to 2018, a total of 142 patients of chemical burns attended the hospital, with 47 of them requiring admission. The chemical burns accounted for 0.45% of the total burn patient's attendance. Male dominance was noted with 64% of patients being males. Nearly 59% of the chemical burn patients were from 21 to 40-year age group. Accidental chemical burns accounted for maximum cases. It was observed that acid burns have decreased in comparison to the initial 3 years. Conclusion: Downward trend in the incidence of overall chemical burns was noted. Acid burns decreased with simultaneous increase in alkali burns. The study period coincided with the Supreme Court's verdict with the formulation of guidelines on sale of acids in 2013 and this could be the major factor in declining trends of acid burns.
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A prospective study on efficacy of topical bupivacaine in split skin grafting donor site in immediate postoperative pain relief p. 18
Srikanth Vasudevan, Sudarshan Reddy Nagireddy, Ashok Basur Chandrappa, YN Anantheshwar, Ritu Batth, Harish Kumar Kablian, Dinkar Sreekumar
Objective: The objective of this study was to compare the effectiveness of bupivacaine-soaked gauze dressing and conventional dressing for pain relief in patients requiring split-thickness skin graft for reconstruction of various defects. Methodology: Fifty patients requiring split-thickness skin grafting for various soft-tissue defects were divided into two groups with 25 patients in each group. In Group A, skin graft donor site dressing was kept moist with 10 mL/100 cm2 of 0.25% bupivacaine solution-soaked gauze, and in Group B, dressing was moistened with the same amount of normal saline-soaked gauze. Outcome was measured by comparing pain scores and calculating rescue analgesia requirements in the two groups in the first 24 h. Significance was determined by comparing analgesia-sparing effect of each dressing using Chi-square test. Results: In Group A, 1 out of 25 (4%) patients required rescue analgesia. In Group B, 23 out of 25 (92%) patients required rescue analgesia (P < 0.0001). There was 96% effectiveness of bupivacaine-soaked dressing while only 8% effectiveness of conventional dressing. Conclusion: Bupivacaine-soaked dressing should be considered as a potent alternative to traditional saline dressings for the skin graft donor site.
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Association between sensory, motor, and functional abilities among burned hand patients p. 24
Himani Kaushik, Pragya Kumar, Jaswinder Kaur
Context: Burn injuries are one of the most common health issues of the universe. Burn injuries in hand are very frequent, and in spite of appearance that the expanse of the hand represents < 3% of the total body surface area (TBSA) on each hand, burn injury may have major significance on the quality of the life of an individual. Although the studies have shown the association of burn with either functional, motor, or sensory functions, no such study was found which evaluated and related all the three aspects of hand function, i.e., sensory, motor, and functional activities. Subjects and Methods: Individuals aged between 18 to 60 years satisfying the examination process were included for the study. Two groups were allocated, including 10 burned hand patients and 10 controlled subjects. All the 20 subjects were examined for sensory, motor, and functional abilities. Pain, temperature, and 2-point discrimination sensitivities were tested; motor functions were tested using Strickland method, Kleinert method, and Jamar hand dynamometer, and functional impairment was tested using Michigan Hand Questionnaire (MHQ). Statistical Analysis Used: The descriptive data was analyzed using Microsoft Excel and Spearman's rank correlation test was applied using IBM SPSS Statistics for Windows, Version 16.0. Armonk, NY: IBM Corp.” Result: TBSA was significantly related to the pain perceived on the Visual analog scale (VAS) (r = 0.509; P < 0.05). Significant correlation was seen with MHQ work (r = 0.611; P < 0.05), MHQ esthetics (r = 0.788; P < 0.05), and MHQ satisfaction (r = 0.654; P < 0.05) in relation to TBSA. Degree of burn was significantly related to the pain perceived on VAS (r = 0.907, P < 0.05), pain sensation, temperature, and 2-point discrimination (r = 0.59, P < 0.05). Significant correlation was seen with grip strength (r = 0.77, P < 0.05) and further, index finger flexion (r = 0.866), middle finger flexion (r = 0.949), ring finger flexion (r = 0.909), and little finger flexion (r = 0.910) were significantly related (P < 0.05) to degree of burn. MHQ was significantly related (P < 0.05) to degree of burn in terms of overall hand function (r = 0.836), ADL (r = 0.825), work (r = 0.790), pain (r = 0.574), esthetics (r = 0.86), and satisfaction (r = 0.884) in relation to degree of burn. Conclusion: TBSA was significantly co-related with pain in terms of sensory function and showed significant relationship with functional abilities in terms of work, esthetic, and satisfaction. Degree of burn significantly related to the pain, temperature, and 2-point discrimination in terms of sensory abilities, grip strength, Strickland method, and Kleinert method in terms of motor abilities and MHQ in terms of functional capabilities. It also indicates that there was a statistically significant difference in sensory, motor, and functional abilities of the hand that were decreased in patients compared with the control group.
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Prevalence and profile of persons with burn injuries in rural field practice area of Rajarajeswari Medical College and Hospital, Bengaluru p. 29
Aishwarya Subramanian, Shashikala Manjunatha
Background: Burn injury is one of the common medical emergencies admitted to any hospital and is an important public health problem globally. Although most burn injuries are preventable, the general lack of safety consciousness, lack of knowledge on first aid measures, compounded by the absence of organized burn care at primary and secondary health-care level, hinder the curbing of this preventable problem. Objectives: (a) To estimate the prevalence of burn injuries in the rural field practice area of RajaRajeswari Medical College and (b) To determine the sociodemographic profile of burn injury victims and describe the burn injuries in the rural field practice area of RajaRajeswari Medical College. Subjects and Methods: A community-based cross-sectional study was carried out among 1220 randomly selected participants in the rural area using a semi-structured, pretested questionnaire. Data were analyzed adopting descriptive statistics, univariate and multivariate statistical techniques using the Statistical Package for the Social Sciences version 22. Results: The prevalence of burn injuries was found to be 9.5% in the present study. Logistic regression analysis showed that various sociodemographic characteristics of participants such as age, type of family, educational status, and socioeconomic status had a statistically significant association with burn injuries. Conclusion: The prevalence of burn injuries was 9.5% among the study participants. There existed a statistically significant association between burn injuries and various sociodemographic determinants.
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The postburn severe flexion contracture neck correction with split-thickness skin graft: Our experience p. 36
Ankur Bhatnagar, Anupama Singh
Introduction: One of the most common burn sequels is postburn contracture (PBC) neck. These contractures affect the patient significantly causing both functional limitations and distorted aesthetic appearance. Therefore, the reconstruction of the head-and-neck area is a challenge for surgeons to restore not only the function but also to improve the esthetic appearance. Materials and Methods: We conducted a tertiary hospital-based prospective study in 12 patients with cases of severe PBC that underwent split-thickness skin graft (SSG) cover as a treatment modality and evaluated the results after the operative procedure in terms of function and appearance of the neck and its complications. Result of the function evaluated with respect to the range of extension movement of the neck –good 120°or more, fair 90°–120°, and bad <90°. Esthetic appearance evaluations were done on the patient's opinion with consideration of color match; maintenance of contour of the neck is good, fair, and not acceptable. Observation and Results: In our study, nine of cases were of thermal burn. All cases were presented with flexion contracture neck, while in seven cases were presented with 0° extensions of the neck. The neck contracture was released in two cases by excision of the scar and in rest of cases by incision methods. The defect was resurfaced with an unmeshed sheet of SSG in six cases, while in six of cases, the defect was resurfaced with a combination of an unmeshed and meshed sheet of SSG. Good functional recovery in terms of extension of the neck >120° in nine cases and fair esthetic appearance in eight cases and good in four cases. Conclusions: The excision of all scar tissue is possible only in few cases, but the incision releases were required in the majority of severe neck contractures. The STS grafting is a simple, reliable, and safe operation. Sheets of unmeshed SSG in the neck and lower face resulted in better postoperative neck function, the cosmetic appearance in terms of color match, and cervicomental angle.
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Evaluation of efficacy of hyperbaric oxygen therapy as an adjunctive therapy in the management of thermal burns p. 44
Naveen Kumar, VK Tiwari
Background: Hyperbaric oxygen therapy (HBOT) is an adjunctive therapy that has been proposed to improve outcome in thermal burns. It involves the therapeutic administration of 100% oxygen at environmental pressures >1 atmosphere absolute (ATA). Methodology: An open, prospective, observational study was conducted for a period of 18 months which included fifty patients who were allocated to either adjunctive hyperbaric therapy in addition to the existing protocol of burn management (Group A) or only existing protocol of burn management (Group B) with daily dressing and debridement. All patients between the age of 18 and 60 years with 15%–60% of second and third degrees of thermal burns were included. HBOT was administered at 2.0 ATA in a “monoplace” chamber for 90 min, 6 days a week. A total of ten sessions were administered to each patient along with conventional treatment. Results: The mean time of wound healing in Group A was 18.96 days, whereas in Group B, it was 43.64 days. The mean number of days of hospital stay in Group A was 32.04 days, whereas in Group B, those were 51.2 days. Similarly, the mean pain score and mean fluid requirement were less in Group A when compared to those of Group B. Conclusion: With our study, we can conclude that HBOT is an effective adjunctive modality of treatment in the management of thermal burns.
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Epidemiology and outcome of childhood burn injury in Hawassa University Comprehensive Specialized Hospital, Hawassa, Southern Ethiopia p. 51
Wegene Jemebere Biru, Fikru Tadesse Mekonnen
Background: Burn-related harms are a substantial problem in children, predominantly in low- and middle-income countries, where over 90% of burn-related childhood deaths occur. The aim of this study was to determine the causes, magnitude, management, and outcome of burn injury among children who attended the Pediatric Emergency Outpatient Department of Hawassa University Comprehensive Specialized Hospital, Hawassa, Southern Ethiopia. Materials and Methods: A hospital-based retrospective cross-sectional study was conducted from 15 November to 20 December 2018 on a sample of 395 patient medical records who have been treated burn injury for 5 consecutive years from September 2013 to September 2018. Systematic random sampling was used to select the patient records, and a pretested structured checklist was organized to collect the data. Epi Info 3.5.4 was used for data entry and the Statistical Package for the Social Sciences version 20.0 for analysis. Results: The majority (62.5%) of the burn injuries affected <5 children. The major cause of burn injury was scald (59.7%). Statistically, a significant association was found between the cause of burn and age of the patient (P = 0.000). The 5 years' prevalence of burn injury was 9.79%. Almost all burn injuries occur at home (97%) and accidental (94.2%), and more than half (56.7%) of the children suffered from the second-degree burn. Almost half (47.1%) burnt 10%–20% total body surface area, and 47.6% have got prehospital first aid interventions and 36.2% received surgical interventions. Almost two-thirds (74.4%) of the children recovered without complication. Six died and four of them were third-degree burn victims and <5 years old. There was a significant statistical association between treatment outcome and age of the patient (P = 0.004). Conclusion: The epidemiology and outcome of burn injury among children were comparable to other developing countries, but the high magnitude was noticed. Public health education and prevention programs may help to reduce the prevalence of childhood burn injury.
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Effects of early enteral glutamine supplementation on the outcome of severe burns: A randomized control study p. 57
Savita Arora, Chandni Shankar
Context: Burns is a condition associated with high mortality and morbidity. Nutrition plays an important role in the recovery of these patients. Amino acid glutamine is an important energy substrate for immune cells and for the intestinal epithelium. Glutamine is the preferred respiratory fuel for both lymphocytes and enterocytes. It stimulates the immune system and prevents catabolism. Aim: This study is aimed at determining if oral supplementation of glutamine can improve the outcome in patients with severe burns. Materials and Methods: It is a randomized controlled study. Patients of severe burns (30%–50%) were randomized into two groups. The first group was started on enteral nutrition but without glutamine supplementation. The second group received enteral nutrition with glutamine supplementation. All patients were followed up for a period of 1 month from the day of burns. Blood culture, wound culture, blood counts, and serum total proteins were done once every week for all patients. Statistical Analysis: Student's t-test was used to analyze the quantitative and Chi-square test was used to measure the qualitative data. Results: One hundred and two patients were included in the study, of which 49 were in Group 1 and 53 patients in Group 2. The mean percentage of burns in the two groups was comparable at 40.71% and 41.72%, respectively. Total leukocyte counts, mean duration of hospital stay, and mortality rates did not show any statistically significant difference between the two groups. However, serum protein levels showed a significant increase in the glutamine-supplemented group from the 3rd week onward. Wound infection rates were also lower in the glutamine-supplemented group, i.e., 19.5% vs. 2.1% by the 4th week. Conclusion: Glutamine supplementation has shown to enhance serum protein levels and hence improve nutritional status of these patients. It is also useful for its immunomodulatory effects, thus reducing burn wound infection, as shown by lesser number of burn wound culture positivity rates.
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Comparing different modalities of managing postburn axillary contracture p. 63
Arshad Hafeez Khan, Vivek Ambedkar, Rajesh Kumar Maurya
Introduction: Axillary postburn scar contracture is a challenging problem to the reconstructive surgeon owing to the wide range of abduction that should be achieved. The aim of this study is to highlight the various management options used in managing axillary contractures in our hospital and to minimize the complications commonly encountered. Aims and Objective: The aim and objective of this study is (1) to evaluate different options for postburn axillary contracture treatment, (2) the functional outcome of different treatment methods, and (3) late squeals of treatment. Materials and Methods: It is a prospective study which was conducted at the department of plastic surgery. Axillary contracture was released and resurfaced using split skin graft and/or with different types of flaps, including the Single Z plasty, Multiple Z plasty, Five flap plasty, Local fasciocuteneous flap, Propeller flap, and Parascapular flap. Results: Eighteen patients were operated. Surgical treatment included split-thickness skin graft in five cases, square flap in three cases and square flap with split thickness graft in two cases, Multipe Z-plasties in two cases and Multipe Z plasty with split-thickness graft in one case, Parascapular flaps with split thickness graft in two cases, while five flap plasty in three cases. Conclusion: Mean degree of abduction is maintain or increased in follow-up (after 6 month) is Square flap, Multiple Z plasty, five flap plasty, and Parascapular flap. Mean degree of abduction is decreased in split thickness graft in follow-up (after 6 month).
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Use of epidermal cell suspension in burns wound management: A pilot study p. 69
Bharat Mishra, Vikas Singh, Chetna Arora
Introduction: It is a standard practice to cover the burn wounds with skin grafts at the earliest. Deficiency of donor skin seriously limits timely cover of extensive burns. Studies have shown that these autologous cells enhance the wound-healing process by reducing the time needed for the host cells to invade the wound tissue and by early synthesis of new skin this technique of enzymatically digesting small skin grafts, centrifuging the suspended cells and spraying the epidermal cells over burn raw areas may allow early healing. Aims and Objective: The aim of this study is to assess feasibility and role of epidermal cell suspension as wound cover in burns. Materials and Methods: This study was conducted at the burn center of a tertiary Hospital in India over a period of 1 year. Patients with postburn raw areas were included. Similar size two sites were identified in the patients. On one site cell suspension was applied, while other areas were managed with conventional dressings. Small piece of split-skin graft (SSG) was used to make cell suspension. Under anesthesia, required size of SSG was harvested from healthy donor site. Trypsinization of graft was done; epidermis was separated from the dermis. The epidermis was cut into tiny pieces, and patient's serum was added and centrifuged. Epidermal cell suspension was made, and viability of cells is confirmed using an inverted microscope. Meanwhile, the wound is thoroughly cleaned by soda bicarbonate solution. The freshly prepared keratinocytes suspension was applied on day 1, 3, and 5. Similar standard dressing protocol was followed on the control side. Wound assessment was done based on the percentage of reepithelization on the 7th and 14th day. Results: Twenty-eight patients (18 males and 10 females with a mean age of 34 years) were included the study. Cell suspension was sprayed on 4735 cm2 area. Wound size reduced to 2247 cm2 and 923 cm2 on the 10th and 14th day, respectively. While, at control site wound reduced to 3882 cm2 and 2134 cm2 on the 7th and 14th day, respectively. The difference in cell suspension and control treated area was found to be significant. Conclusion: Keratinocytes cell suspension is feasible in burns and improves the healing of wounds. However, larger studies are required to standardize and validate its use in major burns.
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The effect of rhythmic deep breathing on pain and anxiety in patients with burns p. 74
Anjana Rajhamsan Iyer, Suroshree Mitra, Rachana Dabadghav
Context: Patients with burns suffer from physical (pain) and psychosocial (anxiety) sequelae due to the burns wounds and mobilization activities. Deep breathing is a simple intervention to manage pain and anxiety in various conditions. Data concerning the effect of breathing on burns patients are limited. In order to add to this information, this study was undertaken on burns patients. Aims and Objectives: The aim was to study the effect of rhythmic deep breathing on pain and anxiety in patients with burns. Methods: This study followed an experimental, pretest–posttest design. A single group of twenty patients in the age group of 5–70 years who had suffered various types of burns to some or all parts of the body were recruited from a tertiary care center in Pune, India. With institutional approval and written consent, deep breathing technique was taught to the patients. Pretest and posttest scores of pain visual analog scale (VAS), anxiety (VAS), and anticipatory anxiety pain anxiety symptom scale were collected in the period from October 2019 to November 2019. Results: Significant change (P = 0.00) was observed in the mean pain, anxiety, and anticipatory anxiety scores over time. Conclusion: Rhythmic deep breathing can significantly help to decrease pain and anxiety in patients with burns.
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Epidemiological study of burn patients admitted in tertiary care hospital in India and associated risk factors: A retrospective observational review p. 79
Krittika Aggarwal, Kuldeep Singh, Bhupender Singh
Introduction: Burn injuries constitute a major part of traumatic injuries and most commonly are accidental. They have devastating mental and functional sequelae apart from increased chances of mortality. Knowledge about the prognosis of various burn injuries and the risk factors leading to complications helps treat them. This study was undertaken to document the epidemiological data of burn patients admitted in Pt BD Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India, from January 2019 to December 2019. Materials and Methods: Demographic details including age, sex, cause and nature of injury, associated comorbidities, depth and percentage of body area involved, involvement of the face and suspected inhalation injury, survival, period of survival, and mortality rate were recorded. For the pediatric population, weight for age was taken as an indicator for nutrition. Patients who left against medical advice were excluded from the study. P < 0.05 was considered to be statistically significant. Results: Burn injuries were most common in the age group of 21–60 years. Males were more commonly injured. Thermal injuries were most common (91%), followed by electric burns. Accidental burns were 88%, in 9% alleged history of suicide, and in rest, homicide was suspected. Out of 104 pediatric patients, 50% were undernourished. The mortality among undernourished patients had the odd's ratio of 8.5. The survival rate was 81% overall. It was noted that burns more than 40% total body surface area (TBSA) involvement had mortality of 56.25% and 9.44% in < 40% TBSA involvement (odds ratio 5.95). Face involvement for suspected inhalation injury had increased risk of mortality (odd's ratio 1.68). The most common cause of death was multi-organ dysfunction syndrome from sepsis within 10 days in 78% of cases. Among survivors, the duration of stay was dependent on the TBSA involvement. Conclusion: Pediatric age group, inhalation injury, undernutrition, and thromboembolism are factors which contribute to increased mortality, apart from large TBSA involvement. Initial 10 days need careful monitoring to decrease mortality and initiate early treatment. Limitation: This study has been conducted in a tertiary care hospital. Only referred cases needing hospital care were included in this study. Hence, the data represent only a part of demographic data sustaining burn injuries.
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Sociodemographic profile of burn patients at a tertiary care hospital of Bundelkhand region of India p. 84
Saurabh Kumar Tiwari, Manish Jain, Satyendra Kumar, Amit Mohan Varshney, Sudhir Kumar
Background: Burns are a serious global public health concern. In India, every year, a substantial proportion of mortality and morbidity occurs due to burn injuries (1.4 lakh and 2.4 lakh, respectively). Burn injuries lead a significant medical, social, and psychological problem along with severe economic loss to individual and nation. A sociodemographic profile of burn patients is essential for the planning of program for the prevention of burns. The present study was conducted to study the sociodemographic profile of burn patients of Bundelkhand. Materials and Methods: Two hundred and fifty burn patients admitted consecutively between March 2018 and September 2018 in the burns unit of Maharani Laxmi Bai Medical College and Hospital, Jhansi, India, (Uttar Pradesh) were included in the present study. Sociodemographic data were obtained by the questionnaire as well as through the interview of patients and attendants. Results: The most affected age group, gender, and religion were 21–30 years (37.60%), female, (51.2%) and Hindus (92%), respectively. The common place of burn was home (88.4%) and maximum patients (75.2%) belonged to the rural areas. The floor cooking was most preferred method used for cooking (83.2%), and majority of patients were wearing synthetic clothes at the time of injury (51.2%). Psychiatric illness and suicidal tendency were present in only 6.8% of the patients. Regarding socioeconomic status, most of the patients (70.8%) belonged to the upper lower class. Thermal burns, electrical burns, and other (filigree and chemical) burns were more common in the married population, whereas scald was more common in unmarried population. Conclusion: All types of major burns were commonly occurred in the rural population, and they had poor educational and socioeconomic status. The incidence of burn injuries was mainly accidental in nature. Floor cooking is prevalent in Bundelkhand.
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Wound pH and autograft taking in burn wounds: An experimental study p. 89
Mostafa Dahmardehi, Ali Ahmadabadi, Majid Khadem-Rezaiyan, Farhang Safarnejad, Tayyeb Ghadimi, Hamidreza Alizadeh Otaghvar
Background: The appropriateness of the wound bed for autograft transplantation is routinely evaluated based on the surgeon's judgment, which might not be reliable in some situations. Therefore, this study was designed to evaluate the association between wound pH, wound temperature, and wound culture results with autograft taking. Materials and Methods: In this prospective, cross-sectional study, the body core temperature, wound pH, and local wound temperature at the beginning of operation and after burn wound excision were measured in 50 patients with burn wounds. Swab culture specimen was obtained from the burn wound after dressing removal and after the completion of wound excision. Autograft taking was evaluated on days 3 and 7 postoperative. Results: There was a statistically significant reverse association between autograft taking on day 3 and wound pH at the beginning of operation (P = 0.016). Besides, there was a statistically significant association between core body temperature and autograft taking on days 3 (P = 0.035) and 7 (P = 0.002). However, there was no significant association between local wound temperature and autograft taking. A positive result for wound culture after excision, even when the colony count was <102, was significantly associated with autograft taking on days 3 and 7. Conclusions: Wound pH measurement after dressing removal in the operation room may be a simple and available modality to evaluate the appropriateness of burn wound for skin autografting.
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Electrical injury in pediatric patients – A case series p. 94
K Mathangi Ramakrishnan, Bala Ramachandran, KG Ravikumar, K Ravikumar, Sulochana Putli, V Jayaraman, T Mathivanan, R Ravi, S Gnanamani, Mary Babu
Electrical injuries in children are gruesome injuries that result in disabilities and death in developing countries. In this article we present a series of 6 children who were treated for electrical burns. Reconstructive surgery followed by prolonged rehabilitation is required.
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Arterial rupture: A delayed sequela of burn injury p. 98
Praveen Kumar Arumugam, Harnoor Momak Walia, Bhagyashri Talele, Sunil Sharma
Burn injuries, especially electrical burns, can lead to significant soft-tissue damage. A delayed sequela of both electric burn and firecracker injury is arterial rupture. The initial phase is characterized by occlusion of small vessels. Large vessels are prone to aneurysm formation due to medial necrosis. This can result in unanticipated bleeding, which can lead to loss of the limb or even be life-threatening. We are presenting here two cases treated in our burns department for electrical burns and firecracker injury involving the lower limbs. Both these patients presented with delayed vascular complications, which were successfully managed and limbs salvaged. We are presenting these cases to emphasize that timely intervention leads to better outcomes.
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Scald burns in a 7-h old neonate: A consequence of traditional hot water bath p. 101
Abubakar Sani Lugga, Bello Muhammad Sulaiman, Lawal Magaji Ibrahim, Yekinni Sakiru Abiodun
Burn injuries are rare in the neonatal period. Most of the cases reported in the literature are iatrogenic. We report the case of a 7-h old female neonate who presented with domestic accidental scald burns involving 18% of the total body surface area. She sustained the burns during a traditional bath with hot water. She was resuscitated with intravenous fluid, and urine output was monitored. She was nursed under a radiant heater and was given analgesics and tetanus antitoxin. She had wound sepsis from Pseudomonas species which was successfully treated with intravenous antibiotic (ceftazidime). She also had anemia which was corrected with packed red blood cell transfusion. Wound dressing was done with antibiotic-impregnated gauze until the wounds were satisfactorily healed. She was discharged from the hospital on the 29th-day postburn.
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Coverage of exposed pericardium with a lateral thoracic artery perforator flap p. 104
Vijay Yashpal Bhatia, Pradnya Desai Sarwade, Pranav Chandrashekhar Thusay, Sukumar H Mehta, Nirav M Visavadia
Electricity is an indispensable part of the society that we live in, depending on it from household appliances to farms and industries. Electrical burn injuries, although form a small proportion of the total burn cases, pose significant challenges in their management due to their varied manifestations and the high associated morbidity and mortality. Most high voltage electrical injuries are work related. The entry wounds are most commonly seen over the upper extremities, whereas the exit wounds are seen over the lower extremities. The thorax presents an uncommon site for an entry wound. In this case report, the authors present one such case of electrical injury with an entry wound over the thorax presenting as a left parasternal defect that was debrided and covered successfully with a lateral thoracic artery perforator-based flap from the lateral chest wall.
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Major COVID-19-positive burns treated successfully p. 108
Vijay Y Bhatia, Kena M Patel, Sruja D Narola, Ranjit R Zapadiya, Ami P Parikh
Extensive burns are severe form of trauma causing a great threat to life. Approximately 300,000 deaths is attributed to burns annually, majority (>95%) of which occur in developing countries. Survival rate of patients decreases as the rate of burn increases. Coronavirus disease (COVID-19) pandemic has affected all the communities worldwide. It has strong infectivity and high transmission rate. When treating corona-virus-infected burns patients, prevention of cross infection to health workers becomes of utmost importance. Here, authors present a case of extensive burns along with COVID-19 infection, the precautions taken to prevent infection among health workers and protocols followed for management. The patient was treated over a span of 75 days where the patient was cured of COVID-19 in 21 days and underwent two surgeries with homograft and autograft application. Multidisciplinary approach with strict protocols of safety and vigilant monitoring is key to successful management.
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Ward ventilation in a burn unit: Food for thought p. 113
Veena K Singh, Sarsij Sharma, Ansarul Haq, Neeraj Kumar
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