Introduction: Normal wound repair of human skin involves several well-orchestrated phases, which are overlapping, yet distinct in their own way. This presentation aims to define, identify, and classify scars, irrespective of the etiology, describe the methods available to differentiate the various types of scar, and describe the current management strategies available to prevent scar formation. From our studies we conclude that for a good scar outcome early intervention during the evolution of wound healing is required. Meticulous surgery is also essential. Various interventions could be with drugs, chemicals, growth factors, or ionizing radiation. Future holds for continued research in cellular signals.

After postgraduation when a surgeon settles down in practice, just the theoretical knowledge does not help him. He has to imbibe certain qualities such as good manners, hard work, good convincing power in explaining the operative procedure and expected results. Besides he has to be very tactful in dealing with a situation when some unfortunate complication occurs. This presentation comprises some important tips a surgeon should know to keep his patients satisfied and avoid litigations.

The incidence of postburn pruritus is reported to vary between 80% and 100% and the persistence of itching leads to disabling symptoms such as sleep disturbance, anxiety, and disruption of daily activities. Recently, a few small randomized controlled trials by investigators have focused our attention to the neurobiology and molecular mechanisms of the postburn pruritus and the role of centrally acting agents in its treatment. It is now recognized that the central nervous system develops aberrant autonomous activity that causes maintenance of pruritic symptoms into a chronic state. This practical review on the topic aims to rationalize and simplify the current treatment options, through emerging and available evidence, to enable the physician to make an even better informed choice. While antihistamines and massage therapy will continue to be effective first-line strategy for most clinicians, the promising results in controlled studies obtained with gabapentin/pregabalin to ameliorate pruritic symptoms in a predictable fashion in burns patients have caused a paradigm shift in the therapeutic approach. Tailoring the drug therapy to the severity of symptoms leads to more successful therapy of this vexing malady and current evidence supports the use of gabapentin/pregabalin in patients with moderate to severe postburn pruritus (visual analog scale score >5) as the first line, even if as an "off label" indication. Other treatment modalities like doxepin, ondansetron, or transcutaneous electrical nerve stimulation may have applications on a case to case basis. However, massage therapy should continue to be an adjunct with all other modalities.

Facial burns commonly involve the eyelids. The eyeball as such is usually protected due to the blink reflex, bell's phenomenon, and protective movements of arms and head. Ocular sequelae are seen secondarily due to retraction of the burned eyelids which leads to drying of cornea and its subsequent ulceration and perforation. Permanent visual impairment is rare if prompt management is done. Superficial lid burns usually heal spontaneously and can be managed conservatively with ophthalmic antibiotic ointments, artificial tears. However, in deeper burns, early surgical intervention in the form of eschar debridement or release of contracted lids and resurfacing defects with split skin grafts can prevent secondary corneal damage. This review article elaborates the principles of management of acute ocular and periocular burns as well as the long-term management of eyelid burns.

This article tells the story of the making of collagen sheets as dressing material in India. The thought process behind the science and the methods of usage of collagen sheets have been deliberated upon. Versatility of collagen based dressings is approved by most of the surgeons and plastic surgeons for burn injuries. There have been no adverse reactions by way of allergy, or anaphylaxis. Collagen dressings are very cost-effective, less labor intensive, but the person who uses must understand the nuances thoroughly, before starting to use. It is better to learn all about the membrane prior to using it.

Aim: The aim of the following study is to assess the efficacy of Raal ointment (herbal plant resin) compared with 1% silver sulfadiazine cream as a burn dressing for the treatment of second degree burns covering less than 30% of the body surface area. Materials and Methods: A randomized comparative study was carried out at our institute during August 2010 to June 2012. Ethical committee permission was obtained. Written informed consent was taken from each patient. Fifty patients with second degree burn wounds of approximately equal size present on both half of the body were selected. One side of the wound was treated with silver sulfadiazine cream and the other side of the wound was treated with Raal ointment. Raal ointment is an herbal product made up of resin of Shorea robusta plant. Both the wounds were assessed for parameters such as pain, infection, rate of healing and resultant scar. Results: The average pain score was 7.02 (Scale 0-10) in silver sulphadizine cream group when compared with 5.14 in the Raal ointment group at the end of 24 h (P < 0.0001). At 48 h the average pain score was 6.12 in silver sulfadiazine group, whereas it was 3.86 in the Raal ointment group (P < 0.0001). The result was statistically significant. Infection rate was 20% in silver sulfadiazine group and was only 12% in Raal ointment group. In Silver sulfadiazine group healing was achieved on an average of 19.06 days. In Raal ointment group, it took an average of 17.2 days (P < 0.0001). This shows that Raal ointment dressing helps in decreasing healing time when compared with silver sulfadiazine cream dressing. Resultant scar of both groups were assessed using Vancouver scar scale at the end of 10 weeks and 14 weeks. Both the treatment groups had equal quality of scar at 10 and 14 weeks. Cost-effectiveness was calculated by comparing the cost of the same amount of silver sulfadiazine cream and Raal ointment. Raal ointment was a cost-effective alternative to silver sulfadiazine cream for treatment of burn wound. Conclusion: Raal ointment was found superior in pain control, rate of healing, control of infection and cost-effectiveness than silver sulfadiazine cream for treatment of second degree burns.

Background: In order to alleviate pain, reduce scarring, and to improve the overall outcome in burn patients multitude of novel agents are being utilized. In this regard, heparin has been introduced because of its research proven role in burn wound management. Objective: The objective was to evaluate, whether the addition of heparin, administered only topically, could improve burn treatment. Materials and Methods: The subjects in this study were 40 consecutive burn patients with 10-20% burns, randomly allocated to heparin group (H-group) (20) and control group (C-group) (20). Results: All patients in the H-group were receiving analgesics on demand only from the 2 ^nd week onwards. This was in contrast to the C-group wherein 35% patients received twice daily dosage of analgesics in the 2 ^nd week of their treatment. When compared to the average hospital stay of 18.3 days in the C-group, patients belonging to the H-group had an average hospital stay of 12.3 days (P < 0.05). Conclusions: The current comparative study demonstrates that heparin significantly decreases the requirement of analgesics and the time required to prepare a burn wound for grafting. Besides as compared to silver sulfadiazine dressings, heparin appears to be cost-effective.

Aims and Objectives: To evaluate the impact of comorbidities on the outcome of burn injuries. Materials and Methods: A retrospective analysis of 108 patients, treated between August 2010 and July 2013, was carried out. All patients were admitted, assessed and managed. The medical notes on 72 patients with comorbidity (Study group) were analyzed and matched with 36 other patients, without comorbidities (Control group), according to age, gender, and interval time between injury and admission. Information regarding types of burn injuries, depth of burn, comorbidities, operative procedures and final outcome were noted. Results: Patients were evaluated in terms of their duration of stay in the hospital and mortality. The comorbidities that influence these factors are renal disease, liver disease, cancer, pulmonary disorders, cardiac disease, obesity, peripheral vascular disorders, alcohol abuse, smoking and neurological disorders. Conclusion: It was found that the associated comorbid conditions influence the outcome of patients, injured due to burn, in terms of the duration of their stay in the hospital and mortality.

Aim: The aim of the present study is to evaluate various prognostic factors in burn patients and predict prognosis and mortality of patients on the basis of prognostic factors. Materials and Methods: A study was conducted on 10 adults, total body surface area burns of >40% (40-90%) sequential thermal burn admissions at Burns Center. Blood samples were drawn from day of admission to discharge. Results and Statistics: (1) Fatal outcome in four patients, persistent serum cholesterol <100 mg%. (2) The difference in cholesterol values in patients with fatal outcome and survivors was significant. On comparing median cholesterol values for non-survivors and survivors on post-burn day-7, there was statistically significant difference (P = 0.039) by Mann-Whitney U-test. Serum cholesterol was significantly lower in fatal cases. (3) Infection or sepsis in patients correlated with the presence of toxic granules, toxic vacuoles on peripheral smear, raised total leukocyte count and low values of serum cholesterol. (4) Echinocytes (spiculated red blood cells [RBC]) were seen in all patients. In four patients, they persisted from post-burn day 4 until death. Progressive decrease in echinocytes, which correlated with rising cholesterol values was seen in survivors. Conclusion: Poor outcome in burn patients is related to persistently low serum cholesterol, high serum triglyceride and presence of echinocytes, toxic granules, toxic vacuoles and high white blood cell counts or vice-versa.

Objective: Prevention of nosocomial infection in burn patient is a major challenge. Endogenous flora or the colonizers of the surrounding environment are the main source of infection in this group of patients. Continuous monitoring of infection in burn patients is necessary to evaluate the source and pattern of distribution of microorganisms. The study was planned to assess the bacteriological and antimicrobial resistance profiles of burn patients in our intensive care unit (ICU). Materials and Methods: Wound swabs from 100 consecutive burn patients were collected on days 1, 4 and 7 of admission to the burn ICU. Environmental samples were also collected from the surroundings of burn ICU and studied for the bacteriological and anti-microgram profiles. Results: Acinetobacter baumanni, Pseudomonas aeruginosa remained the major isolates from the wound swabs. Acinetobacter baumanni and Staphylococcus aureus found to be the common isolates from the environmental samples. In both the instances the strains were found to be multidrug resistant (MDR) type. Majority of the environmental colonizers were isolated from sink, bed cradle and patient's bed. Conclusion: In this study, colonizers of the environment appeared to play a major role in causation of nosocomial infection in burn patients. Hence, periodic monitoring and assessment should be done to strengthen the infection control practices in burn unit.

Neck reconstruction for cervical scar contracture after burn injuries often takes priority over other areas. The ideal material for coverage of defects created by neck contracture release is thin, supple, large well vascularized healthy tissue. We present here our experience of seven cases of postburn neck scar contracture release and reconstruction with free parascapular flap cover. Patients and Methods: Seven adult females, 18-44 year age group, 6-15 months postburn, total body surface area 20-60% burns, moderate to severe contractures limited to the most visible anterior aspect of the neck were reconstructed with free parascapular flap. Results: All flaps survived with good aesthetic and functional mobility. Donor sites were closed primarily in all patients. Conclusion: Parascapular free flap reconstruction of postburn neck contracture is reliable and effective method. It provides large supple skin flap with good color match for esthetic and functional reconstruction of postburn neck scar contracture.

Upper gastrointestinal lesions are a known complication in burn injuries and are considered to be caused by acid-peptic digestion of gastric mucosa. Antacids and H2- receptor blockers are administered to neutralize the gastric secretions. The study aims to observe the incidence of upper gastrointestinal lesions, their natural course, the influence of the early oral feeds, oral Sucralfate and parenteral Ranitidine, the clinical and endoscopic incidence of the bleed. This study was undertaken on 92 patients having burns varying between 10% and 70% of body surface area and admitted within 24 h of the injury. Patients were divided randomly into three groups. Group I: Ranitidine at a dose of 50 mg intravenously twice a day was commenced from the time of admission and oral feeds after 24 h. Group II: Oral feeds, and sucralfate, 2 g at four hourly interval were administered from the time of admission. Group III: Oral feeds alone were given from the time of admission. Endoscopy was done at weekly interval, starting after 3 ^rd postburn day, after stabilization of the patient. Upper Gastrointestinal lesions were seen in 46% of patients, and they lasted up to 6 weeks while only 8% developed bleed. The lesions showed a direct proportionate relationship to the percentage of burn. Both Group I and Group III patients developed bleed, the incidence of which was more on endoscopy than the clinical manifestation. Group II patients did not have any bleed.

Introduction: The incidence of electrical accidents has increased, due to use of electricity in the house hold, institutions and industries. Electrical injuries can cause extensive disFigurement to that of significant functional disability and sometimes can be fatal due to cardiac events and therefore the patients need to be closely monitored in an ICU set up. Management of electrical burns patient requires a team work of surgeons and physicians. Materials and Methods: This retrospective study was conducted between January 2007 and December 2012 in the Burn Unit of Sri Devaraj Urs Medical College, Kolar, Karnataka, a rural tertiary care center of South India, to assess the demography, degree of disability and loss of life due to electrical burn. Result: We had 47 patients of electric burns admitted in our center. Most of the accidents leading to the electrical burn injuries could have been prevented. Conclusion: Prevention is possible by increasing public awareness through primary education among the rural people and by taking adequate precautions such as the use of personal protective equipments (insulated gloves and footwear.) and following national electrical codes.

Background: Burns are among the most devastating of all injuries and a major global public health crisis. The objective of this study was to record and to evaluate the epidemiology and mortality of burn cases as they vary widely in different regions and then bring about a prevention program designed according to the needs of the region. Materials and Methods: Prospective data was collected after informed consent from all burn patients admitted to the Government District Hospital during the study period. The District Hospital is a 750 bedded Government Hospital with the burns ward of 20 beds under the Surgery Department. Information about patients socio-demographic profile, mode and cause of burn, total burn surface area, place of burn, material of clothing worn by the victim at the time of the incident and outcome were recorded on a pre-designed and pre-tested questionnaire from the patients themselves if they were well enough or from their caretakers. Results: Out of 240 burn patients admitted during the study period, 134 (55.83%) were females. Majority (54.58%) were between 21 and 40 years of age. Flames caused 83.75% injuries (P = 0.001163). Maximum number (81.66%) were accidental followed by 9.58% alleged suicidal and 8.75% alleged homicidal injuries. At the time of injury, 48.75% victims were wearing synthetic clothes (P = 0.0000001). It was observed that the majority of the males (55.66%) recovered, whereas mortality was 51.47% in females (P = 0.0000001). The overall mortality rate was 37.50%. Conclusions: Utmost attention should be given by all concerned for prevention of burns and education regarding safety measures should be implemented in schools and colleges to decrease morbidity and mortality.

Background: Burns are the third most common cause of mortality in children and adolescents. It is also a major cause of morbidity and mortality in individuals of all age groups, particularly in individuals living in the developing countries. Objective: The objective of this study is to determine the causes of extensive burn injuries in our population, sex, age, distribution of extensive burn injuries by years, duration of treatment, the methods of treatment and mortality. Materials and Methods: In this retrospective study, we retrospectively analyzed data of 69 patients during the 4-year period between January 2008 and January 2012, with extensive burn injuries admitted to the ICU-University Clinical Center of Kosovo. Among them, 53 patients were males and 16 were females with a male to female ratio of 3.3:1. Conclusion: The high rate of transferring patients for treatment abroad to other countries of 28.9% and high mortality rate of extensive burns in our country with 11 cases (15.9%) is a reflection of lack of burn care in our department.

Background: Injuries and deaths from burns are a serious, yet preventable health problem globally. This paper describes burns in a cohort of children admitted to the burn's ward of Victoria Hospital, BMCRI, Bengaluru, India. This 3 years study was of the consecutively admitted patients from August 2008 to July 2011. Information was collected using a protocol-specific data collection sheet. Descriptive statistics (percentages, medians, means, and standard deviations) were calculated, and data were compared between age groups (and other criteria as indicated in comments). Findings: During the study period, 900 children were admitted with 280 (31.1%) girls and 620 boys (68.9%). The peak age of occurrence was between 1 and 4 years (44.7%). The peak period of occurrence is between August and October (41.5%). The majority of children 411 (45.6%) suffered scald burns. Closely following is the group of accidental thermal burns involving 375 (41.7%) children and 96 (10.7%) children sustained electrical burns. There has been an alarming rise of suicidal thermal burns in the pediatric population. Conclusion: Toddlers are most at risk for sustaining severe burns when their environment is disorganized while adolescents act on impulse. Burns injuries can be prevented by improving the home environment and socioeconomic living conditions through the health, social welfare, and education and housing departments apart from reducing stress levels of older children. It is high time that we introspect into the social support system of the country with regard to its addressing the emotional needs of the adolescent group and stress management strategies that are available to these youngsters who are giving up on life so easily.

Background: Burns are a common injury in developing countries creating a major public health problem and are associated with significant morbidity and mortality. Our aim was to study the epidemiology of various demographic characteristics, their outcome and prevention. Materials and Methods: All acute burn cases admitted to the burn unit of Sheri-Kashmir Institute of Medical Sciences, ( tertiary care referral centre in Kashmir, India) over a period of 2 years (2010-2011) were investigated. The registration data regarding various demographic characteristics, mode of burn injury, time of presentation after burn and associated risk factors and illness. Assessment of burn wound was done regarding site, affected body surface area, degree, depth, severity of injury and complications. Data were collected and analyzed statistically. Results: Patient's ages ranged from 1 to 65 years with a mean age of 24.2 ± 7.6 years. The most common class of the population burnt were school going children (32.70%) followed by housewives (19.10%). Eighty percentage of patients belonged to rural areas and 20% to urban areas. Flame burns were more common in females (52.1%), electric burns were more common in males (93.3%) and scalds were more common in children (64.3%). Most of the burns were accidental (96.4%). 64.5% of patients reported within 24 h to hospital. 56.3% of patients had mixed degrees of burns, and 22.7% had third degrees of burns. Mortality was 11.8% and most common causative agent responsible was flame. The outcome was significantly associated with mode of injury, degree, depth, extent, causative agent and gender. Conclusions: This study provides important aspects of burn injuries for medical and nonmedical healthcare workers. The majority of burns are accidental seen in school going children, housewives and linemen of Power Development Department as a result of scalds, flame and electric burns respectively. Measures should be taken regarding awareness and education programs about burn prevention to reduce morbidity and mortality associated with it.

Introduction: Electrical injuries represent a special type of thermal injury, with a patho physiology depending on the voltage, current flow and resistance of the skin. Electrical injuries can produce significant morbidity and long-term sequelae. Aims and Objectives: This study is a comprehensive institutional review of database of patients with electrical injuries, from initial resuscitation through final impairment ratings. Materials and Methods: The study period was for 5 years from January 2008 to December 2012. All Patients admitted in burns ward with electrical injury are included in the study. A proforma was used to collect details. Procedures needed, their timing, final impairment ratings, and return to work were recorded. The results are quantified in terms of incidence of various complications incidence of amputations, mortality rate, disability incidence, etc. Result and Analysis: Electrical injuries can produce significant morbidity despite relatively small burn sizes. Electrical injuries occur in young males and leads to high incidence of upper extremity amputations, resulting in long period of unemployment and extensive new job training and rehabilitation. Patients require early operative procedures for prevention of further injury. Timely reconstructive surgery may improve final function and return to productivity. Work site accident, which is an important cause is largely preventable.

We report a series of trouser pocket burns caused by firecrackers. This study is a single center, prospective case series in which the records of seven patients with trouser pocket burn injuries were analyzed. The main cause was keeping failed firecrackers in the trouser pocket. Involvement of genitalia makes these burns serious.