Epidemiological evaluation of burn cases is poor in India. Past data can help us to move into future of prevention & treatment of burns cases. India is poor country where we still have unsafe and obsolete uses of fire as source of light & cooking. These greatly increase the number of burns in country but unfortunately we do not have a registration center where whole data can be collected and definite conclusions can be made. This presentation is a humble attempt for the same. We hope more of such studies will be done and we will be able to get some direction for prevention and treatment of burns.

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A vast majority of the accidental burns admissions are reported to be due to domestic accidents, allegedly due to the infamous ‘Primus’, the kerosene cooking stove and most of these victims belong to the low socioeconomic background. Besides the ‘Primus’, there are other formidable appliances in the modern kitchen and each one of these commonly used user-friendly devices have their own safety limitations. The routinely used Pressure Cooker is one such appliance, which, if just taken for granted for its maintenance and repair, could proveto bethecause of serious injury. The case report purports to highlight the magnitude of deformity caused by an unusual mode of a domestic accident due to the use of at times substandard pressure cookers or spurious spares or even bad maintenance and tampering with the spares. The victims were young females, who sustained the injury to the face while cooking. Three cases of varying severity are being reported, all of them sustained facial injuries, two having superficial second degree burns of the face and the other had the injury to the right eye from the whistle of the pressure cooker during the lid blowout, the eye had to be enucleated.

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This prospective study was done in 46 patients admitted from Nov.2002 to Jun.2003 in Burns and Plastic Surgery Department, Civil Hospital, Ahmedabad, with partial thickness symmetrical burns(TBSA<20%) on both upper limb or both lower limb to compare the efficacy of two newer dressing materials (hydrogel and polyoleifen mesh) with conventional dressing (vaseline gauze). After proper evaluation and resuscitation, all of them received immediate coverage with either hydrogel or polyoleifen mesh on one limb and conventional dressing on opposite limb with symmetrical burn areas. Main outcome measures included pain, wound healing time and infection. The application of newer dressing materials causes less pain and showed early healing as compared to the conventional dressing. Although newer dressing materials caused less pain and showed early healing, more randomized control trial studies are required to validate the efficacy of newer dressing materials.

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Several methods of skin grafting have been used to treat extensive burns with limited autogenous skin. A simple method which provides different expansions of 1:4, 1:6 and 1:9, with effective and uniform distribution of small skin graft was described by Meek in 1958 and has been reviewed in this study with our two years experience. This technique, however, became eclipsed by the introduction of mesh skin grafting. In 1964, a team of surgeons surgeons of Red cross hospital, Beverwijk, and two biomedical engineers of Humeca group improvised the imperfections of meek technique ,and this modified meek micrograft technique is now used world wide. We feel that The meek micrografting is better, reliable and cost effective method for coverage of large raw areas specifically for a developing country like ours where paucity of skin bank facility and availabilityof integra exists.

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Clinical governance in burn care is extensive and exhaustive process of quality reforms. The process of clinical care becomes more patient friendly and follows processes and protocols. Implementation of clinical governance has to be preceded by overall awareness of the staff. Motivated staff is further encouraged to constitute a clinical governance team. Enthusiastic leader and open-minded team form core of the process of quality improvement. Streamlining is started for systems and processes that revolve around patient care. Quality focused groups identify avenues in burn management that can be reformed with active participation of entire burn team. All such quality-oriented exercises add to change in organisational culture and develop an excellent team. Useful adjuncts to clinical governance in burn care would be identification of capabilities and capacity of each member, devotion of sufficient time and resources for the process, and updating of the information machinery. Quality improvement follows cultural change and shift in the way people think and behave. The burn team can set out to identify short, medium and long-term agenda in relation to quality excellence in patient oriented clinical care. The team will then formulate processes to achieve quality for all these clinical situations. There will be greater focus on performance. The focus will shift to evidence based clinical practice and will have increasing involvement from patient and relatives. Implementation of clinical governance in burn care though will be a slow process, and will have far reaching impact on culture and development of burn facilities.

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With the revolution in the burn care and development of specialized burns centers, survival rate of the burn patients has increased significantly. Many patients not receiving proper post burn care develop unacceptable deformities. In this article, we have presented study of 29 patients with post burn facial deformities conducted over a period of one year, including facial hypertrophic scars, deformities of ears, eyelids, nasal defects, alopecia treated with various modalities including excision & primary suturing or staged excision and suturing, excision and suturing or coverage with local or distant flap, ear reconstruction; staged, and single stage with autogenous rib cartilage framework. The ultimate aim of managing facial deformities is to reconstruct and reposition the various parts of face in near normal anatomical position and to prevent any damage to vital structures.

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Scar revision in post-burn deformities is a tricky problem. Requires careful planning in terms of setting realistic goals, prioritization of goals after assessment of the patient variables (age, socio-economic and health status) wound variable (scar site and extent, scar maturity) and availability/paucity of tissues. Varieties of procedures were performed to manage 46 scars in 33 patients. Majority of our patients belonged to 3rd decade of life (20-29 years) and were unmarried. Grafting was the most frequently performed procedure (33 scars in 26 patients). The most common complication after scar revision technique was widening of scar. Instead of very high cost of the expander and various complications related to it, the tissue expansion technique was useful in the management of post-burn large area scarring of face.

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A case report of a patient with multiple post burns contractures and hypertrophic scarring restricting his normal social life is presented here. The patient was treated without proper care in acute phase of burns and developed multiple deformities leading to psychological disturbances. The patient was treated in multiple stages to correct his deformities and making him capable of doing routine day to day activities, and correction of his disfigurement also helped in psychological recovery of the patient.

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This article highlights the role of a tube pedicle skin flap in the salvage of near total circumferential tissue loss following high voltage electrical injury to the upper limb which otherwise would have resulted in an amputation

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