First web space widening is crucial in the reconstruction of severe thermal burn contracture of the hand. We describe our experience with various methods of coverage following release of contracture in form of split thickness skin graft (STSG) and Z plasty in total 16 patients over three years. Splintage is a crucial part of our management and was given by thermoplastic splints. We were able to achieve good functional and cosmetic outcomes with minimal morbidity. We conclude that good functional results can be obtained by simple procedure of STSG & Z plasty if proper post op splintage is maintained.

Post burn hand contractures are still a problem in everyday plastic surgery. Out of all conflicting reports in literature regarding optimal treatment of these patients varies from simpler methods to more complex reconstruction. Use of external fixator and distractor device for management of burns is a relatively new concept. In our study, 24 patients and 86 fingers with long standing post burn hand contracture were treated with application of external fixator and distractor devices after it was seen that complete release was not possible intra-operatively. The age group range from three years to 46 years. Assessing the patient preoperatively and deciding after intra-operative assessment carried out the selection of patients. The common indications for its application were early exposure of tendons at PIP joint level, shortened neurovascular pedicle, stiff joints and recoil of PIP joints with K wire unable to maintain joint stability. Distraction was started as early as tenth postoperative day to more commonly on 14th-21 ^st postoperative days and was continued up to 6-8 weeks as required. Patients were followed up for a period of up to 1 year to detect and treat early and late complications and it is concluded that external fixator and distraction devices are an excellent tool in the armamentarium of the surgeon to treat complex burn deformities of hand. The functional and aesthetic results of this simple procedure are excellent with minimal morbidity.

Aims: The present study was done to clinically assess the role of gamma irradiated amniotic membrane and silver dressing material on superficial partial thickness burns. Methods and Material: The clinical assessment was made based on following five parameters: - a. Erythema, b. Pus discharge, c. Swelling, d. Pain while changing dressing , e. Healthy epithelialization. Both amniotic membrane and silver dressing was applied on 23 patients each. Results: Out of 46 patients, 34 patients had excellent results with complete epithelialization of wounds. Out of these 34 patients, amniotic membrane was applied on 16 patients and silver dressing was applied on 16 patients. Severe pain, as assessed by visual analogue pain scale was present in 3 patients on amniotic membrane and 12 patients on silver dressing. Erythema and swelling settled in both group of patients within one week. Pus discharge was present in 2 patients in amniotic membrane group and 1 patient in silver dressing group. Conclusions: In this study we analyzed clinical efficacy of gamma irradiated amniotic membrane and silver dressings based on clinical parameters and have found them to be effective in wound healing.

Aim: Early auto graft cover for severely burns and access long term results. Method and material: The important limiting factor in the management of severely burned is the lack of auto graft donor skin. Early excision of full thickness burns & covers with widely; expanded postage stamp auto graft by "Meek Micro graft technique" has been used in the study of 868 severely burned patients in 8 yrs at Lahane Hospital, Latur, India. The expansion ratio of 1:4, 1:6 & 1:9 was used. Area grafted per procedure was 15 to 20 %. The mean percentage of the burns was 40 %. Hospital stays 2 to 3 weeks. Procedures required were 2 to 3. The long term outcome accessed in treated patients for the one to seven years period. The skin quality, texture, elasticity, color, hypertrophy etc. Results: The long term results are excellent in the term of skin quality and texture. good color match. Usually Hypertrophy is noted in 1:9 expansion, similar hypertrophy in 1:4 and 1:6 to that of meshed split thickness graft. After removal of polyamide gauges on 10th post operative day. The epithelialisation rate was 90 % - 95% & complete epithelialisation in one week in 1:3 and 1:4 expansions and in next 2-3 weeks in 1:6 and 1:9 expansions. It is economic, requires less antibiotics, blood and its products. It also reduces the chances of infection. Conclusion : Meek micro grafting is the method of choice in severely burned patients in country like India wherein the skin culture and skin banks are at premium.

Long term follow up of Nipple Areola Complex Reconstruction (NAC) in patients with burns of the anterior chest wall is poorly documented. Between 2002 and 2006, five patients with burns of the anterior chest wall requiring reconstruction of the NAC were reviewed. These patients underwent reconstruction using the local burned tissue. All these patients had their initial tangential excision and skin grafting done elsewhere for acute care of their burns. In spite of significant thermal injury to the anterior chest wall with involvement of the NAC, no patient failed to develop breast. Results of nipple reconstruction using local burned tissue were symmetrical with the projection of uninjured nipple by using skate flap. Areola reconstruction with full thickness skin grafts was the method of choice. At follow up, all patients had excellent results.

Objectives Objectives of the study were to assess demographic, socio-cultural factors, causes and outcome of burn injuries in children. Materials and Methods This prospective epidemiological study of 81 pediatric burn injury patients admitted in two tertiary care hospitals in Belgaum city was conducted during April-2004 to March-2005. Ethical clearance was obtained from Institutional Ethics Committee. The data regarding demographic and socio cultural variables, types, modes, causes, risk factors and factors affecting outcome was obtained and recorded on predesigned and pretested proforma. The data was analyzed using chi-square test and percentages. Results A total of 81 children with burn injuries were admitted in two hospitals during the study period. Among them, 48.14% were boys and 51.85% were girls with male to female ratio of 0.9: 1. Majority (40.74%) 4 of children were <4 years of age. 49.90% of children belonged to Class V SES. Maximum (76.54%) cases sustained burn injuries at home (p=0.011). Majority (82.71 %) of burn injuries was accidental and 40.74% of children had 20 to 39% TBSA and flame injuries contributed to 62.96% cases. Mortality rate was 26.08%. Conclusion Results of this study clearly highlight the specific epidemiological features of burn in juries in children in the area and this information can provide necessary measures to develop adequate burn prevention programmes

Post burn hand contractures are still a problem in everyday plastic surgery. Out of all conflicting reports in Literature regarding optimal treatment of these patients varies from simpler methods to more complex reconstruction. Use of external fixator and distractor device for management of burns is a relatively new concept. In our study, 24 patients and 86 fingers with long standing post burn hand contracture were treated with application of external fixator and distractor devices after it was seen that complete release was not possible intra-operatively. The age group range from three years to 46 years. Assessing the patient preoperatively and deciding after intra-operative assessment carried out the selection of patients. The common indications for its application were early exposure of tendons at PIP joint level, shortened neurovascular pedicle, stiff joints and recoil of PIP joints with K wire unable to maintain joint stability. Distraction was started as early as 1 Oth postoperative day to more commonly on 14 th-21" postoperative days and was continued up to 6-8 weeks as required. Patients were followed up for a period of up to 1 year to detect and treat early and late complications and it is concluded that external fixator and distraction devices are an excellent tool in the armamentarium of the surgeon to treat complex burn deformities of hand. The functional and aesthetic results of this simple procedure are excellent with minimal morbidity.

Aims and Objectives : To evaluate the effect of topical Heparin on burn wound healing. Patients and Methods : During the period from Jan 2008 to July 2009, 81 adult patients with 20 to 50% burns and with bilateral limb involved were recruited. The right and left limb were used as test and control respectively. Topical heparin was applied to test limb for 10 days and compared to control limb till wound healing. Pain relief, eschar separation, requirement of fasciotomy, number of days required for wound to heal, percentage reduction in wound area, wound biopsy and mortality were studied. Results : There was no significant difference between the two limbs with respect to eschar separation (p =0.3620), requirement of fasciotomy, mean percentage reduction in wound area, number of days for wound to heal (p=0.6680), and scar appearance. Conclusion : There was no significant improvement in wound healing and reduction of pain with application of topical heparin to the burn wound.

Aims: The present study was done to clinically assess the role of gamma irradiated amniotic membrane and silver dressing material on superficial partial thickness burns. Methods and Materia(: The clinical assessment was made based on following five parameters: - a. Erythema, b. Pus discharge, c. Swelling, d. Pain w h i l e changing dressing, e. Healthy epithelialization. Both amniotic membrane and silver dressing was applied on 23 patients each. Results: Out of 46 patients, 34 patients had excellent results with complete epithelialization of wounds. Out of these 34 patients, amniotic membrane was applied on 16 patients and silver dressing was applied on 18 patients. Severe pain, as assessed by visual analogue pain scale was present in 3 patients on amniotic membrane and 12 patients on silver dressing. Erythema and swelling settled in both group of patients within one week. Pus discharge was present in 2 patients in amniotic membrane group and 1 patient in silver dressing group. Conclusions: In this study we analyzed clinical efficacy of gamma irradiated amniotic membrane and silver dressings based on clinical parameters and have found them to be effective in wound healing.

This study was aimed to evaluate renal dysfunction during three weeks after burn injuries This study was done on 30 moderate to major burned patients to evaluate renal efficiency during three weeks postburn. Renal function tests were done for all patients, including serum creatinine, BUN (Blood Urea Nitrogen), microalbuminuria, creatinine clearance and ABG (Arterial Blood Gas Analysis). These tests were done on days 0, 7,14,21 postburn day. Six out of 30 patients developed acute renal failure.They had been diagnosed by rising serum creatinine>Zmg/dl and BUN>25mg/dl, and microalbuminuria. There was significant relation between burn size and increased incidence of ARE

One fifteen years male patient presented with post burn contracture of second to fourth toes of right foot. He had got burns fours years back. A flap based on perforator in first web space of foot was used to cover the defect after contracture release.

Metabolic acidosis is common in early burn injury due to inadequate fluid resuscitation and dehydration and in late burn injury due to sepsis. We present a case of unusual cause of metabolic acidosis in pediatric burn patient, secondary to inborn error of metabolism. This case is being presented to emphasise on the importance of keeping in mind causes other than dehydration and sepsis in a setting of metabolic acidosis in paediatric burns