Wound closure in burns largely depends on application of Allograft human skin. Fresh or stored, this skin is of cadaver origin in many countries where skin banking has developed. In India, the burn surgeon has to rely on the supply of Allograft skin from living donors. In view of the restrictions implied by the legislations of the country on the organ transplantation, legal picture on skin harvesting from live donors is nearly clear. Skin is treated as tissue and not organ. Live donor skin harvesting requires voluntary authorization from the donor, and such consent must be obtained after making the donor understand the procedure and post procedure sequels.

Burn injury is the most devastating type of trauma, and extensive loss of integument and adjacent tissues takes place. lmproving the compromised immune status of the burnt individual, by various methods is called immuno modulation. These 8 burned pediatric subjects were provided immunonutrition support in terms of inclusion of 1 sachet of “Impact” in 24 hours that provides immunity enhancing nutrients arginine, dietary nucleotides and omega 3 fatty acids in addition to the oral intake of food and beverage. They were additionally provided 1 sachet or dosage calculated as 0.57g of Glutammune™ which is pure L-Glutamine powder in granule form. This was continued for 10 days post burn. The immuno globulin (IgG) levels effectively dropped from 800 to 450 (Normal 800-1800). These levels were estimated on day 3, 7, 10 and 15. By the fifteenth day, these improved considerably. The IgG reached 1000 mg/dl. The drop in IgA was not as remarkable. C.R.P. was always above 50 in major infection, reaching to almost 176. But by the end of fifteen days it dropped to a bout 11.

The diagnosis of infection by culture of microorganism and administration of appropriate antibiotics is the mainstay in the management of burn. Wound sepsis is the major cause of death in the late post burn period, which needs early diagnosis and specific treatment. About 407 wound swabs were obtained from indoor patients. The common organisms cultured from the burn wound swab taken on 3^rd, 5^th and 15^th post burn day were studied. The prevalence of microorganism was identified in first culture and changing behavior of organism noticed in subsequent culture. The detection of microorganisms by culture and administration of appropriate antibiotics helps in control of infection and morbidity, which facilitates early discharge from hospital and reduces the cost of treatment. Selection of antibiotics on the basis of swab culture helps in identifying the bacteria and their response to different antimicrobials. On the basis of the study we have frame worked a protocol for administration of selected antibiotics. However, if given without knowing the microorganism, it could both increase the cost and reduce the quality of care due to inadvertent use of antibiotics. The study shows that prevalence of Pseudomonas species has reduced but Staph. Aureus and Klebsiella have emerged as most common organism '. We have formed a template for administration of antibiotics after studying the changing sensitivity patterns and behavior of organisms.

Burns patients require nutritional and metabolic support throughout the period of treatment. Nutritional support reduces the complications, increases survival chances and fastens recovery. The catabolic hormones released during the flow phase promotes proteolysis of skeletal muscles and releases amino acids chiefly alanine and glutamine which are major carriers of nitrogen from skeletal muscles to visceral organs. Carbohydrate in the form of glucose is considered to be the best source of nonprotein calories. Tissues like burn wound, neural tissues, red blood cells (RBC) and white blood cells (WBC) utilize glucose in an obligatory way. The combination of glucose and protein improves nitrogen balance and allows more calories to be utilized for restoration of nitrogen balance. Fat is less effective in reducing catabolism of body protein mass as it does not stimulate insulin release. The depletion of intra cellular pool of Glutamine in burns is due to a decrease in muscle synthesis. Glutamine therefore becomes a “conditionally essential amino acid” and needs to be administered.

Management of facial burns remains a challenge to the treating surgeon. Though majority of head and neck burns heal spontaneously or occasionally need excision and grafting, there is a small group of patients with complex head and neck defects who need some kind of flap cover. Local or regional flaps may not be useful because of involvement of surrounding skin in burns or extensive nature of defect. Free flap cover remains an ideal procedure in such patients, being a single stage procedure distant healthy donor tissue is used and it doesn't depend on bed of burn wound for its survival. We present our series of six patients with post burn head and neck defects treated by free flap coverage. Indications, complications and special precautions while doing free flaps in burn patients are discussed.

Autologous bone marrow was applied in two patients with chronic non healing raw areas with the objective of healing them. One was a case of postburn raw area thigh and other was donor raw area thigh. These patients had earlier had undergone conventional measures such as repeated skin grafting unsuccessfully. Following application of autologous bone marrow, there was clinical evidence of healing and histological evidence of incorporation of bone marrow cells leading to formation of neodermis with epithelialization of the raw areas. These patients were followed up regularly for 1½ years .The results indicate that topically applied bone marrow cells can modulate wound healing positively.

An epidemiological Study dealing with patients injured by fireworks from November 2001 to November 2004. In this period there were 50 injured patients, with a predominance of males; the age group most affected was below 12 years. Burn accidents occurred with greatest frequency during Deewali, between 8 p.m. and midnight. The most frequent injury-causing agents were firecrackers, sparklers and rockets. The upper limbs, head and neck were the most affected parts of the body. It is suggested that the domestic use of fireworks of any kind should be supervised and that their use in public firework displays should be strictly regulated

This study attempts to compare the recent trends of burn wound infection by various microorganisms and their sensitivity and resistance to commonly used antibiotics. A total of 100 cases were studied from January 2003 to January 2004. The swab for culture was taken from various sites of burn wounds on the seventh day after admission. Culture was done and analyzed to individual member of microbial flora, and then the sensitivity to various antibiotics was studied. In our study we found that in our set-up Pseudomonas was the commonest microorganism isolated and Piperacillin and Amikacin were most effective antibiotics against them. Klebsiella and E.Coli responded best to Ciprofloxacin. Staphylococcus Aureus was sensitive to Amikacin and Erythromycin and no resistance was found against Vancomycin. Proteus responded to Ciprofloxacin. A combination of Ciprofloxacin and Amikacin can be considered as first line therapy for management of burn infections with selective use of Piperacillin in resistant pseudomonas infections.

In this study, 185 patients with post burn deformities were evaluated. Hand was most commonly involved part as seen in 52 out of 185 patients. This article aims to emphasize the need for better primary treatment in preventing and reducing the incidence of these deformities and highlight various methods used for their correction.

Twenty patients irrespective of gender who sustained burns of varying etiology and TBSA (Total body surface area) not exceeding 40% were selected for a nonrandomized prospective clinical trial to test the efficacy of a topical herbal ointment (1% pure extract of Argyreia Speciosa) as an alternative to current topical antibiotic therapy. The efficacy of the ointment was gauged by clinical parameters and was compared with Silver Sulphadiazine cream in cases of symmetrical wounds. The ointment did not have any inherent antimicrobial action as indicated by bacteriological studies in serial concentrations but wound healing proceeded without any deterioration of wounds. Complete healing occurred in 8 out of 20 patients (40%) while wound contraction was evident in the rest i.e.12 patients (60%) who all underwent split thickness grafting. The average duration of appearance of a raw area was higher with Argyreia Speciosa group as compared to Silver Sulphadiazine (28.5 days vs.24 days and was not statistically significant (t = 1.969, p>0.05). The mechanism of action of this agent has not been fully elucidated and further studies are required to validate the role of this topical herbal agent.

Two cases of Post Burn Neck Contracture with Apertognathia are presented. Both patients had untreated flame burns sustained in childhood and resulted in deformity of mandible along with cervical contracture. Complete correction mandated release of neck contracture with split thickness skin cover and an anterior segmental osteotomy of mandible in the second stage to correct the open bite deformity.

The article highlights the management of a large tracheocutaneous fistula following accidental high voltage electrical burns. This large tracheocutaneous fistula with a surrounding raw area was managed with a two flap cover along with reconstruction of the tracheal rings. A superiorly based sternocleidomastoid myocutaneous flap was used to provide the inner lining of fistula and the tracheal rings were reconstructed by costochond ral grafts and the skin cover was provided by a deltopectoral flap. The post-operative period was uneventful and with a satisfactory result.

This article emphasizes the need of perseverance and the role of team approach in management of old chronic burns. It is a team effort consisting of burns surgeon, trained staff nurse, hospital administration, dietician, physiotherapist and last but not the least the relatives of patient. This article also emphasizes the state of burns management outside major institutes and especially in peripheral centers and villages. In this case an 8 year old child came to our department in a critical manner after being treated for a month and half outside at a peripheral centre. Management of patient with old infected burns starts with arrival of patient to the burns department. Starting of right antibiotics, resuscitation if required, correction of metabolic parameters and correction of biochemical parameters take the front seat. Then comes various modalities of supportive measures like coverage of raw areas initially with homograft or xenograft, taking patient to positive metabolic balance and other modalities like hormonal therapy like growth hormone, correction of existing contractures with splintage and supportive medicines. Finally comes covering the patient with his own skin and rehabilitation of the patient both physically and mentally.