A Surgeon treats the body of a Burn patient. But it is still a long way before an individual can re-establish his body image and quality of life. They face complex rehabilitation issues including physical, emotional, social, and vocational challenges. The psychological aspects of burn injury have been researched in different parts of the world, producing different outcomes. Studies and literature have shown that greater levels of acute pain are associated with negative long-term psychological effects such as acute stress disorder, depression, suicidal thoughts, and post-traumatic stress disorder, poor self esteem and body image for as long as two years after the initial burn injury. The core concern of this study is to find if a brief supportive psychotherapy can bring some change with regard to depression and body image.

Burn injury to the rescuers is one aspect of burns which has not been sufficiently studied and very few studies are available on pattern of burns in rescuer of victims of burn injury. With this aim, a retrospective study of 15 rescuer burn patients was conducted on patients managed at Department of Burns and Plastic surgery, Civil Hospital Ahmedabad. Twelve patients were males and 3 patients were females. Average age of rescuers was 32.3 years (range 23-55 years) and body surface area ranged for 1-20%. Most rescuers had a primary level of school education and did not have any knowledge of the techniques of rescuing a burns victim. The most common site of incident was kitchen. The primary victim had suicidal burns in 10 cases and accidental burns in 5 cases. The burns were predominantly limited to the upper extremity, head and neck and anterior trunk in most cases. Lack of knowledge about the correct techniques of rescuing a burn victim was a major factor related to the sustenance of rescuer burn. Also the incidence of rescuer burns is grossly underreported as most of such cases never come up for their own treatment in the presence of a more severely burnt relative and if the primary victim succumbs to his /her injuries, the rescuer never turns up for follow up treatment.

Post burn contracture release is required in all patients with functional deficit of the affected region, however timely intervention is required to preserve the form and function of involved area. We hereby share our experience of 136 patients of PBC release, out of which 71 contractures were released before 1 year of initial burn injury. Though postoperative splintage and physiotherapy was required for around 1 year in 21 cases, final outcome was good in view of preservation of form and function.

Facial burns reconstruction is a real challenge for plastic surgeons. Its goal is to improve the function as well as aesthetics of the patient. Some of the common methods of facial burn reconstruction are single sheet resurfacing with full thickness skin graft, Local flaps such as Cervicopectoral flap, Angle rotation flap, Tubed pedicle skin flap,Microvascular tissue transfer,expanded skin flaps etc.In this article we have discussed the principles of tissue expansion as applied to facial burn reconstruction. We have elaborated it with clinical photographs of a patient

Introduction Thermal injury is followed by a period of hypermetabolism that is directly proportional to the size of insult sustained. Modulating postburn hypermetabolism is of overwhelming importance in both the immediate care stage and the rehabilitative stage. Postburn hypermetabolism cannot be completely reversed but may be manipulated by nonpharmacologic and pharmacologic means. Propranolol reduces hypermetabolism postburn. Aim To determine the effect of propranolol on hypermetabolism during the acute phase postburn by easily assessible clinical and investigational parameters. Methods A prospective randomized control study was conducted at Victoria Hospital, Bangalore between August 201 0 to June 201 1.100 patients with burns 15- 40% total body surface area were enrolled into the study and randomized to receive standard burn care (controls, n = 50) or standard burn care plus propranolol for more than 3 weeks (propranolol, 0.5-1.5 mglkg per oral every 6 hours, n = 50). Clinical parameters were assessed daily including weight, pulse rate /heart rate, sleeping pulse rate /heart rate and mid-arm circumference. Laboratory parameters, analyzed at regular intervals, included serum albumin, CRP and wound culture and sensitivity .The effect on wound healing and wound infection were also evaluated. Statistical analysis was performed using Student's t test. Results Patients in the control group and the propranolol group were similar with respect to weight, percentage of total body-surface area burned, percentage of body-surface area with third-degree burns, and length of time from injury to metabolic study. Propranolol treatment reduced heart rates and sleeping pulse rate by 25%, significantly increased serum albumin, while it significantly decreased CRP and urinary nitrogen (P < 0.05). The incidence of infection throughout hospital course was significantly lower in the propranolol group. An increase in weight and improvement in wound healing in the test group were noted. Conclusion Following burns, propranolol attenuates infections, inflammatory markers and while improving wound healing. We suggest that propranolol is a safe, cheap and efficacious modulator of the postburn response.

Introduction: Persistent burn wound leads to infection, internal organ failure, and malnutrition adding to significant morbidity. Early healing is a key step to prevent complications. rhEGF enhances the cellular proliferation and differentiation, hence promotes (4,6,7) wound healing. Aim: To compare role of rhEGF + silver sulfadiazine and silver sulfadiazine alone in healing of second degree thermal burn wounds. Patients & Methods: We conducted a single blinded prospective comparative study at the burns ward, Victoria hospital, Bangalore from August 2010 to June 2011. 32 patients ranging from 1yr to 40 yrs with TBSA ≤ 25% with second degree thermal burns were included. Pregnancy, infected wounds; chemical, electric & old burns were excluded. Paired burn wound of the same degree in the same patient were selected. One burn site was treated topically with SSD and labeled (A). The other site was treated with combination of SSD + rhEGF and labeled (B). Dressing was changed every alternate day. Each time a sterilized transparent sheet was placed on the wound & its perimeter was traced using a permanent marker. This was then transferred onto a metric graph and the area was measured by counting the number of squares. Sequential photographs of both sites were taken and the progress of healing observed. Results: The healing time of burn wound was (12+/-2) days (superficial II degree) and (24 +/- 2) days (deep II degree) at site (B), & (16 +/- 2) days (superficial II degree) and (30 +/- 2) days (deep II degree) at site (A), showing a significant difference in the healing between the two sites (P < 0.05). Conclusion: The combination of rhEGF with SSD can enhance burn wound healing significantly in second degree thermal burns.

Background: In India, burn is the second most common cause of accidental injury. Only limited studies have evaluated the pattern of burn injury in the rural part of India. Aim: To evaluate prospectively the patterns of burn injury in the rural hospital situated in the central part of India. Study design: The consecutive 343 cases of burns admitted in our hospital were analyzed prospectively to review the scenario of burn over a period of two and half years. Results: The study revealed female (68.81%) predominance with female to male ratio of 2.2:1. Most of the victims of burn were between the ages of 21 to 30 years. Married (69%) outnumbered unmarried. Out of total female victims' majority were Hindus, illiterate and housewives. The domestic burn was common with Kerosene stove with kerosene being the main accelerant. Mortality was directly proportional to the total body surface area (TBSA) involved. Shock was the commonest cause of deaths occurring within 48 hours of burn injury while it was septicemia in cases of deaths occurring after three days. Conclusion: The young married females were the commonest victims of burn injury. Knowing this the government and other social organizations need to put in efforts for running the prevention and education programs against burn injuries.

After burn injury various metabolic and functional changes occur in the body. Serum transaminases, alkaline phosphatase and amylase were measured in 30 patients with thermal injury over the first 10 days of post burn period. No clear correlation between elevated serum enzymes except amylase and the burn size was observed on admission. Transaminases values increased till 5th day then declined on 10 ^th day, while alkaline phosphatase and amylase activities continued to rise till day 10. It is concluded that monitoring serum ALP and amylase in post- burn period has valuable prognostic importance.

This study was aimed to check alterations in lipid profile after burn injury. This study clearly showed the importance of measuring serum cholesterol, TG, LDL and HDL in burn patients and targeting changes that occur in their levels along burn course, which may have beneficial effect in protecting organ damage, increasing survival rates and improving burn outcome. This study was carried out on 25 patients with various degrees of burn. Lipid profile was done at 1st, 2nd and 3rd week after burns. Results showed decrease in serum cholesterol, serum LDL and serum HDL, while increase in serum triglyceride level in burned patients compared to normal subjects.

Coverage of post burn contracture release areas with the flap and not graft has always remained a goal for a plastic surgeon. However, limited availability of healthy tissue in scarred area limits the use of traditional local flaps in most of the cases. We tried covering these raw areas in the centre with flap and grafted surrounding areas. This helped us achieve better cosmetic appearance, good patient compliance for post op splinting and exercise and coverage of important neurovascular structures in few cases. Large raw areas resulting after post burn contracture release, once grafted, tend to recontract. It is always desirable to break such long grafts by putting flap in centre directly over joint where there will be maximum movement and maximum chance of contracture. Unscarred skin if present in the nearby vicinity of contracture should be utilized as a flap to decrease graft recontracture.

Aims and Objectives: (1) To study epidemiological characteristic of female burn patients. (2) The reason for such injuries and possible strategies to reduce them. Methodology: This was a 6-months study from June 2011 to December 2011. 106 patients with different type of burns admitted in the Department of Plastic Surgery & Burns (C5 ward) of Civil Hospital, Ahmedabad were included in study. Data were collected using a pre tested questionnaire. Details were obtained from interviews with doctors, patients and relatives. Total body surface area (TBSA) was estimated by Doctors of Plastic Surgery & Burns. Analysis was done in Epi Info version 3.5.1. Result: Out of 106 patients, majority belong to 15-40 years of age group (76%) with maximum mortality among them subsequently. 75% of them were married and most of them belonged to Schedule Cast (SC) and Socio Economic Backward Class(SEBC) and family belonged to socio economic class 4. Among them, 69.81% were literate and 57.55% lived in nuclear family. Among the admitted, 86% of women got burns due to accidental injuries with 87.74% had a flame type of burn. Hired vehicle (41.51%) and 108 or ambulance (51.89%) were the commonest modes of transport to reach hospital facility. 75% of them reached within an hour and mostly accompanied by the husband and 87% got the first aid treatment at home by covering with blanket. TBSA more than 50% have highest mortality.

It is a randomized case control study of bovine collagen cream containing silver sulphadiazine dressing in second degree partial thickness burns to evaluate its utility as a drug delivery device and wound cover to facilitate the healing without complication, its efficacy, safety, pain control, outcome, and duration of healing in comparison to plain silver sulphadiazine cream dressing. Patients of less than 35%, second degree partial thickness burns of all age groups and both sexes were included. On the first day, after thorough cleaning of the wound, two anatomical sites were selected for comparison of two different dressing. Dressing was done every morning with application of cream and assessment in terms of pain relief, secondary infection, healing time, appearance and pigmentation of area. It was done in both areas of wound on 7th, 14th and 21st post burn days with clinical photographic recording. Collagen cream impregnated with silver sulphadiazine was well tolerated .It functions as a drug delivery system, effective pain control, early epithelization and wound healing with less incidence of secondary infections , good cosmetic appearance of wound observed. Early rehabilitation is possible compared to conventional dressing. There is no need for preservation of cream like collagen sheet. Based on our observations, Collagen cream impregnated with silver sulphadiazine dressing has proved to be cost effective as well.

Background: The pathophysiologic alterations involving the vascular system of the burn wounds are of crucial importance. They can thus be used to study and predict the clinical outcome of these patients. Aims and objectives: The study was conducted to ascertain the histopathological changes in blood vessels in and near the burn wounds and correlate these with morbidity and mortality of the patient including relation with burn wound infections Material and methods: The present study was conducted on 56 in-patients with burns involving 30% total body surface area (TBSA). Biopsies were taken from the burn wounds on first instance and subsequently according to relevant signs and symptoms. A total of 72 biopsies were performed. Histopathological examination with particular attention to blood vessels as well as microbiological cultures was performed on the biopsies. These findings were correlated. Observation: Out of the 72 biopsies observed, 39 (54.16%) showed congestion of the blood vessels. Thrombosis was seen in 9 (12.5%) biopsies, and this finding heralded the onset of disseminated intravascular coagulation and septicemia in the patients. Biopsies from cases with massive destruction of tissues showed unremarkable vessels (17 i.e. 23.61%). Other important finding was fibrinoid necrosis which was seen in 11 biopsies (15.27%) and this was associated with uncontrolled burn wound infection. Conclusion: The study showed that congestion of the vessel was the commonest finding in the biopsies while thrombi were associated with a poor prognosis. Other important finding was fibrinoid necrosis which correlated with uncontrolled wound infection.

Fillet flaps are deboned axial pattern flaps of a limb or its parts. It incorporates the principle of "spare parts" surgery. They are usually harvested from expendable, non- salvageable or amputated limbs. Here we report a case with a rare coincidence of marjolin's ulcer in the lower back and post burn deformity of the upper limb. After wide excision, the defect was reconstructed with sensate musculocutaneous fillet flap from the deformed upper limb producing a good quality skin cover without donor site morbidity. This case is presented for the rare combination of the tumor and deformity and no similar case has been reported using a pedicled fillet upper limb flap for back reconstruction.

A case of localised cutaneous zygomycosis was diagnosed on histopathology in a one month old burn wound. The diagnosis was made by the presence of characteristic fungal hyphae on histopathological examination. The importance of the findings can be emphasised by the fact that cutaneous zygomycosis is a relatively rare but potentially fatal infection encountered in general hospital setup. The characteristic findings on histopathology confirmed the diagnosis in the absence of fungal culture.

The major causes of morbidity and mortality after flame burns are due its complications. Most common complication is bacterial sepsis. Nonbacterial complications include acute cardiac failure, acute anemia, hemolytic jaundice, renal failure, encephalopathy, complex hyper metabolic effects including pseudo diabetes, gastric and duodenal ulceration, deep vein thrombosis and pulmonary embolism, pulmonary and glomerular micro thrombosis, hepatic jaundice, and arterial thrombosis. Stroke is a rare complication of burn in the clinical setting which is either ischaemic or hemorrhagic. Here we report, a case of 38 year, male who allegedly sustained accidental flame burn injuries while cooking at his workplace. Then he was immediately rushed to Lok Nayak Hospital. During the course of treatment in the hospital, he developed spontaneous intracerebral hemorrhage after twelve days manifesting as stroke leading to death. The autopsy findings and the literature relating to the case are described.

Comprehensive airway management of the respiratory tract is crucial in the care of the burn patient especially in the presence of inhalation injury. Tracheostomy may be required either early or late in the post-burn period as an adjunct to the care of these patients. Its use has been controversial and there is no clear consensus on either the indications of or the correct timing of the procedure. However, tracheostomy still has a role in the management of acute burns to be performed in patients with specific indications, having clear cut benefits of improved patient comfort, role in management of patients with inhalational injury, and ease of maintenance of airway especially in patients likely to undergo repeated surgeries, the patients also requiring lesser doses of sedatives for maintenance.