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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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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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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Background: Burns in the pediatric patients are usually caused due to accidental spillage and scalding by hot liquids. These are usually partial thickness burns. Collagen dressings have a better outcome in the management of partial thickness burns. Methodology: One hundred patients <12 years of age were included in a retrospective study from January 2013 to 2016. Patients were analyzed in terms of age and sex of the patient, type of burns, duration of presentation, degree and percentage of burns, and complications. Results: The mean age of presentation was 4 years. Ninety-eight percent of children had burns secondary to scalding. Collagen was applied for all patients. Ninety-two patients had no complication. Eight patients had minor complications. Conclusion: Collagen sheet is very useful in first- and second-degree burns in children. It is well tolerated, provides multiple benefits, and it has fewer complications.

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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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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.

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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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Objective: The objective was to study and describe the presenting patient characteristics for those with chemical burns acquired from hair removal beauty products. Methods: Retrospective single-center chart review was done to identify all burn injuries caused by the use of depilatory cream use. Results: A total of seven patients who acquired burn injuries due to depilatory cream use were identified. Six were female and one was male. Patients' age ranged from 3 to 43 years, with a mean age of 27.2 years. Total body surface area of the burns ranged from 0.18% to 0.79% including first- and second-degree burns; none of the patients acquired third-degree burns. Most of the injuries involved groin and pubic area. All patients were treated with wound care, and none required inpatient care. All of the patients who presented to follow-up visits showed re-epithelialization and good healing. Conclusion: Depilatory cream is a corrosive chemical hair removal agent that can lead to unintended chemical burns if used improperly. Burn-care provider, as well as other health-care providers, should be aware of this unusual cause of chemical burn and educate their patients appropriately.

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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.

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Introduction: Postburn contracture (PBC) is one of the common sequelae encountered after burns in general surgical practice. Surgical management of such deformities involves release of contracture followed by cover by skin graft or skin flap. Optimum management of PBCs has always been a challenge to the surgeon because of paucity of adequate healthy skin in the affected areas. Various operative techniques are available, and the surgeon has to decide which particular technique will be more suitable for a particular patient. We have employed the techniques of release by Z-plasty, and release and skin grafting in managing PBC involving upper extremity, and this study is based on our experience with these techniques. Aims and Objective: The study was carried out to evaluate the frequency of different PBCs involving upper extremities and comparing the relatively simpler techniques of release of contracture and cover by skin grafting and Z-plasty, which can be undertaken by a general surgeon as well. Materials and Methods: A total of 100 cases having PBC of upper extremities of more than 6 months duration were included in this study. Complex contractures of hands involving tendons and joints were excluded from this study. Linear contractures were managed by single or multiple Z-plasty techniques whereas patients having wider and dense scars were managed by release/excision of scar and cover by skin grafting. Observations: The mean visual analog score for patient satisfaction was 8.06 for Z-plasty group versus 5.33 for split skin grafting (SSG) group. The mean stay for patients who had undergone Z-plasty was 9.40 days as compared to 15 days for SSG. Conclusion: Contracture release with local flap cover was better technique in relation to patient satisfaction, recurrence of deformity, hospital stay, and time taken for rehabilitation.

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Each year in India, burn injuries account for more than 6 million hospital emergency department visits; of which many require hospitalization and are referred to specialized burn centers. There are few burn surgeons and very few burn centers in India. In our state, Odisha, there are only two burn centers to cater to more than 5000 burn victims per year. This article is an attempt to share the knowledge that I acquired while setting up a new burn unit in a private medical college of Odisha.

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Respiratory burns are caused by the aspiration of heated gases or toxic products of incomplete combustion. The extent of damage is determined by the temperature of the inhaled gases, their composition and the duration of exposure. Along with age and size of full-thickness burn injury, the presence of respiratory burns is one of the most powerful predictors of poor outcome in patients admitted to burn centers. There are three types of respiratory burns: (a) Inhalation of systemic asphyxiants such as carbon monoxide. (b) Thermal damage to airway above vocal cords. (c) Injury to tracheobronchial tree and pulmonary parenchyma by inhaled toxicants. The goals of initial management of the airway and breathing are to protect the patency of the airway to prevent suffocation and to ensure adequate ventilation and oxygenation. High levels of inspired oxygen are necessary to treat carbon monoxide poisoning. Intubation and mechanical ventilator support with low tidal volumes is required to treat subglottic respiratory burns. Because there are no known antidotes to the poisonous effects of inhaled smoke, treatment of respiratory burns is protective and supportive.

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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.

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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.

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Introduction: Burn injury remains one of the biggest health concerns in the developing world and is a formidable public health issue in terms of mortality, morbidity, and permanent disability. The incidence of burn injuries is found all over India; detailed epidemiological studies from the eastern part of the country are sparse. Materials and Methods: We present an epidemiological study form the burn care unit (BCU) of Tata Main Hospital, Jamshedpur, Jharkhand, India of a period of 5 years from January 2009 to December 2013. Results: A total of 1975 burn patients were admitted in the BCU in this 5-year period. The mean age of all the patients included in the study was 29.16 years. There was a slight female predominance in this 5-year period. The overall male to female ratio was 1:1.05. The mean percentage total body surface area (TBSA) burn of all the patients over the period of 5 years was 42.5%. Flame burns were the most common form of burn, accounting for 65.16% of all burns. The overall mortality of the patients over 5 years was 40.8%. If the data are further classified, the overall mortality of patients up to 30% burns was 3.45%, with 30-60% burns was 42.3%, and above 60% burns was 91.8%. Conclusion: Analysis of the 5-year data fairly represents the epidemiological pattern of burns in this region, which has never been studied before and this study can serve as a pilot study for any burn care-related development in this region.

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Introduction: The rehabilitation of the burn patient is difficult, time consuming and yet an undeniably integral part of their management. The long-term effects of burns are wide ranging; from permanent scarring and debilitating contractures and deformities, to deep psychological trauma, which often results in fear of social exclusion, depression and suicidal ideation. Methods: The successful rehabilitation of the burn survivor requires the involvement of a multi-disciplinary team from the 1 ^st day in order to meet the patient's complex needs. Following this, the burns team ensures the continuation of rehabilitation of the patient before and after discharge of the patient from the hospital. Finally, the patient is encouraged to join social networking activities to help regain confidence. Objectives: A burns unit must utilize all the skills and resources it has available to it, in order to provide the burn survivor with the best possible outcome. However, in hospitals located in resource-limited areas across India, the professions and resources required for this task may not be readily available to support the burns patient. The team must be able to reflect on itself and consider how best to continue to improve the provision of burns rehabilitation in the future so as to further reduce morbidity and improve quality-of-life. Conclusion: Nothing short of a multidisciplinary burn team that is dedicated to securing the patient's physical, psychological, social and spiritual wellbeing is required to ensure that a burn victim can return to their families, their work and their society and lead a long and fulfilled life.

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Background: Morbidity and mortality by burns are alarmingly high among the developing countries due to inadequate care facilities. Among these nations, Pakistan has one of the highest burn-related incidents. The dilemma is that most of these deaths and disabilities are curable and preventable. Therefore, there is an urgent need of creating an effective infrastructure to cut down these high number of cases. Methods: We conducted a cross-sectional study at Burns Center, Civil Hospital Karachi. Two hundred and seventy-five patients participated in the study. Data were analyzed using SPSS version 17.0. Results: Among these 275 patients interviewed 63.6% (n = 175) were males whereas 36.4% (n = 100) were females. The mean age of our participants was found to be 26.36 years. A large proportion of the population belonged to the urban areas, i.e. 76.4% (210), whereas only 23.6% (65) were from rural areas, with P = 0.001. About 63.6% of the burn injuries occurred at home (175) while 25.1% (69) got injured at the place of work. Most of the cases were found to be accidental 93.8% (258). About 53.1% (146) had <20% of the total body surface area effected, whereas 16.7% (46) had more than 40% burns. Conclusion: By introducing an effective awareness program regarding burns and teaching first aid techniques to general population, a high number of burn-related accidents could be prevented.

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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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Background: The use of topical chemotherapy is fundamental to prevent infections thereby reducing local inflammation, pain and early healing in superficial, and deep dermal burns. Among the whole gamut, choice of topical agents became an important decisive factor. Silver sulfadiazine (SSD) cream has been an important part of burns management for many years. The major complications attributed to silver compounds are due to the complex or anion sulfadiazine, not the silver itself. With better understanding of the physical and chemical properties, nanocrystalline silver particles have emerged as the most studied material for burn wound dressing recently. Having in mind the difficulties experienced, the aim of the present study is to compare SSD with nanosilver (nano-Ag) gel dressing to treat second-degree burn wounds. Materials and Methods: Over a period of 24 months, a total of 90 cases were studied. 45 patients randomly included in each group, further divided into two subgroups depending on depth (superficial and deep) and involvement of total body surface area (10%–20% and >20%–30%) to minimize bias. Clinical, microbiological, and histological parameters were analyzed. Results: In NS group, significantly less pain observed throughout the study period in both superficial and deep dermal burn patient. Pseudomonas was the predominant flora. Nano-Ag gel was effective in controlling most of the microorganisms except Klebsiella and Proteus sp. Healthy granulation tissue appeared faster (P = 0.0009) in deep dermal burns in nano-Ag group and confirmed histologically. Overall wound healing was more satisfactory in nano-Ag group for both superficial and deep dermal wounds, clinically as well as by histological examination. Conclusions: Clinical and histological studies showed that nano-Ag gel has a positive impact on overall healing process of the patients and proved more beneficial for the management of partial thickness burn as compared to SSD.

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Background: The major morbidity of split skin graft is donor site pain, soaking and delayed healing. Numerous donor site dressing modalities are available, but the ideal material remains elusive. Method: We compared the effect of bovine type 1 collagen dressing to conventional paraffin impregnated gauze dressing in 20 patients. After harvesting graft by standard technique, one-half was covered by collagen sheet and other half by paraffin gauze. Pain was assessed daily by Visual Analog Scale. Any soaking of dressing was noted. The dressing was removed on 10th day and both areas were inspected for the amount of epithelization. Results: The pain was less in the collagen area when compared to the paraffin gauze area. The difference was highest for the first 3 days (2.16 vs. 5.86, P < 0.01) reduced for the next 4 days (0.4 vs. 3.4, P < 0.01) and was minimal for the last 3 days (0 vs. 1, P > 0.02). Seven patients had soaking limited to paraffin gaze area whereas two patients had soaked in both areas. On removal of dressing on 10th day, average epithelization was slightly higher in collagen area (98%) compared with the paraffin gauze area (95%). Conclusion: Bovine type 1 collagen reduces pain and soaking at skin graft donor site with minimal effect on the rate of epithelization.

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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.

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While the trunk is injured in about one-fifth of burn incidents, the groin and perineal contractures are relatively infrequent. Truncal and groin/perineal involvement with disfiguring and functionally restrictive contractures are usually seen in the setting of large surface area burn injuries. In a majority of cases, the treatment of truncal contractures is aimed at mitigating the effects of hypertrophic scarring. In groin/perineal contractures, the contractures are treated to restore movements that enable the important functions of excretion, squatting, and sexual intercourse. Many innovative local and regional flaps have been described to treat such contractures that provide a durable result. Even then, split skin grafting remains a valuable method to treat these contractures, especially for the severe ones. Although tissue expansion can be frequently used to provide color and texture-matched skin resurfacing after the release of truncal contractures, it is deemed unsuitable for groin/perineal contractures owing to high complications rates.

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Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common red cell enzymopathy found in humans. It clearly has an X-linked recessive inheritance with its prevalence varying from 0% to 27% in a different caste, ethnic, and linguistic groups. This deficiency may result in hemolytic anemia during stress, infection, and use of certain drugs. The use of topical silver sulfadiazine can produce hemolysis in patients having G6PD deficiency. Here, we describe one case successfully treated of pediatric burn of 25% of body surface area who was a known case of G6PD deficiency.

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Skin covers the entire body. It is the most important protective organ. Since the burn injury is most painful of all injuries, dressings play an important part of the management. Dressing of the burn wound is very essential to provide pain relief, to promote early healing, to prevent contractures, and to help early mobilization. Many workers from time immemorial have used different types of dressings so as to provide desired results. I use sterile polyethylene drape as a dressing material after covering it with the first layer of gauze soaked in silver sulfadiazine cream. The results are encouraging as there is near total absence of pain experienced by patients and removal is totally pain-free without any bleeding. There is no need for escharotomies, and there is early removal of the slough with no contracture. The polyethylene drapes are easily available in the market, easy to store, available sterile, and totally cost-effective. They help reduce the hospital stay of the patient. The need of anesthesia for surgeries such as escharotomies and debridement is significantly reduced.

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