Background: Pseudomonas aeruginosa is an important cause of hospital acquired infection especially in patients admitted in critical care units such as intensive care units and burn care units. Because of its considerable potential to become resistant to important anti-pseudomonal agents, infection of burn wounds by P. aeruginosa, especially by multi-drug resistant (MDR) strains has become a major problem. Aim: This study was carried with an aim to determine the antimicrobial resistance pattern and prevalence of MDR P. aeruginosa infection among burns patients at a tertiary care center. Materials and Methods: This cross-sectional study was carried out from June 2013 to July 2014 in microbiology laboratory of a tertiary care center. In this study, 102 nonrepetitive clinical samples from patients admitted in burn unit were collected and the isolates were identified by conventional phenotypic methods. The antibiotic sensitivity testing of all P. aeruginosa isolates was done using Kirby-Bauer disc diffusion method and the results were interpreted according to the Clinical and Laboratory Standards Institute guidelines. Results: Out of 102 clinical samples, P. aeruginosa was isolated from 56 (54.9%) samples. Out of these 56 isolates, 43 (76.8%) isolates were MDR. Majority of the isolates were resistant to amikacin (73.2%), gentamicin (84%), tobramycin (75%), ceftazidime (76.79%), ciprofloxacin (71.4%), cefepime (64.6%), piperacillin (80.36%) and imipenem (61%). Conclusion: The prevalence of P. aeruginosa infection in patients admitted in burns unit was found to be 54.9%. This study showed an increased prevalence (76.8%) of MDR P. aeruginosa infection in burn patients.

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Background: Diwali is an occasion when many people get injured or burnt. Most of the data on morbidity profile of the communities is the hospital-based and there is a lack of community-based surveys. Materials and Methods: The present study was a cross-section survey conducted in the resettlement colony of Gokalpuri, Delhi, after Diwali in the month of November and December, 2013. A total of 406 households were interviewed with questions on demographic details, any injuries suffered post-Diwali and the treatment sought thereafter. Results: In the population of 1826 surveyed, only 148 (8.1%) suffered from any problem this Diwali. Majority of the participants (105; 70.9%) had respiratory complaints ranging from mild cough and wheeze to asthmatic attack while 24 (16.2%) suffered burns on any part of the body. Eighty four (56.7%) people who suffered any problem post-Diwali didn't do anything for the problem, rather left it to get well on its own. Only 32 persons had gone to health center for treatment. Conclusion: In the current study, prevalence of post-Diwali morbidity was 8.1%. The observed prevalence in the current study is much higher than that reported in a hospital based retrospective study by Tandon et al. from Delhi which collected data from 2002 to 2010 and where the incidence was one patient with firecracker-related injury per 100,000 population of the city.

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Post-burn neck contracture (PBC) is one of the most common burn sequela. These contractures affect the patient significantly causing both functional limitations and esthetic disfigurements. Hence, the reconstruction of this area is a challenge to surgeons who must choose a technique, which restores the function and also improves the esthetic appearance. Aims: The aims of this study are to provide a simple classification of PBC and offer surgical solutions for each section of our classification. Materials and Methods: This retrospective study was carried out on 140 patients with PBC neck who were classified according to the functional defect and the anatomical type of scar. Results: We offer a simple classification system for PBC neck depending on the degree of contracture into mild, moderate and severe and also according to the type of the scar into linear, band or broad type.

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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.

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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.

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Background: Burn injuries account for a significant cause of mortality and morbidity amongst the Indian population. Since prevention is more important than the treatment of such injuries, this study was undertaken to find out the exact epidemiological determinants of such injuries and thus to try and formulate effective preventive strategies. Aims and Objectives: To find out the epidemiological characteristics of burn patients in a tertiary care hospital. Materials and Methods: A Cohort review of patients admitted over a period of 3 years from January 2010 to September 2013 in the burns unit of our institute. Data were collected from hospital admission books which included age, sex, religion, Total body surface area burns, location, mode of burn and the cause of burns. Data were entered in MS EXCEL software and analysed. Results: There are 3179 patients included in the study. The mean age of patients was 28 years (SD=14.7 years) and overall male to female ratio was 0.6. The percent of Total body surface area for burned patients ranged between 1% and 100% and maximum number of patients were admitted with 30 to 50 % burns (27.5%) The median hospital stay was 5 days. There was a significant association between Total body surface area burns and hospital stay (P<0.001). 7.3% patients were discharged from the hospital after successful treatment. 1733 (54.51%) deaths were recorded. Death rate was higher amongst females as compared to males. Mortality rate was highest in age group of 12–26 years. There was a significant correlation between Total body surface area burns and mortality (P<0.001). Death rate was highest amongst patients with suicidal burns as compared to accidental and homicidal burns.75% patients died within 5 days of hospitalization. Conclusion: High mortality rate amongst patients is a major concern in the present scenario of health care towards burn injuries.

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Introduction: Thermal burns could prove dreadful to humankind. The morbidity and mortality is the interplay of intraneous and extraneous factors. Multidisciplinary approach plays a cardinal role in managing this catastrophe. This study is carried out to analyze the oxidative stress in thermal burns, its implications in management, and the significance it carries with it. Materials and Methods: This prospective study was carried out in 30 patients from January 2016 to December 2016. Quantitative analysis of oxidative stress and total antioxidant capacity was done on postburn day 3 and every 5 days thereafter. Results: The quantitative oxidative stress level was high, and antioxidant capacity was low in patients who had higher percentage total body surface area burn and predominant deep burn with temporal analysis. The patterns were strikingly different in patients who had mortality with patients who survived. Discussion: Thermal burn releases reactive oxygen species which causes profound changes in internal and external milieu. This alters the physiological response to treatment and impresses on the morbidity and mortality of the patient. Conclusion: Thereby, it could be construed that oxidative stress along with tailored intervention, timing of treatment, and recalcitrant attitude to treatment methodology has a significant role in determining the outcome of burn patients.

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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.

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Radiation dermatitis is the commonest side effect encountered during definitive radiotherapy. Radiation depletes the basal cell layer of skin and initiates a complex sequence of events leading to dose-dependent acute or late sequelae. The incidence and severity of radiation dermatitis depends upon multiple patient and treatment related factors. With the use of megavoltage radiation and implementation of conformal radiotherapy, the incidence of severe radiation dermatitis has reduced significantly. Treatment interruptions due to severe reactions may affect outcome. Prevention and management of radiation dermatitis requires a multidisciplinary approach. For acute radiation dermatitis, maintaining hydration which will eventually promote epithelialization is the key; while for moist desquamation, prevention of infection and facilitation of epithelialization are important. Barrier dressings like human amniotic membrane and hydrocolloid dressing are useful as they prevent trauma and infection, trap moisture, and thus facilitate healing. Late radiation dermatitis presenting as a difficult to treat long standing chronic radionecrotic ulcer is seen rarely in the current practice. Radionecrosis refractory to hyperbaric oxygen therapy (HBOT) may require surgical intervention to restore function and alleviate pain. Although there is lack of robust data to define strict policies for management of radiation dermatitis, the current practices are based on institutional protocols and personal experiences.

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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.

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Introduction: Acid attack in women is a burning issue in the present scenario. It is the most heinous form of violence against women. This study was designed to know the victim's profile, motives behind the acid attack, and the role of restorative treatment in improving their living standards. This study also makes people aware about the program running for acid attack survivors in Uttar Pradesh. Materials and Methods: This is a retrospective observational, analytical study of acid attack victims who were admitted to the plastic surgery department between July 2012 and June 2017 following the assault, 52 cases were included in this study period. Results: Roughly more than 50% of cases recorded were <30 years of age, while the most common age group involved was 18–28 years age group. Relationship problems were the most common reason for the attack. All cases of acid attack survivors were disfigured; 78.8% were visually impaired. Bilateral blindness occurred in eight cases. A total of 65% of the victims belong to urban areas. More than 90% of cases were suffering from more than 2% burn over the face. Surgical correction was done in all cases to improve them functionally and cosmetically as far as possible. Conclusion: In spite of several laws and schemes, a continuous increase in number of acid assault in North zone of India is a matter of serious concern. Along these laws and schemes, strategies for social upliftment against orthodox culture should also be adopted.

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Purpose: To investigate the common aetiological agents and their antibiotic resistivity pattern in burn wound infections in this geographical area. Methods : Swabs from the burn wounds were collected on random basis using sterile cotton swabs from the patients admitted to Burn ward of Government Hospital, Gulbarga, Karnataka (South India) during 2012-13. Antimicrobial susceptibility testing was done by Kirby-Bauer disc diffusion method according to M02-A11 and M100 -S22 Clinical Laboratory Standards Institute (CLSI) January 2012 guidelines and procedures on Mueller-Hinton agar. Results: A total 91 swabs from burns wound infection were collected from the patients of Burn Ward, out of which 83 were positive. Pseudomonas sps (33.73%) and S. aureus (27.71%) accounted for 61.44% of the positive cases as single aetiological agents. Klebsiella sps and E. coli accounted for 22.88% of the cases. The remaining 15.65% of cases had mixed aetiological agents. The results revealed the dominance of Gram negative organisms. It is significant to note that 64.52% and 24.19% of Gram negative bacterial isolates (62) were ESBL and MBL producers respectively indicating the base for the emergence of drug resistance. S. aureus was isolated from 23 positive cases as a single aetiological agent (27.71%) while it accounted for 11 (13.24%) cases with other co-pathogens. In the present study 67.65% (23 out of 34) Staphylococcus aureus isolates were Methicillin-resistant. Conclusions: The present study has revealed the emergence of MDR strains of Gram negative bacilli especially Pseudomonas sps and S. aureus as the predominant aetiological agents in burn wound infections in the hospital environment.

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Background: Burn patients are at high risk for infection, and it has been estimated that 75% of all deaths following burns are related to infection. It is, therefore, essential for a burn institution to determine its specific pattern of burn wound microbial colonization, time-related changes in predominant flora and antimicrobial profiles. Aim: To find out the bacterial and fungal profile of burn wound and evaluate the antimicrobial susceptibility pattern of the organism isolated. Materials and Methods: The present study was conducted in the Department of Microbiology, Dr. V. M. Government Medical College, Solapur, Maharashtra from December 2012 to December 2014. The wound swabs were collected from 50 patients, having total body surface area of burn in between 20% and 40% on the 4 ^th , 10 ^th , and 16 ^th day. Total 202 wound swabs were collected aseptically and cultured for the growth of bacteria and the fungi. Bacterial growths were then subjected to various biochemical tests for identification and antibiotic sensitivity testing. Results: Single isolates were present in 71.28%, and multiple isolates were noted in 18.31% of wound swabs. The isolation rate of Gram-negative organisms was high. The most common isolate was Klebsiella pneumoniae (34.40%) followed by Pseudomonas aeruginosa (23.94%), Staphylococcus aureus (22.94%), Escherichia coli (7.34%), Acinetobacter spp. (2.75%), Proteus mirabilis (2.75%), and Citrobacter species (1.38%). Candida species (4.59%) was the only fungus isolated, of which Candida albicans (50%) was the most common. Gram-negative bacteria were the most sensitive to imipenem (93.67%) and amikacin (75.94%) while Gram-positive bacteria were the most sensitive to linezolid (100%) and vancomycin (100%). Conclusion: K. pneumoniae was found to be the most common bacterial agent involved. The results of the present study will be helpful in understanding the pattern of burn wound microbial infection, the dominant bacterial and fungal flora, and the antimicrobial resistance.

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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.

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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.

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Introduction: The aim of the reconstructive burn surgeon is to remove all the scar tissue in the affected area and resurface the area with supple tissue, which allows proper movement of the neck and is esthetically pleasing. We present our series of 10 patients of burn neck contracture, primary and recurrent, who were treated with free flap reconstruction. Patients and Methods: A retrospective review of all the data of the patients was done and the demographic data, preoperative and postoperative examination findings, surgery offered, results and follow-up details were tabulated and analyzed. Results: All the flaps survived completely. Two flaps showed postoperative congestion on day 1 and were taken to the operating room to be reexplored. All patients showed marked improvement in the degree of neck extension, lateral flexion, and rotation which remained unchanged with successive follow-ups. Conclusion: The results of free flap reconstruction of the burn neck contracture area appear to be better than other methods in terms of functional and esthetic restoration of the normal anatomy. The postoperative morbidities for the patient are also reduced and patient comfort is enhanced. The authors feel that in centers where microsurgical expertise is available, the patients of burn neck contractures may be offered the option of complete scar excision and free flap reconstruction as a primary option instead of scar release and split skin grafting.

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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.

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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.

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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.

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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.

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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.

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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.

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Context: Early surgical debridement in burns has its disadvantages like extensive blood loss and long anaesthesia time and risks. Enzymatic wound debridement as an alternative to surgical debridement has been assessed for its effectiveness, safety and patient compliance. Aims: To assess the effectiveness and safety of papaya pulp as an enzymatic wound debriding agent in burns. Setting and Design: The study was conducted including 50 patients with second degree and third degree burns, age ranging from 15 to 60 years from January 2004 to December 2004 at the Burns Centre, Department of Plastic, Reconstructive and Burns Surgery, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India. Materials and Methods: A prospective study including 50 patients with second degree and third degree burns, age ranging from 15 to 60 years was carried out from January 2004 to December 2004 at the Burns Centre, Department of Plastic, Reconstructive and Burns Surgery, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India. There were 38 female and 12 male patients in the study group. Areas of burns ranging from 10% to 60% TBSA were included in the study. Daily dressings were done using autoclaved unripe papaya pulp smeared on potato peel dressing. The progress was assessed daily and application stopped when adequate debridement has been achieved or a maximum of 1 week. Statistical Analysis Used: None. Results: All 50 patients included initially completed the study. There were 38 females and 12 males. Papaya pulp was found to be a very effective debriding agent in all cases. Deep dermal wounds cleared up in 5 to 6 days and eschar in full thickness burns became loose by this period so that it needed minimal surgical debridement. The granulation tissue found following debridement with papaya pulp was pink and healthy. In patients who had to be taken up for grafting, a mild scraping was sufficient before placement of a graft. This has helped on reducing blood transfusions and has considerably reduced anaesthesia time. Conclusions: The use of papaya pulp results in 1. Early and complete non-invasive debridement, 2. Healthy granulation tissue, 3. Decreased blood loss and hence decreased number of blood transfusions in cases which have to be grafted, as excision is avoided. 4. Less operating time and hence less anaesthesia time.

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Introduction: Accurate assessment of burn wound depth is important because it determines the choice of treatment and prognosis. Clinical evaluation remains the most commonly used modality with its accuracy varies from 50% to 70%. This study was conducted to assess the accuracy and feasibility of burn wound depth using noninvasive noncontact technique using infrared thermometry. Materials and Methods: Fifteen patients' burn wounds depth was classified clinically into full-thickness, deep partial-thickness, or superficial partial-thickness burns. Thermometry was performed on 3^rd day of burn injury using the handheld infrared thermometer. A punch biopsy was taken from all three areas (deep, deep-partial, and superficial-partial burns). A correlation between surface temperature and depth of burn by histopathology was done. Results: 12/15 patients total burn surface area (TBSA < 65%) survived and three patients (TBSA > 65%) died. In 11/12survivors, thermometry correctly predicted final burn depth. One of 12 burns superficial burn was wrongly assessed clinically as full thickness but was correctly classified by thermometry and healed within 21 days without surgery. 3/12 burns on clinical assessment thought to be superficial were deep; two were correctly predicted by thermometry. Conclusions: Handheld infrared thermometer can be used in conjunction with clinical examination to improve the efficacy of burn wound depth assessment.

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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.

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