H. Sharma, Dharm Dev, Rajpal, C. Lamba, Piyush Thayal, Heema
Objectives: The primary objective of this study was to evaluate the efficacy of Calendula officinalis in the wound healing of burn wound in comparison with standard povidone-iodine solution. Materials and Methods: A prospective randomized controlled study with 3 weeks of intervention and follow-up was conducted at the Department of Burns, Plastic and Maxillofacial Surgery, Safdarjung Hospital and VMMC, New Delhi, in collaboration with Homeopathic Treatment Centre, Safdarjung Hospital, New Delhi, from January 1, 2017, to December 31, 2018. The patients between 15 and 60 years of age reporting to the burns outpatient department with burn wounds due to thermal bums having the involvement of 5%–20% of total body surface area within 24 h of injury were randomized to either the Calendula (n = 20) or Betadine (n = 20) group. Results: There was no significant difference between the Calendula and Betadine groups, however, by day 14, 75% of cases in the Calendula group showed 80% and above epithelization as compared to 45.0% of cases in the Betadine group. Similarly, there was no significant difference between the wound discharges between the two groups but 95% had no discharge by the 14th day in the Calendula group as compared with 65% in the Betadine group. The Calendula group had a reduced incidence of wound infection when compared with Betadine. Conclusion: Therefore, Calendula dressing had a positive influence in early epithelization, better control of wound discharge, and lesser infections but these need to be evaluated on adequate sample size for a definite outcome.
{"title":"An analytical study to establish the role of Calendula Q as a topical wound dressing in partial-thickness burn wound","authors":"H. Sharma, Dharm Dev, Rajpal, C. Lamba, Piyush Thayal, Heema","doi":"10.4103/ijb.ijb_14_22","DOIUrl":"https://doi.org/10.4103/ijb.ijb_14_22","url":null,"abstract":"Objectives: The primary objective of this study was to evaluate the efficacy of Calendula officinalis in the wound healing of burn wound in comparison with standard povidone-iodine solution. Materials and Methods: A prospective randomized controlled study with 3 weeks of intervention and follow-up was conducted at the Department of Burns, Plastic and Maxillofacial Surgery, Safdarjung Hospital and VMMC, New Delhi, in collaboration with Homeopathic Treatment Centre, Safdarjung Hospital, New Delhi, from January 1, 2017, to December 31, 2018. The patients between 15 and 60 years of age reporting to the burns outpatient department with burn wounds due to thermal bums having the involvement of 5%–20% of total body surface area within 24 h of injury were randomized to either the Calendula (n = 20) or Betadine (n = 20) group. Results: There was no significant difference between the Calendula and Betadine groups, however, by day 14, 75% of cases in the Calendula group showed 80% and above epithelization as compared to 45.0% of cases in the Betadine group. Similarly, there was no significant difference between the wound discharges between the two groups but 95% had no discharge by the 14th day in the Calendula group as compared with 65% in the Betadine group. The Calendula group had a reduced incidence of wound infection when compared with Betadine. Conclusion: Therefore, Calendula dressing had a positive influence in early epithelization, better control of wound discharge, and lesser infections but these need to be evaluated on adequate sample size for a definite outcome.","PeriodicalId":13336,"journal":{"name":"Indian journal of burns","volume":"30 1","pages":"33 - 38"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49577886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The gold standard for burn scar reconstruction is to utilize adjacent skin flaps for the ease of operation and to match the skin characteristics. The objective of this study is to share our experiences using propeller flap cover for “postburn contracture of axilla (PBCA)” release reconstruction. Materials and Methods: This 5-year retrospective observational study was undertaken in the Plastic Surgery Department of GMCH, Guwahati, from 2016 to 2020 with the data available after obtaining the Ethics Committee approval. The patient records and photographs were gathered from the Medical Records and the Plastic Surgery Department of GMCH, Guwahati, respectively. Patients treated with a propeller flap cover were scrutinized. Results: The patients operated for PBCA were 36. There were 12 males and 14 females with a mean age of 21 years. Twelve patients with spared axillary dome skin underwent a central axis subcutaneous pedicle propeller flap. The flaps had dimensions of 8–12 cm in length and 6–9 cm in width. The pedicle was approximately 2–2.5 cm in diameter. The few complications seen included wound dehiscence and delayed wound healing, edge hypertrophy, band contractures, marginal necrosis, and pin cushioning. During follow-up, no recontractures were seen. Conclusions: We conclude that central axis subcutaneous pedicle propeller flap is a simple and effective treatment for mild-to-moderate PBCA with spared axillary dome skin. These flaps provide durable soft tissue cover with enhanced flap survival, functional mobility, and esthetics.
{"title":"A retrospective study on treatment for postburn contracture of axilla with propeller flap cover at a tertiary care center","authors":"K. Kalita, Swamy Gurindagunta, M. Nithin","doi":"10.4103/ijb.ijb_6_22","DOIUrl":"https://doi.org/10.4103/ijb.ijb_6_22","url":null,"abstract":"Background: The gold standard for burn scar reconstruction is to utilize adjacent skin flaps for the ease of operation and to match the skin characteristics. The objective of this study is to share our experiences using propeller flap cover for “postburn contracture of axilla (PBCA)” release reconstruction. Materials and Methods: This 5-year retrospective observational study was undertaken in the Plastic Surgery Department of GMCH, Guwahati, from 2016 to 2020 with the data available after obtaining the Ethics Committee approval. The patient records and photographs were gathered from the Medical Records and the Plastic Surgery Department of GMCH, Guwahati, respectively. Patients treated with a propeller flap cover were scrutinized. Results: The patients operated for PBCA were 36. There were 12 males and 14 females with a mean age of 21 years. Twelve patients with spared axillary dome skin underwent a central axis subcutaneous pedicle propeller flap. The flaps had dimensions of 8–12 cm in length and 6–9 cm in width. The pedicle was approximately 2–2.5 cm in diameter. The few complications seen included wound dehiscence and delayed wound healing, edge hypertrophy, band contractures, marginal necrosis, and pin cushioning. During follow-up, no recontractures were seen. Conclusions: We conclude that central axis subcutaneous pedicle propeller flap is a simple and effective treatment for mild-to-moderate PBCA with spared axillary dome skin. These flaps provide durable soft tissue cover with enhanced flap survival, functional mobility, and esthetics.","PeriodicalId":13336,"journal":{"name":"Indian journal of burns","volume":"30 1","pages":"51 - 56"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46416638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.4103/0971-653X.206974
V. Jain, K. Atodaria, Shashank Sringapure, J. Brahmbhatt, Pradipkumar R. Atodaria
Burns of all etiologies are among one of the leading causes of morbidity and mortality, especially those with poorer prognose. The fundamental aim of treatment is to restore the burn victim to his/her previous socioeconomic status by giving a reasonably good esthetic and functional outcome as we firmly believe that “Quality of life is as important – if not more – as life itself.” This goal can be achieved by applying the basic principles of proper evaluation, adequate resuscitation, thorough planning, and apt execution of the treatment plan and has been stressed upon since time immemorial. Through this case report, we desire to show light on the other, less talked about factors, for example, psychological support, motivation for physiotherapy, rehabilitation, and occupational therapy, which play a substantial role in reinstating the patient's socioeconomic lifestyle.
{"title":"Long-term functional outcome of a patient with 54% burns in the presence of inhalation burn injury","authors":"V. Jain, K. Atodaria, Shashank Sringapure, J. Brahmbhatt, Pradipkumar R. Atodaria","doi":"10.4103/0971-653X.206974","DOIUrl":"https://doi.org/10.4103/0971-653X.206974","url":null,"abstract":"Burns of all etiologies are among one of the leading causes of morbidity and mortality, especially those with poorer prognose. The fundamental aim of treatment is to restore the burn victim to his/her previous socioeconomic status by giving a reasonably good esthetic and functional outcome as we firmly believe that “Quality of life is as important – if not more – as life itself.” This goal can be achieved by applying the basic principles of proper evaluation, adequate resuscitation, thorough planning, and apt execution of the treatment plan and has been stressed upon since time immemorial. Through this case report, we desire to show light on the other, less talked about factors, for example, psychological support, motivation for physiotherapy, rehabilitation, and occupational therapy, which play a substantial role in reinstating the patient's socioeconomic lifestyle.","PeriodicalId":13336,"journal":{"name":"Indian journal of burns","volume":"30 1","pages":"84 - 86"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44154976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
V. Bhatia, Sruja Narola, Ranjit Zapadiya, R. Kaushik, A. Thakur
Introduction: In Indian culture, it is considered auspicious to conduct prayers before beginning one's day or even before starting to celebrate any of the festivals. The variations in conducting the prayers are numerous, but one thing which is constant is fire, which in the form of diya or candle or incense stick is always present. This many a times becomes the source of clothes catching fire leading to burns. The flame burns can cause serious complications depending on the age and the percentage of the body involved. Herein, we are presenting an article regarding the same. Methods: All burns which occurred while praying from September 2019 to September 2021 were included in the case series. Results: In our study, the patients above 60 all had comorbid conditions, and 5 out of 8 (five out of eight) patients expired that is 62.5% of the study group. These patients had the accident at home while praying where the flame from diya which is lit on the temple floor near the idol of god caught fire to the clothes. Indian females prefer to wear clothes with flairs such as chaniya choli, long Indian skirt, or saree which increases the chances of contact with diyas or source of flame leading to accidental burns. Considering that 5 (five) patients were more than 50 years of age, they survived for mean days of 16.2 days and then expired, the three younger patients recovered with an average stay of 47.3 days. Even with extensive burns due to younger age the patients recovered and did require skin grafting in the course of their treatment. Discussion: Diminished alertness of the senses, impaired mentation, slower reaction time, reduced mobility, and decreased ability of elderly people to identify the severity or risk of a situation as well as their capacity to escape from harm, puts them at higher risk of sustaining burn injury. These circumstances will also lead to larger increased total body surface area (TBSA) and deeper burns; moreover, there is an increased risk for the development of inhalation injury. These factors are closely related to a higher mortality rate. Conclusion: Age plays an important role in treatment response in a major trauma like burns. Increased age with associated co morbidities add to the severity of the burns. Younger age group however have better survival chances, though even they required prolonged hospital stay in our study considering the higher percentage of burns involved.
{"title":"Prayer burns: A retrospective study","authors":"V. Bhatia, Sruja Narola, Ranjit Zapadiya, R. Kaushik, A. Thakur","doi":"10.4103/ijb.ijb_26_21","DOIUrl":"https://doi.org/10.4103/ijb.ijb_26_21","url":null,"abstract":"Introduction: In Indian culture, it is considered auspicious to conduct prayers before beginning one's day or even before starting to celebrate any of the festivals. The variations in conducting the prayers are numerous, but one thing which is constant is fire, which in the form of diya or candle or incense stick is always present. This many a times becomes the source of clothes catching fire leading to burns. The flame burns can cause serious complications depending on the age and the percentage of the body involved. Herein, we are presenting an article regarding the same. Methods: All burns which occurred while praying from September 2019 to September 2021 were included in the case series. Results: In our study, the patients above 60 all had comorbid conditions, and 5 out of 8 (five out of eight) patients expired that is 62.5% of the study group. These patients had the accident at home while praying where the flame from diya which is lit on the temple floor near the idol of god caught fire to the clothes. Indian females prefer to wear clothes with flairs such as chaniya choli, long Indian skirt, or saree which increases the chances of contact with diyas or source of flame leading to accidental burns. Considering that 5 (five) patients were more than 50 years of age, they survived for mean days of 16.2 days and then expired, the three younger patients recovered with an average stay of 47.3 days. Even with extensive burns due to younger age the patients recovered and did require skin grafting in the course of their treatment. Discussion: Diminished alertness of the senses, impaired mentation, slower reaction time, reduced mobility, and decreased ability of elderly people to identify the severity or risk of a situation as well as their capacity to escape from harm, puts them at higher risk of sustaining burn injury. These circumstances will also lead to larger increased total body surface area (TBSA) and deeper burns; moreover, there is an increased risk for the development of inhalation injury. These factors are closely related to a higher mortality rate. Conclusion: Age plays an important role in treatment response in a major trauma like burns. Increased age with associated co morbidities add to the severity of the burns. Younger age group however have better survival chances, though even they required prolonged hospital stay in our study considering the higher percentage of burns involved.","PeriodicalId":13336,"journal":{"name":"Indian journal of burns","volume":"30 1","pages":"14 - 17"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46816115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
I. Ahmad, Somnath Karad, M. Khurram, S. Ali, Sudhanshu Tripathi, Gautam Chaudhury
Introduction: Delayed burn wound healing, due to lack of proper initial treatment, especially in deep partial-thickness and full-thickness burns leads to the formation of burn scar contracture. Because of the loose tissue in the anterior neck and also due to habitual and ignorant use of a pillow in burnt patients during the postburn recovery phase, contracture of the neck is a common sequela. Many reconstructive modalities have been described in the literature which include skin grafting, pedicle flap with or without expansion, and free flap. Keeping the esthetic concern in mind, we modified the method of contracture release and skin grafting into two stages. Materials and Methods: This is a prospective study conducted on 15 patients with extensive postburn contracture of the neck during the period ranging from January 2020 to August 2021. Results: In our study, 80% of the patients were females. The mean age was 25.9 years. The number of type 2 and type 3 neck contractures was 7 and 8, respectively. The mean duration of contracture was 8.26 months. Graft loss was the only complication seen and that too was < 10% in all cases (mean - 4.46). At 6 months, mandibular border and thyroid bulge were distinctly visible, and cervicomental angle was within the normal range (mean - 110.46) giving a youthful and appealing esthetic appearance. The mean of the Patient and Observer Scar Assessment Scale score was 2.06 for the observer component and 3 for the patient component. Conclusion: Interval skin grafting can be undertaken following postburn neck contracture release for better functional and esthetic outcomes.
{"title":"Postburn neck contracture reconstruction by interval skin grafting","authors":"I. Ahmad, Somnath Karad, M. Khurram, S. Ali, Sudhanshu Tripathi, Gautam Chaudhury","doi":"10.4103/ijb.ijb_4_22","DOIUrl":"https://doi.org/10.4103/ijb.ijb_4_22","url":null,"abstract":"Introduction: Delayed burn wound healing, due to lack of proper initial treatment, especially in deep partial-thickness and full-thickness burns leads to the formation of burn scar contracture. Because of the loose tissue in the anterior neck and also due to habitual and ignorant use of a pillow in burnt patients during the postburn recovery phase, contracture of the neck is a common sequela. Many reconstructive modalities have been described in the literature which include skin grafting, pedicle flap with or without expansion, and free flap. Keeping the esthetic concern in mind, we modified the method of contracture release and skin grafting into two stages. Materials and Methods: This is a prospective study conducted on 15 patients with extensive postburn contracture of the neck during the period ranging from January 2020 to August 2021. Results: In our study, 80% of the patients were females. The mean age was 25.9 years. The number of type 2 and type 3 neck contractures was 7 and 8, respectively. The mean duration of contracture was 8.26 months. Graft loss was the only complication seen and that too was < 10% in all cases (mean - 4.46). At 6 months, mandibular border and thyroid bulge were distinctly visible, and cervicomental angle was within the normal range (mean - 110.46) giving a youthful and appealing esthetic appearance. The mean of the Patient and Observer Scar Assessment Scale score was 2.06 for the observer component and 3 for the patient component. Conclusion: Interval skin grafting can be undertaken following postburn neck contracture release for better functional and esthetic outcomes.","PeriodicalId":13336,"journal":{"name":"Indian journal of burns","volume":"30 1","pages":"39 - 44"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48798215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
V. Babu, Mukesh Sharma, Ashok Daram, Manoj K Jha, Sreeramaraju Vulchi
Background: Burn injuries involving the dorsum of the hand are very common. Most burn injuries heal with dressings or skin grafting. Deep burns can lead to soft tissue defects and require durable cover to protect the underlying extensor tendons and the bone. Dorsal metacarpal artery-based flaps are reliable locoregional flaps that provide good soft tissue cover. Materials and Methods: This study included nine patients with postburn dorsal finger defects who underwent debridement and coverage using dorsal metacarpal artery perforator (DMAP)-based flaps from January 2019 to January 2022. Parameters in terms of flap dimensions, reliability, complications, and donor-site morbidity were assessed. Results: The flap size ranged from 5 cm × 2.5 cm to 7 cm × 2.5 cm. Two flaps had marginal necrosis, and one had venous congestion, which settled over time and healed with dressings. All the flaps settled well with a satisfactory outcome. The patients were followed up for 6–24 months. Conclusion: DMAP-based flaps are reliable in providing good soft tissue cover for reconstructing postburn dorsal finger defects with acceptable donor-site morbidity.
背景:累及手背的烧伤是非常常见的。大多数烧伤通过敷料或植皮愈合。深度烧伤可导致软组织缺损，需要持久的覆盖物来保护下面的伸肌腱和骨骼。掌骨背动脉皮瓣是可靠的局部皮瓣，提供良好的软组织覆盖。材料和方法:本研究包括2019年1月至2022年1月期间9例烧伤后手指背缺损患者，他们使用基于掌骨背动脉穿支(DMAP)的皮瓣进行清创和覆盖。评估皮瓣尺寸、可靠性、并发症和供区发病率等参数。结果:皮瓣大小为5 cm × 2.5 cm ~ 7 cm × 2.5 cm。两个皮瓣边缘坏死，一个有静脉充血，随着时间的推移，用敷料愈合。所有的皮瓣都固定得很好，结果令人满意。随访6 ~ 24个月。结论:dmap基皮瓣可为烧伤后手指背侧缺损的重建提供良好的软组织覆盖，供区缺损发生率可接受。
{"title":"Dorsal metacarpal artery perforator-based flaps for the reconstruction of postburn dorsal finger defects","authors":"V. Babu, Mukesh Sharma, Ashok Daram, Manoj K Jha, Sreeramaraju Vulchi","doi":"10.4103/ijb.ijb_21_22","DOIUrl":"https://doi.org/10.4103/ijb.ijb_21_22","url":null,"abstract":"Background: Burn injuries involving the dorsum of the hand are very common. Most burn injuries heal with dressings or skin grafting. Deep burns can lead to soft tissue defects and require durable cover to protect the underlying extensor tendons and the bone. Dorsal metacarpal artery-based flaps are reliable locoregional flaps that provide good soft tissue cover. Materials and Methods: This study included nine patients with postburn dorsal finger defects who underwent debridement and coverage using dorsal metacarpal artery perforator (DMAP)-based flaps from January 2019 to January 2022. Parameters in terms of flap dimensions, reliability, complications, and donor-site morbidity were assessed. Results: The flap size ranged from 5 cm × 2.5 cm to 7 cm × 2.5 cm. Two flaps had marginal necrosis, and one had venous congestion, which settled over time and healed with dressings. All the flaps settled well with a satisfactory outcome. The patients were followed up for 6–24 months. Conclusion: DMAP-based flaps are reliable in providing good soft tissue cover for reconstructing postburn dorsal finger defects with acceptable donor-site morbidity.","PeriodicalId":13336,"journal":{"name":"Indian journal of burns","volume":"30 1","pages":"65 - 69"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42479110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Hypertrophic scars (HS) remain the main cosmetic concern after complete healing of burns for both patients and treating burn surgeons. HS are managed conservatively using compression therapy, but in our study, we attempt fat grafting with compression therapy to identify which treatment modality leads to better outcomes in patients. Materials and Methods: A total of 84 patients (42 in each arm) in this prospective single-blind randomized controlled study had undergone fat transfer with compression therapy and compression therapy alone at a tertiary care burn center for treatment of HS from July 2015 to June 2017. Results: Out of the total of 84 patients, 54 were male and 30 were female with the mean age being 26.19 and 37.93 years in the case (test) and control group, respectively. Among them, 54 were flame burns and 20 were electrical burns. Mean total body surface area of 23.67% and 44.36% in the case and control, respectively, represents the extent of burns in majority of patients. Assessment of scars was done using the Patient and Observer Scar Assessment Scale which was found statistically significant (<0.005) in both patient and observer assessment in case group, i.e., fat grafting with compression therapy at all times during follow-up. Early complications in form of erythema and swelling in 20 cases, swelling in 13, erythema in 4, and none in 5. Conclusion: Our study suggested the superiority of fat grafting with compression therapy in the improvement of HS. Patients tolerated outpatient procedures well with minimal morbidity and self-limiting complications.
{"title":"A comparative study of fat transfer with compression therapy versus compression therapy alone in the treatment of hypertrophic burn scars: A prospective randomized trial","authors":"R. Saroha, V. Langer, S. Singh","doi":"10.4103/ijb.ijb_14_21","DOIUrl":"https://doi.org/10.4103/ijb.ijb_14_21","url":null,"abstract":"Introduction: Hypertrophic scars (HS) remain the main cosmetic concern after complete healing of burns for both patients and treating burn surgeons. HS are managed conservatively using compression therapy, but in our study, we attempt fat grafting with compression therapy to identify which treatment modality leads to better outcomes in patients. Materials and Methods: A total of 84 patients (42 in each arm) in this prospective single-blind randomized controlled study had undergone fat transfer with compression therapy and compression therapy alone at a tertiary care burn center for treatment of HS from July 2015 to June 2017. Results: Out of the total of 84 patients, 54 were male and 30 were female with the mean age being 26.19 and 37.93 years in the case (test) and control group, respectively. Among them, 54 were flame burns and 20 were electrical burns. Mean total body surface area of 23.67% and 44.36% in the case and control, respectively, represents the extent of burns in majority of patients. Assessment of scars was done using the Patient and Observer Scar Assessment Scale which was found statistically significant (<0.005) in both patient and observer assessment in case group, i.e., fat grafting with compression therapy at all times during follow-up. Early complications in form of erythema and swelling in 20 cases, swelling in 13, erythema in 4, and none in 5. Conclusion: Our study suggested the superiority of fat grafting with compression therapy in the improvement of HS. Patients tolerated outpatient procedures well with minimal morbidity and self-limiting complications.","PeriodicalId":13336,"journal":{"name":"Indian journal of burns","volume":"30 1","pages":"6 - 13"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44920399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Routinely changing central venous catheters (CVCs) as a prevention strategy of bbloodstreaminfections in burns patients has been controversial due to the paucity of evidence for appropriate timings of line changes. This study aims to ascertain the risk factors associated with central line-associated sepsis and thrombosis and to evaluate the role of heparin lock, routine line changes, and thromboprophylaxis in reducing the risk of complications associated with central venous catheterization. Materials and Methods: A retrospective observational hospital-based study on 50 patients admitted with major burns (involving 40% or more total body surface area [TBSA] in burn intensive care unit/ward at Gandhi Medical College and Associated Hamidia Hospital from May 2021 to June 2022. Nontunneled, triple-lumen central lines were inserted usingthe Seldinger technique preferentially on healthy skin and secured with Tegaderm™ CHG Chlorhexidine Gluconate transparent dressing. The removal of central lines was done sepsis (persistent rise of fever unresponsive to antipyretics or empirical antibiotics) or when distal limb swelling edema) developed. Routine removal of the central line was also done when resuscitation was over and parenteral nutritional supplementation was no longer needed (after 12–15 days) or before shifting from HDU or on discharge. Data collection included: Demographics, co-morbidities, type and cause of burn, %TBSA, route (subclavian, femoral, and jugular line), access (healthy/burned) of line, duration of line in situ, complications (cellulitis, edema, venous thrombosis, and persistent high-grade fever), culture/sensitivity (c/s) reports, duration of hospital stay, heparin prophylaxis, or treatment. The data were processed with Chi-square test. The primary outcome of this observational study was a measure of catheter-related bloodstream infections and symptomatic deep vein thrombosis and their correlation with demographics and various comorbidities. Result: Central line duration and age were identified as independent risk factors for central line-associated bloodstream infection (CLABSI), with central line duration the most significant predictor (P < 0.05). CLABSI occurred at 12.81 ± 2.967 days' postline insertion. Further research is needed to assess the role of routine line changes (every 12–15 days' postinsertion) in preventing CLABSI and heparin lock in reducing the incidence of venous thrombosis. Hospital stay was prolonged in the patients developing CVC-associated complications independently increasing morbidity in patients with severe burns, but was not found to be significant (P < 0.05). Conclusion: Jugular venous route should be preferred as the site of CVC insertion (easier and associated with a lower complication rate) and the duration of line kept in situ should be reduced. The blood c/s (preferably central line tip c/s) should be sent routinely after 10 days or on the first suspicion of complications to reduce the incid
{"title":"Study of central venous catheter-related complications in major burn patients","authors":"Itisha Agrawal, Arun Bhatnagar","doi":"10.4103/ijb.ijb_1_23","DOIUrl":"https://doi.org/10.4103/ijb.ijb_1_23","url":null,"abstract":"Background: Routinely changing central venous catheters (CVCs) as a prevention strategy of bbloodstreaminfections in burns patients has been controversial due to the paucity of evidence for appropriate timings of line changes. This study aims to ascertain the risk factors associated with central line-associated sepsis and thrombosis and to evaluate the role of heparin lock, routine line changes, and thromboprophylaxis in reducing the risk of complications associated with central venous catheterization. Materials and Methods: A retrospective observational hospital-based study on 50 patients admitted with major burns (involving 40% or more total body surface area [TBSA] in burn intensive care unit/ward at Gandhi Medical College and Associated Hamidia Hospital from May 2021 to June 2022. Nontunneled, triple-lumen central lines were inserted usingthe Seldinger technique preferentially on healthy skin and secured with Tegaderm™ CHG Chlorhexidine Gluconate transparent dressing. The removal of central lines was done sepsis (persistent rise of fever unresponsive to antipyretics or empirical antibiotics) or when distal limb swelling edema) developed. Routine removal of the central line was also done when resuscitation was over and parenteral nutritional supplementation was no longer needed (after 12–15 days) or before shifting from HDU or on discharge. Data collection included: Demographics, co-morbidities, type and cause of burn, %TBSA, route (subclavian, femoral, and jugular line), access (healthy/burned) of line, duration of line in situ, complications (cellulitis, edema, venous thrombosis, and persistent high-grade fever), culture/sensitivity (c/s) reports, duration of hospital stay, heparin prophylaxis, or treatment. The data were processed with Chi-square test. The primary outcome of this observational study was a measure of catheter-related bloodstream infections and symptomatic deep vein thrombosis and their correlation with demographics and various comorbidities. Result: Central line duration and age were identified as independent risk factors for central line-associated bloodstream infection (CLABSI), with central line duration the most significant predictor (P < 0.05). CLABSI occurred at 12.81 ± 2.967 days' postline insertion. Further research is needed to assess the role of routine line changes (every 12–15 days' postinsertion) in preventing CLABSI and heparin lock in reducing the incidence of venous thrombosis. Hospital stay was prolonged in the patients developing CVC-associated complications independently increasing morbidity in patients with severe burns, but was not found to be significant (P < 0.05). Conclusion: Jugular venous route should be preferred as the site of CVC insertion (easier and associated with a lower complication rate) and the duration of line kept in situ should be reduced. The blood c/s (preferably central line tip c/s) should be sent routinely after 10 days or on the first suspicion of complications to reduce the incid","PeriodicalId":13336,"journal":{"name":"Indian journal of burns","volume":"30 1","pages":"70 - 77"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45283227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Although the mortality and morbidity from burns have diminished significantly over the last few decades, these do not truly reflect whether the victim could lead a normal life, owing to postburn contractures (PBCs) and other deformities, which have functional and aesthetic implications. Objective: The main objective of this study was to compare the improvement in cervico-mental angle after surgery, using a goniometer; and to assess the postoperative complications, cosmetic outcome and patient satisfaction after contracture release and split-thickness skin grafting. Methods: In this prospective study, we have studied a total of 20 patients with PBCs of neck, who underwent contracture release and split skin grafting. The preoperative cervico-mental angles were compared to postoperative measurements using a goniometer. Results: In this study, we observed that the mean cervicomental angle before the surgery was 85.5° ± 12.8° and after the surgery was 106.4° ± 7.8°. The percentage improvement was 24.3% which was found to be statistically significant (P < 0.001). Patients were also classified based on age, gender, mechanism and classification of burns, time elapsed since burn injury. Postoperative complications, cosmetic outcome and patient satisfaction were also studied. Conclusion: PBCs can affect a patient's life functionally, aesthetically, and psychologically. Split-thickness skin grafting is a safe and reliable option for PBC neck. This causes improvement in cervicomental angle and thus range of movements of the neck in different axes (as measured by a goniometer). lthough the mortality and morbidity from burns have diminished significantly over the last few decades, these do not truly reflect whether the victim could lead a normal life, owing to postburn contractures (PBCs) and other deformities, which have functional and aesthetic implications. In this prospective study, we have studied a total of 20 patients with PBCs of neck, who underwent contracture release and split skin grafting. The preoperative cervico-mental angles were compared to postoperative measurements using a goniometer, and a significant improvement was noted. Overall patient satisfaction was also very good. Hence, split thickness skin grafting is a safe and reliable option for PBC neck.
{"title":"Improvement in functional and aesthetic outcome in postburn contracture of neck following split skin grafting using goniometer","authors":"S. Dhua, Shifa Raheel","doi":"10.4103/ijb.ijb_12_22","DOIUrl":"https://doi.org/10.4103/ijb.ijb_12_22","url":null,"abstract":"Introduction: Although the mortality and morbidity from burns have diminished significantly over the last few decades, these do not truly reflect whether the victim could lead a normal life, owing to postburn contractures (PBCs) and other deformities, which have functional and aesthetic implications. Objective: The main objective of this study was to compare the improvement in cervico-mental angle after surgery, using a goniometer; and to assess the postoperative complications, cosmetic outcome and patient satisfaction after contracture release and split-thickness skin grafting. Methods: In this prospective study, we have studied a total of 20 patients with PBCs of neck, who underwent contracture release and split skin grafting. The preoperative cervico-mental angles were compared to postoperative measurements using a goniometer. Results: In this study, we observed that the mean cervicomental angle before the surgery was 85.5° ± 12.8° and after the surgery was 106.4° ± 7.8°. The percentage improvement was 24.3% which was found to be statistically significant (P < 0.001). Patients were also classified based on age, gender, mechanism and classification of burns, time elapsed since burn injury. Postoperative complications, cosmetic outcome and patient satisfaction were also studied. Conclusion: PBCs can affect a patient's life functionally, aesthetically, and psychologically. Split-thickness skin grafting is a safe and reliable option for PBC neck. This causes improvement in cervicomental angle and thus range of movements of the neck in different axes (as measured by a goniometer). lthough the mortality and morbidity from burns have diminished significantly over the last few decades, these do not truly reflect whether the victim could lead a normal life, owing to postburn contractures (PBCs) and other deformities, which have functional and aesthetic implications. In this prospective study, we have studied a total of 20 patients with PBCs of neck, who underwent contracture release and split skin grafting. The preoperative cervico-mental angles were compared to postoperative measurements using a goniometer, and a significant improvement was noted. Overall patient satisfaction was also very good. Hence, split thickness skin grafting is a safe and reliable option for PBC neck.","PeriodicalId":13336,"journal":{"name":"Indian journal of burns","volume":"30 1","pages":"24 - 32"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45765472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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