Airway management is an important aspect during reconstructive surgeries of patients with postburn contracture (PBC) due to significant morbidity and mortality associated with it. The standard recommendations by the American Society of Anesthesiologists for Difficult Airway Management may not be appropriate for these patients due to the high risk of intubation failure and airway crisis. With recent advancements, many techniques and devices have been used successfully in patients with PBC of the head and neck. This article focuses on various barriers faced during the airway management of such patients along with common techniques to overcome them.

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Postburn neck contractures are frequent sequelae after deep thermal burns. They are a significant cause of morbidity and pose a serious challenge for anesthesia. In developing countries, lack of adequate burn care infrastructure, training, and workforce leads to the occurrence of multiple postburn deformities. Wound healing can never occur without wound bed contraction. Therefore, the best treatment for any problem related to burn wound contraction is to prevent or at least reduce its severity. The same is the case with postburn contractures and deformities. The use of simple measures can prevent or at least limit the severity of deformities even when used by trained paramedics and nursing staff.

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Improvement in quality of life and optimum functional recovery after burn injury is the final goal of burn care. After major burn injuries, look (body image) and functionality changed a lot. How a person perceive himself or herself, how confident about his/her looks, and how much confident about his/her body appearance are collectively known as body image. Severe distress is present in 30% of burn survivors and perceives their distorted body image after their first hospitalization. Pre- and postoperative physiotherapy and occupational therapy provide alternative ways for these problems of burn patients. Almost everyone has certain degree of changes in their recovery phase, but most of them get used to the change in their appearance over the time.

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Most commonly, skin grafts are used to resurface the raw areas resulting after the release of postburn contractures but in the extensively burned patient, donor sites may be limited. There is no accurate technique described in literature for the assessment of the true defect preoperatively. We describe a technique to accurately assess the true defect which helps to determine the amount of skin graft required preoperatively.

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Introduction: Management of burn blister has always been controversial. The options available are deroofing the blister, aspiration of fluid or leaving the blister intact. There is no set dressing protocol for managing blisters. Aims and objectives: To compare two treatment modalities i.e. deroofing and keeping the burn blister intact for the optimal management of minor superficial 2nd degree burns. Material and Methods: This prospective study was done on 27 patients who presented with minor superficial 2nd degree burns of upper limbs. Total of 50 blister wounds were randomly split into two categories of 25 each. One subset of blisters (Category 1) was deroofed and dressed every alternate day with silver alginate dressing. The other subset of blisters was left intact (Category 2) and dressed every alternate day. The parameters assessed and compared were pain at burn site, soakage of dressing and time to complete healing Statistical Analysis: Student t –test and Chi square (χ²) test . SPSS 21 software Results: The mean age of patients was 36 years. Category 1 wound patients had more pain (as assessed by Visual Analogue Scale) in comparison to Category 2 wounds. The time to wound healing was less by mean of 1.7days in Category 1 wounds compared to Category 2 wounds. Wound soakage was comparable in both subsets. Conclusion: De roofing a burn blister results in statistically significant decrease in time to wound healing and is recommended for management of minor superficial 2nd degree burns.

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Background: Burn injury remains one of the most frequent public frequent public health concerns that are associated with significant morbidity and mortality. This study aims to understand the epidemiological profile of burn patients admitted to Burn Unit, Hospital Melaka between January 2016 and December 2018. Methods: A retrospective study was conducted to review burn cases that were admitted to Burn Unit, Hospital Melaka from January 2016 to December 2018. The epidemiological data of 241 patients were collected and studied. Results: The etiology of burn was determined: 230 (95.4%) thermal burns, 4 (1.7%) electrical burns, and 7 (2.9%) chemical burns. In 230 cases of thermal burn, 85 (37.0%) of accidents were caused by flames, 119 (51.7%) by scalds, and 26 (11.3%) by contact with hot objects. One hundred and eighty-nine (63.2%) of the patients were male, the remaining 110 patients (36.8%) were female. The female/male ratio was 1:1.7. The duration of hospitalization stay was 8 days. Mortality rate was 3.34% with 50% of deaths following major burn were due to sepsis with multiorgan failure. Conclusion: This study provides an overview on demographic features of burn patients admitted to Hospital Melaka.

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Water bodies purvey plenty of natural resources that are utilized to manufacture materials or are employed as novel medicines in medical and dental practice. Among sponges, corals, fishes, and other marine life forms, one promising source is the “tilapia fish.” It is principally farmed for the utilization and construction of therapeutic biomaterials. As oral physicians or dental practitioners, we grapple with many oral lesions and wounds in routine practice, “burns” being one of them. Tilapia skin and its collagen are being applied for dermatological burns. Since the branch of medicine encourages innovative ideas and research work in the treatment of challenging oral lesions, this article aims to communicate the idea of its usefulness in oral burns and alike lesions, making tilapia a neoteric healing agent, keeping in mind the remarkable biological properties it possesses.

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Context: The time of debridement of burn wounds is controversial. This study assessed the outcomes of various times of excision of full-thickness thermal burns involving a total body surface area (TBSA) of 15%–40% when immediate grafting is not possible. Aims: This study aimed to compare mortality rate and hospital days between very early excision, delayed early excision, and delayed excision. Setting and Design: This was a retrospective observational research study of 103 patients older than 18 years with full-thickness thermal burns involving a TBSA of 15%–40%, admitted to our Adult Burns Unit from January 2014 to December 2016. Subjects and Methods: Only “traditional” burn wound dressings such as Jelonet, Melladerm, Anticoat, or bandages were used without immediate skin grafting. Using the STATA Version 14.2 (College Hill, TX) statistical program, the Mann–Whitney U-test was used to compare any two groups, the Kruskal–Wallis test to determine differences between any three groups and the Chi-square test to measure associations between gender and patient outcome. Linear regression was used to determine the predictors of the number of hospital days postsurgery. Results: With a median patient age of 34 years, 66% were male. The majority had delayed excision (41.7%), 34% had delayed early excision and 24.3% had very early excision. Conclusions: Where immediate cover after excision is not possible due to cost or availability, and the wound is only covered with “traditional” burn dressings, early excisions had no advantage over delayed excisions with regard to mortality rate or duration of hospital stay.

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Background: Firecracker injuries are common in India, of which the majority takes place during Diwali. This study analyzes the profile of firecracker injuries in the emergency department (ED) of GMCH, Guwahati. Materials and Methods: This is a retrospective observational study of all firecracker-related injury patients presenting to our ED 3 days prior and post Diwali from 2016 to 2020. Details of the demographics, cause, and percentage of burns were included. Treatment given for the patients is not mentioned in this study. Results: We received a total number of 195 patients with burn injuries to the ED from 2016 to 2020, 3 days prior and post Diwali, of which 54.3% (106) cases are firecracker-related burn injuries. 46.2% of the cases were under the age of 19 years. Male (71.7%) predominance was noted. The majority of the injuries involved <20% total body surface area (80.2%). It is noted that the right hand (54%) is most commonly involved followed by the face (17%) and torso (17%). Fountain (38%) is observed to be the most common firecracker causing injuries. In 2020, during the COVID pandemic, there were only two reported cases attending to the ED during the specified period. Conclusions: This study has expressed the pattern of firecracker injuries in our place during Diwali. An alarmingly high number of young adolescents with significant upper limb injuries were noted. These injuries are prevalent in the productive age groups. Public awareness and education along with an increase in legislative enforcement are needed for the betterment and well-being of the people during the festival season to prevent the catastrophe.

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The use of alcohol-based sanitizer solutions has become ubiquitous during the COVID-19 epidemic. However, the public at large is not aware of the hazards associated with their use. In this article, through three representative cases, we discuss accidental burns occurring due to the use of alcohol-based sanitizers and highlight the hazards associated with flammability of the compound. We also would like to propose precautions to be followed during the sale and use of such products and discuss preventive measures for sanitizer burns.

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SARS-CoV-2 (COVID-19) pandemic is still ravaging territories and spreading like wildfire. Infection with this virus is already complicating many clinical and emergency situations by overlapping symptoms, development of newer protocols for disease management, by redefining prognostic indicators, and upscaling the level of protection required for health-care workers. The current report outlines the tribulations and dilemmas of managing an asymptomatic 35% total body surface area burn patient with concomitant SARS-CoV-2 infection, from its diagnosis till full wound healing. Countries with a large population and a high incidence of SARS-CoV-2 infection need to maintain a high index of suspicion for a concomitant SARS-CoV-2 infection because asymptomatic patients can present with burns and they can also be carriers. Further, there is a need to strategize the deployment of resources, workforce, and burn wound management and to adopt effective precautionary measures for better outcomes and safety of health-care workers.

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Introduction: The incidence of electrical accidents has increased due to the use of electricity in households, institutions, and industries. Electrical injury is a major cause of burn injury and significant cause of mortality, morbidity, and disability. Materials and Methods: This prospective analytical study which was conducted in the department of surgery of our tertiary care center MBS hospital from July 2016 to June 2017. A total of 120 patients of electric burn were included in our study burn unit. We reviewed the following variables such as age, sex, occupation, socioeconomic status, mechanism of injury, body surface area involve, voltage, course at hospital stay, prognosis, and surgical modalities. Results: There were 111 males and 9 females. Seventy-four electric injuries were due to high-tension line above 1000 V and remaining by household line. In 84% of patients, upper limbs were involved. Most of the patients were farmer and student who belong to farmer families and most were of the working age group. Twenty-three (19.17%) patients underwent major amputation due to extensive tissue and bone destruction. During the follow-up period, 22 patients had only the ability to perform their usual and daily activities and could not work at all. Conclusions: Electric burns are preventable public health problem. Preventative strategies need to be put in place to decrease the incidence of electrical injuries. The prevention is possible by increasing awareness through primary education and advice precautions such as the use of insulated gloves and footwear.

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Background: A burn injury necessitates immediate emergency treatment that should be furnished securely to the victims. Appropriate precautions need to be undertaken to cut down the risk of exposure. A proper assessment and treatment commencement ought to be carried out before the viral infection has even been excluded as it is a race against time. The prognosis is determined by the established factors with viral infection acting as an ancillary addition. Burns are associated with many systemic disorders such as coagulopathy, sepsis, and respiratory distress which need to be differentiated from similar manifestations of the disease. Materials and Methods: A retrospective study was conducted in our burn unit (analysing data from Burn Registry of the Department), comparing various parameters during the pandemic year with those of the previous year. The aim was to observe whether COVID-19 has any sinister impact on burn management and outcome or not. Results: There was a 30.5% decrease in burn admissions with reduction in male burns (9%; M: F ratio decreased from 3:2 to 1:1) and delayed presentations (4%). The epidemiological parameters largely remained unaltered. The intensive care unit (ICU) admission rate and mortality remained the same. Our COVID positivity rate among burns was 5.3%. Conclusion: We conclude that incidence of burn admissions decreased during the pandemic with increase in delayed presentations. The ICU admission rate and mortality increased by 9% rate (outcome) remained unchanged. Hence, COVID-19 did not at the end of the “first wave” put any sinister impact on burn increased, management as well as the outcome.

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Context: Keloids and hypertrophic scars are a cause of severe impairment of quality of life. Intralesional triamcinolone acetonide has been used at different intervals at various centers. Aim: This study was aimed to compare the efficacy of intralesional triamcinolone acetonide at 2-, 4-, and 6-week intervals in hypertrophic scars and keloids. Settings and Design: This study was conducted in the plastic surgery outpatient department of a tertiary care hospital. This is an interventional prospective study, randomization was done using a computer-generated sequence. Materials and Methods: In this study conducted from October 2015 to January 2017, administration of triamcinolone acetonide 40 mg/ml at 2-weekly, 4-weekly, and 6-weekly intervals was done in case of hypertrophic scars and keloids for up to 8 doses or till Vancouver Scar (VCS) scale of 4 was achieved. VCS, pain, and itching were noted and compared. Statistical Analysis: VCS scale was used for comparison using analysis of variance test. The visual analog scale was compared using an unpaired t-test. Qualitative data were compared using the Chi-square test/Fischer's exact test. P < 0.05 was considered statistically significant. Results: The 2-weekly regimen was found to show better results in terms of pain and scar improvement. It also required a lesser number of doses to produce the same effect. The response to itching was comparable in 2- and 4-weekly groups and was better than 6-weekly group. Minimal complications were noted in the three groups. Conclusion: Two-weekly regimen of triamcinolone acetonide is recommended for intralesional use in hypertrophic scars and keloids.

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Inhalation of thinners is known to have systemic toxic effects on the human body. Despite this, thinners have been abused for mood alteration. Accidental injury following thinner inhalation includes burns from the ignition of volatile substance or secondary trauma (as the patient loses consciousness). Chemical burn from prolonged contact with thinner-containing toluene may occur, although rare. We present a case of accidental burn injury resulting from prolonged contact with spilled thinner.

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Introduction: Inhalation burn is a major cause of mortality in burn patients. Early diagnosis of smoke inhalation injury (SII) is imperative in the management and prevention of burn injury. The gold standard modality for the diagnosis of SII is fiber-optic bronchoscopy (FOB). Materials and Methods: This prospective, observational study included thirty patients and was conducted from November 2016 to May 2018. Patients with thermal burns sustained < 72 h with facial burns, age group 18–60 years, were included in the study. Results: FOB was done in thirty patients. About 26.67% of patients had closed space injuries. Singeing of scalp hair/eyebrows was present in 46.67% of patients. Singeing of nasal vibrissae/mustache was present in 56.67% of patients. Eversion of eyelids and lips was present in 33.33% and 50% of patients, respectively. Hoarseness of voice, edema of tongue, and tachycardia were present in 16.67%, 50%, and 66.67% of cases, respectively. On auscultation, 26.67% patients had basal crepts. In the chest X-ray, 16.67% of patients had pulmonary edema. Forty percent of patients had arterial hypoxemia and acidosis at the time of arrival. About 56.67% of patients were proved bronchoscopically to have features of SII. Conclusions: FOB has significant value in evaluation, prediction of prognosis, and management of SII when performed within 72 h of burns.

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Introduction: Skin coverage is a greatest challenge in severe burns when the donor sites are limited. Early skin cover is important to reduce morbidity and mortality in severe burns. We use to harvest skin from cadavers at intensive care units (ICUs) for temporary cover of excised burn wounds. As we do not get enough cadaveric donations from ICUs, we plan to conduct this study to identify awareness and knowledge on it. Methods: We collected data from doctors and nurses working in surgical ICUs (general surgical, accident and emergency, and neurosurgical) by a self-administered questionnaire. Then, we analyzed the results by SPSS 19 data package. Results: One hundred and forty participants responded to our questionnaire including 118 nurses and 22 doctors. Only 40% (n = 48) of nurses and 60% (n = 13) of doctors were aware about cadaveric skin donation. Only 31% (n = 44) knew that tissue or blood matching is not needed for it. 88% (n = 124) knew that graft is mainly taken from thighs. Some responded as skin of the patients with comorbidities cannot be used for the transplant. Twelve percent (n = 18) knew whom to contact when the patient for cadaveric skin transplant is identified. Only 17% (n = 24) thinks that it does not cause much disfigurement to the cadaver. Thirteen percent (n = 18) did not know any details about skin donation. Conclusion: There is a knowledge deficit in ICU staffs regarding awareness and knowledge on cadaveric skin harvest. We could not compare the doctors and nurses as there were less participants in doctors. In ICUs, an awareness campaign is required. In future, this concept should be assessed in general public as well.

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Background: The primary care of a burn victim focuses on the resuscitation. The burns wound draws the attention, with interest of the provider as well as the patient waning after the healing of the wound. “Late burn care” is an important part of burns management that, if delayed, results in the formation of contractures. Simple methods suh as early skin grafting, splintage, and physical therapy prevent the development of these debilitating contractures. Despite this, postburns contractures are a common sequelae. Aims and Objectives: The aim of this paper is to identify the lacunae in late primary care, provided to patients presenting to us with postburn contractures. Materials: A review of all patients admitted with postburns contractures from January 2016 to December 2018, was done. Results: A total of 427 patients were admitted in this period out of which 254 responded for the interviews. The epidemiology of postburn contractures has been described. The lacunae in late primary burn care have been identified. Conclusion: Critical contracture areas are areas, which although innocuous in terms of body surface area burnt, have a high propensity to form contractures and require special care. Public health programs, effective in combating diseases like polio and tuberculosis, can also help preventing burn contractures. Spreading awareness about the basic tenets of contracture prevention will drastically reduce the burden of burn contractures.

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Introduction: Burns are a major burden to the society in terms of lives lost, treatment costs, and postburn deformities. This study aims to identify the incidence, causes of burns, associated risk factors, and mortality in a tertiary care center in Uttarakhand. Patients and Methods: This study was an observational study conducted from October 2018 to April 2021 at a tertiary care center in Uttarakhand. It includes the patients with thermal burns who were admitted in the burns unit of the hospital. The interrelationship between various risk factors and mortality was studied. Results: A total of 247 patients were included in the study. Males outnumbered females constituting 55.47% of the population. Most of the patients were of age group 21–40 years and were from rural backgrounds, belonging to lower socioeconomic class. The literacy rate was 76.52%. Farming was the predominant occupation. Major cause of burns was flame burns with second-degree burns being the most common. Accidental burns were common, and mostly (39.68%) patients sustained burns with total burn surface area (TBSA) <25%. The mortality rate was 11.34%. Majority (56.68%) of the patients belonged to Class IV socioeconomic class (modified BG Prasad classification). Conclusions: Young males of rural background and low socioeconomic strata were the most common victim of burn injuries. The majority of cases were accidental thermal burns. The mortality rate was high in patients with TBSA >60%, third-degree burns and housewives. Appropriate measures need to be taken regarding the education of the public for prevention of burns and improvement in healthcare to decrease the incidence and improve the outcome of burn patients.

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Acetic acid solution is effective in healing of chronic wounds by its ability to eradicate biofilms. One percent silver sulfadiazine (SSD) cream is the commonly used topical antimicrobial agent in burn wound care. In our study, we compared the efficacy and safety of 1% acetic acid gel with 1% SSD in partial-thickness burn wound with <20% total body surface area. Context: Bacterial colonization of burn wounds results in delayed wound healing. SSD is commonly used as a topical antibiotic in the second degree and third-degree burn wounds. The acetic acid solution is found to be clinically effective against the eradication of mature or chronic biofilm.^[6] We have used 1% acetic acid gel as an anti-microbial dressing for acute burn wounds and compared it with 1% SSD. Aims: To evaluate the efficacy and safety of acetic acid gel with SSD cream in patients with second-degree burn wounds involving up to 20% of total body surface area. Outcome parameters evaluated were Wound healing (BWAT score and status as on Day 21), Pain (VAS score), Healing quality (VSS score at 1 and 3 months) and adverse effects if any. Settings and Design: The study was conducted in the burn department affiliated with a tertiary care centre. It is a prospective randomized, investigator-initiated open-label case-control study. Inclusion criteria 1. Males and females between the ages of 18 and 65 years 2. Second-degree burn involving total body surface area up to 20% at 48 h of burn injury. Exclusion criteria1.Patients with pre-existing comorbidities. Uncontrolled diabetes Mellitus. Renal insufficiency.2. Patients with known keloid tendency3.Patients with electrical burn4.Patients with inhalation burn. Patients were included in the study in accordance with mentioned inclusion and exclusion criteria. Informed consent was obtained from all patients. All procedures contributing to this work comply with the ethical standards of the relevant national and institutional guidelines on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008. The study group received 1% Acetic acid gel while the control group received 1% SSD cream for antimicrobial dressings. Simple randomization was followed for the allocation of patients. Outcome parameters were assessed, compiled, and were statistically analyzed. Subjects and Methods: Eighty cases were included in the study, forty in each group. Each group patient underwent dressing with respective allotted topical antimicrobial agent, and outcome parameters were compared. In both groups, Bates-Jensen Wound Assessment Tool (BWAT), Visual Analog Scale (VAS), and Vancouver Scar Scale (VSS) scores were documented. Parameters compared were wound healing, patient acceptability, any adverse events, and quality of the healed scar. Statistical Analysis Used: The data was compiled and analyzed statistically for Outcome parameters will be analyzed for distribution, central tendency, and variability by calculating Mean, SD and p-value using Microsoft excel software (2007). Results: At 21 days, the acetic acid group showed complete reepithelialization in 45% of the cases and complete granulation in 7.5% of the cases, whereas the SSD group showed complete reepithelialization in 32.5% of the cases. The remaining cases in both groups healed after 21 days. BWAT scores were reduced in both groups. Mean VAS and mean VSS scores were comparable in both groups. No adverse event was noted in any group due to respective agent. Conclusions: In our study, we found that 1% acetic acid gel was comparable to 1% SSD in terms of efficacy and is safe to use in partial-thickness burn wounds <20% total body surface area (TBSA) with good clinical outcomes.

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Objectives: The objective of the study is to analyze the presence and intensity of depression symptoms in burn survivors. Methods: This is a descriptive and quantitative study, with 36 participants with burns admitted to a referral center in Londrina/PR, between January 2016 and May 2019. Interviews were conducted at two moments after hospital discharge with the application of psychometric scales for depression (Beck, Hamilton, and Montgomery-Asberg) and a semi-structured questionnaire for information on sociodemographic data. Data analysis was performed using statistical tests. Results: Most participants presented moderate and severe depressive symptoms, which were higher in the second interview. Regardless of having a previous diagnosis, there was an increase in the intensity of depressive symptoms from the first to the second assessment due to dissatisfaction with self-image, but without a significant association with sociodemographic variables. Most participants reported not wearing clothing to cover the injury and not worrying about hiding the injury. Conclusion: The expressive majority of the participants had depressive symptoms, the majority of which were of moderate and severe intensity.

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Herpes simplex virus infection in major burn wounds is a well-known entity. Here, I am reporting a relatively rare case of a pediatric patient who presented with superficial partial-thickness scald burn injury over his face and neck. He was managed in outpatient department services with topical antibiotic dressings. After 2 weeks, he presented with multiple vesicular lesions over his lower face and neck with delayed wound healing in that area. Clinical suspicion of superadded viral infection was made. Tzanck smear and polymerase chain reaction test confirmed the infection with herpes simplex virus. Antiviral treatment was started, and regular dressings were continued. The patient responded well to the treatment, and lesions were disappeared. Later, he developed hypertrophic scarring over the lower part of face. Now, he is being managed on massage and pressure therapy. There has been no relapse of viral infection till 6 months of follow-up.

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It has become the fashion to have a gas cooking facility in the kitchen of even the middle class personnal like teachers, and office going people (middle income group) in Chennai.

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