In our vast country, with poor communication and transport facilities, there is no "Burn Program" or facilities for the treatment of burn injuries. Acute burn care requires meticulous planning and attention to details. I propose them as "The Ten Commandments" of burn care. These are - maintain circulation and blood pressure (shock management), maintain airway, increase body resistance, avoid bacterial toxemia, avoid auto-toxemia, watch for renal complications and multiple organ dysfunctions, maintain nutrition, abide by principles of biomechanical physiotherapy and rehabilitation and analyze factors for reducing mortality. Adherence to these principles can help us decrease the morbidity and mortality in this unfortunate set of patients.

Ear is a very prominent part of the face after nose and eyes especially in Indian subcontinent where in both the males and females it adorns a variety of ornaments to beautify the face. However, because of limited functional importance of external ear the burns of the ear are often neglected. More often, isolated burns of the ear are very rare. They are usually involved with facial burns and therefore inhalational injuries. Overall management of burns to improve survival takes precedence over the management of just the burned ear. Therefore, neglected ear burns can lead to cosmetic deformity which can vary from minor to very severe. Giving due importance to this small structure can prevent a lot of morbidity during the acute phase and deformities later on as a sequel of burns. Correction of those deformities and giving a normal shape to the ear can be a very daunting task because of the intricacies involved in framing the cartilage and inadequate soft tissue availability in the surrounding area. This article emphasizes on the steps which can be taken from the first postburn day to avoid complications like chondritis, chondral abscess, and various other deformities because in a patient surviving burn injury, the quality of his or her life will be determined by the degree of these deformities.

Introduction: The need to focus on reducing the incidence of burn wound infection in the low and middle income countries is highlighted. The high income countries (HIC) have been working towards achieving this objective and in the process have improved their burn outcomes remarkably. In India there are vast variations in the incidences of gram positive and gram negative infections, with some centers reporting a very high incidence of fungal infections responsible for higher mortality. These challenges were faced by the hospitals in HICs but they worked aggressively towards curtailing it and improving survivals. Materials and Methods: A retrospective analysis of the burn wound infection at the Burn unit of the Choithram hospital Indore, was done from 1 ^st July to 31 ^st December 2011. Aims: 1. To analyze incidence of multi drug resistance (MDR) organisms in burn patients, and 2. To co-relate sepsis induced mortality with underlying MDR infection. Results: The highest incidence was of Pseudomonas aeruginosa (43%). Methicillin resistant Staphylococcus Aureus (MRSA) was seen in 12% patients. We did not have any fungal infection in our patients. Sixty three point fifteen percent of these reports had multi drug resistance (MDR) infection. Overall mortality in the current study was 33.33% and mortality due to sepsis was 19.6%. Challenges and problems faced by the low and middle income countries (LMICs) burn care facilities are discussed and how it affects the outcomes. Conclusion: To overcome these challenges, strategies for training, education, motivation and resource allocation by the hospital administration are suggested to ensure a comprehensive burn care program from prevention to rehabilitation.

Background: Post burn axillary contracture along with breast contracture is a challenging problem to the reconstructive surgeon. Most often both types co-exist. The goal is to achieve full functional range of movement of shoulder with reconstruction of the aesthetic breast unit. Materials and Methods: This is a retrospective hospital based study of 15 patients, conducted over a period of 1 year from Aug 2009 to Sept 2010. All the patients in this study were prepubertal and postpubertal females of ages ranging from 13 years to 36 years and having post burn contractures of the axilla with involvement of breast. Axillary and breast release was done in the same sitting in all the cases. Axillary contracture was released followed by split skin graft (SSG) and/or with different types of flaps including propeller flap, along with release of breast mound to its proper size and shape to match the opposite breast. Raw areas were covered with radially placed medium thickness split skin graft around the nipple areolar complex (NAC). Assessment was done on the basis of functional and aesthetic outcome. Results: Out of 15 cases, 10 cases were of type 3 axillary burn contracture with breast contracture of moderate degree in severity. The abduction angle achieved post-operatively was >90 degrees in 14 out of 15 cases. The patients were assessed on the basis of patient satisfaction, size and shape of the axilla and the breast and position of the NAC from defined landmarks. It was found to be aesthetically fair in 9 cases, good in 5 cases and excellent in 1 case.

Objective: The objective of this study was to evaluate the etiological factors, nature and pattern of injuries, early and late morbidities of injuries, corrective surgeries, and final outcome and rehabilitation in pediatric electrical burns. Materials and Methods: This study includes 53 children, below 14 years of age. All children, irrespective of severity of injuries, were admitted, assessed, and treated. The charts of pediatric patients who had been admitted to the authors' Centre with electrical burn injuries from January 2006 to December 2011 were reviewed retrospectively. Etiological factors, nature and pattern of injuries, early and late morbidities of injuries, corrective surgeries, and final outcome and rehabilitation were evaluated. Results: Injuries resulted from biting an electrical cord (n = 8), placing an object into an electrical socket (n = 7), coming in contact with a low-voltage wire or appliance indoor (n = 18), coming in contact with a high-voltage wire outdoors (n = 17), e.g., while flying a kite (n = 3). Most of the injuries occurred at the age between 4 and 7 years. Sixty-seven percent of the patients having electrical burns were boys and 33% were girls (M:F, 2.1:1). Most of the injuries occurred between 12:00 and 6:00 PM (51%) and most common organs involved were trunk and upper limb (30%). A 100% skin graft take was recorded in 14 patients (78%) on day 4 postoperatively. Three patients (17%) required partial regrafting and one (5%) experienced a complete loss, which was resolved with regrafting. There were no flap losses. Four amputations were performed and three patients did not survive. Conclusion: The study revealed that if the basic principles of early and adequate resuscitation, proper wound care, maximum tissue preservation, early wound coverage by proper reconstructive procedures, and appropriate rehabilitation are adhered to, there will be a successful outcome for patients with these injuries. Almost every child with high-voltage current injury had a bad prognosis due to the severity of the injury.

Background : Burns occurring in conjunction with pregnancy can be a potentially life-threatening scenario as it may lead to a rapid depletion of the already diminished maternal reserves. The management protocol in a pregnant burn female has to be tailored, taking into consideration the additional factor of fetal well-being and the fetal susceptibility to various agents. For such alterations to be incorporated, it is imperative on part of the treating doctor to correctly ascertain the pregnant/nonpregnant status of an adult burn female. Though most cases of pregnancy can be diagnosed on the basis of history/ examination but it is not a totally reliant method and hence liberal use of the urine pregnancy test should be done. Material and Methods : This is a retrospective study of a total of 2217 burn patients who were admitted to JNMCH, AMU between July 2007 and July 2011. All burned women have been included and no exclusion criteria were used. Incidence of pregnancy in burned females, etiology, gestational age, total burn surface area, fate of pregnancy, duration of hospitalization, and the relationship between mentioned items were studied. Results : Out of a total of 2217 patients studied 954 of them were female of whom 685 were in the reproductive age group and 87 of these females were pregnant. 76 burnt mothers had sustained burns less than 50% TBSA. 19 mothers died as a result of burns of whom 14 had burns more than 50% TBSA. All fetuses died of mothers burnt more than 50% TBSA, while fetal mortality was 62.5% in burns involving 31-50% of TBSA and fetal mortality was 2.5% in burns with TBSA less than 30%. Conclusion : Both maternal and fetal mortality are directly proportional to the TBSA and best care should be offered to such patients suffering burns during pregnancy by a special multidisciplinary team experienced in managing such critical patients.

Introduction : Diwali is one of the most important festivals in India, but it also sees lots of people suffering from burns due to fire crackers. Methodology : This is a prospective study of 120 cases of Diwali-related burns in a period of 3 years. The data in the prescribed format were collected from two hospitals of Guwahati, the capital city of Assam. Results : There were 85 males and 35 females in the series. While 90 patients were directly involved in the use of the crackers, 30 were passersby or onlookers. The most common offending agent was the Flower pot (Kalgach) - 84 cases, while fire crackers were responsible for 23 cases, eight cases were due to chakari and five cases were due to the flame of earthen lamps. Majority of the cases (112) had burns between 2% and 6%, while six cases had 10-15% burns and two other cases sustained 45% and 60% burns. Seventy percent of the cases burnt their right hands, 10% burnt their left hand, 5% had burns in both the hands, 4% had burns of the trunk and limbs to a variable extent and 6% sustained facial burns. There were six cases (5%) of eye injuries. While 112 cases were treated as outpatients, 18 cases required indoor treatment. Most of the cases were treated with Collagen dry sheet dressing. A few cases (n = 5) were subjected to Early Excision and Grafting, while three cases required delayed grafting. Burn Prevention programs before Diwali were also undertaken in both the hospitals during the study period. The effect of the Burn Prevention Program on the incidence is also discussed in this paper. Conclusions : Awareness among the masses and strict implementation of government legislation may help in bringing down the incidence of Diwali-related burns.

Introduction: A majority of burn injuries in India occur amongst women, primarily in the lower and lower middle class population. The cost of burn treatment is high and the burden is increased because of the poor penetration of medical insurance amongst this unfortunate population. Aims: To study the socio-economic impact burn injuries have on the families of the patients. Materials and Methods: The study was performed using a formulated questionnaire. Twenty-five patients who had been admitted in the burns ward and discharged after treatment in 2011-12 were included in the study. The patients/attendants of the patients were interviewed telephonically and the responses were taken from the patient and/or their attendants and results were studied. Observations: All the patients were female. Amongst the 25 patients studied (n = 25), the average age was 29.44 years, with an average total burn surface area of 32.32%. Average overall expenditure was Rs 89,000 (approx. US$ 1750) of which in the early tangential excision and grafting group (n = 8), the expenditure was Rs. 60,000 (approx. US$1150); in the late grafting group (n = 6), it was Rs. 2,25,000 (approx. US$4320); whereas in the conservative management group (n = 11), it was Rs. 35,863 (approx. US$690). None of the patients were covered by medical insurance. Non-institutional loans and/or sale of assets were required by all respondents to bear the costs. Conclusions: The socio-economic burden of burn injuries is very high and government support is the need of the hour. In patients needing surgery, early tangential excision and grafting has a significant cost-benefit advantage.

Introduction : This study was carried out in the Department of Burns, Plastic and Maxillofacial Surgery, Safdarjang Hospital, New Delhi. Aim : The aim of this study was to assess the psychological status of patients with facial burn scars and to assess the quality of life (QOL) of these patients. Materials and Methods : The study was performed on 20 patients who were interviewed to assess depression (psychological status) and QOL. The assessment of depression was carried out using Beck's depression inventory, which has been translated into Hindi for use. The depression based on this questionnaire was graded into present or absent and further into mild, moderate and severe if present. QOL was assessed using the World Health Organization (WHO) QOL index questionnaire. The QOL was assessed to determine the environmental well being, adjustment to social relations, psychological well being and physical health and level of independence. The assessment of the patients was compared with the general population of similar socioeconomic strata. Results : The study showed presence of depression in all the studied subjects, with more females in the moderate and severe group of depression and more males in the mild group of depression. QOL assessment revealed significant derangement of psychological well being and social interaction in all subjects, but the physical abilities and environmental interaction were comparable to the normal subjects. Further, it is concluded to carry out larger and well-designed studies in burn and trauma patients to establish a protocol for assessment and management of post-traumatic stress disorders.

Background: A large number of burn injuries in India go unreported; injuries are largely preventable but still burn injuries lead to deformities and contractures limiting optimum and normal functioning of the individual. Materials and Methods: A community based cross-sectional study was conducted in the rural village of Phanda block. A house-to-house survey was conducted and the interview technique was employed to collect the data. Results: A total of 756 households with 3,677 population were surveyed. There were total 309 (8.4%) patients with burn injuries during the last 6 months. Majority of the patients were females (54.7%). Out of the total domestic burns, 71.3% occurred in the kitchen. Conclusion: Burn injuries are a serious public health problem. These injuries are preventable through design and promotion of more aggressive prevention programs especially for flame injuries occurring in the home environment.

Aim: To analyze the profile of acute thermal burn patients admitted to intensive care unit of a tertiary burn care center in India. Materials and Methods: Acute thermal burn patients admitted to the burn intensive care unit during June, August and December 2011 representative of summer, monsoon and winter season were included in this study. Observations: Overall 416 patients were admitted during this period. A total of 162 patients fulfilled the study criteria. Females outnumbered male victims. Patients in the age group of 20-40 years were most affected. Burns in females involve greater total body surface area (TBSA). Liquefied petroleum gas stoves, kerosene oil stoves and kerosene oil lamps are the most common causes of burns reporting to our center. Average distance travelled by patients to reach this hospital was 69.4 kilometers. Ten percent of the female thermal burn victims were pregnant and 3% were lactating. Discussion: An education program is needed to make the population aware of various etiological factors causing burns and their prevention. Safer means and practices should be adopted in kitchen. Local health care facility should play a major and proactive role in managing burns. Burn care needs to be decentralized for better management.

Splinting the hand in an anti-deformity position is mandatory in the management of acute hand burns. In this article, we demonstrate our modification of anti-deformity splint, made of an aluminium framework and rubber bands and show its advantages over traditional plaster of paris (POP) splint.

Postburn kyphosis is extremely rare. Literature on this subject is lacking. We successfully managed a case of postburn mentosternal contracture with kyphosis of thoracic spine by a pedicled thoracodorsal artery perforator (TDAP) flap, postoperative postural bracing and physiotherapy. We had good functional and aesthetic outcomes with a satisfied patient and possible surgery for the spine was avoided. We would like to highlight this rare occurrence of a postburn kyphosis and present a detailed study of this case.