Background: Burn-related harms are a substantial problem in children, predominantly in low- and middle-income countries, where over 90% of burn-related childhood deaths occur. The aim of this study was to determine the causes, magnitude, management, and outcome of burn injury among children who attended the Pediatric Emergency Outpatient Department of Hawassa University Comprehensive Specialized Hospital, Hawassa, Southern Ethiopia. Materials and Methods: A hospital-based retrospective cross-sectional study was conducted from 15 November to 20 December 2018 on a sample of 395 patient medical records who have been treated burn injury for 5 consecutive years from September 2013 to September 2018. Systematic random sampling was used to select the patient records, and a pretested structured checklist was organized to collect the data. Epi Info 3.5.4 was used for data entry and the Statistical Package for the Social Sciences version 20.0 for analysis. Results: The majority (62.5%) of the burn injuries affected <5 children. The major cause of burn injury was scald (59.7%). Statistically, a significant association was found between the cause of burn and age of the patient (P = 0.000). The 5 years' prevalence of burn injury was 9.79%. Almost all burn injuries occur at home (97%) and accidental (94.2%), and more than half (56.7%) of the children suffered from the second-degree burn. Almost half (47.1%) burnt 10%–20% total body surface area, and 47.6% have got prehospital first aid interventions and 36.2% received surgical interventions. Almost two-thirds (74.4%) of the children recovered without complication. Six died and four of them were third-degree burn victims and <5 years old. There was a significant statistical association between treatment outcome and age of the patient (P = 0.004). Conclusion: The epidemiology and outcome of burn injury among children were comparable to other developing countries, but the high magnitude was noticed. Public health education and prevention programs may help to reduce the prevalence of childhood burn injury.
背景:烧伤相关危害是儿童的一个重大问题，主要发生在低收入和中等收入国家，90%以上的儿童死亡发生在这些国家。本研究的目的是确定在埃塞俄比亚南部阿瓦萨的阿瓦萨大学综合专科医院儿科急诊门诊部就诊的儿童烧伤的原因、程度、处理和结果。材料与方法:2018年11月15日至12月20日，对2013年9月至2018年9月连续5年治疗烧伤的395例患者病历进行回顾性横断面研究。采用系统随机抽样的方法抽取患者病历，并组织一份预先测试过的结构化检查表进行数据收集。数据录入使用Epi Info 3.5.4，分析使用Statistical Package for Social Sciences version 20.0。结果:以5岁以下儿童为主(62.5%)。烧伤的主要原因是烫伤(59.7%)。统计上，烧伤原因与患者年龄有显著相关性(P = 0.000)。5年烧伤患病率为9.79%。几乎所有的烧伤都发生在家中(97%)和意外(94.2%)，超过一半(56.7%)的儿童遭受二度烧伤。近一半(47.1%)烧伤面积占体表总面积的10%-20%，47.6%接受院前急救干预，36.2%接受手术干预。近三分之二(74.4%)患儿康复无并发症。6人死亡，其中4人是三度烧伤，年龄小于5岁。治疗结果与患者年龄有显著的统计学相关性(P = 0.004)。结论:中国儿童烧伤的流行病学和预后与其他发展中国家相当，但程度较高。公共健康教育和预防计划可能有助于减少儿童烧伤的患病率。
{"title":"Epidemiology and outcome of childhood burn injury in Hawassa University Comprehensive Specialized Hospital, Hawassa, Southern Ethiopia","authors":"Wegene Biru, F. Mekonnen","doi":"10.4103/ijb.ijb_28_19","DOIUrl":"https://doi.org/10.4103/ijb.ijb_28_19","url":null,"abstract":"Background: Burn-related harms are a substantial problem in children, predominantly in low- and middle-income countries, where over 90% of burn-related childhood deaths occur. The aim of this study was to determine the causes, magnitude, management, and outcome of burn injury among children who attended the Pediatric Emergency Outpatient Department of Hawassa University Comprehensive Specialized Hospital, Hawassa, Southern Ethiopia. Materials and Methods: A hospital-based retrospective cross-sectional study was conducted from 15 November to 20 December 2018 on a sample of 395 patient medical records who have been treated burn injury for 5 consecutive years from September 2013 to September 2018. Systematic random sampling was used to select the patient records, and a pretested structured checklist was organized to collect the data. Epi Info 3.5.4 was used for data entry and the Statistical Package for the Social Sciences version 20.0 for analysis. Results: The majority (62.5%) of the burn injuries affected <5 children. The major cause of burn injury was scald (59.7%). Statistically, a significant association was found between the cause of burn and age of the patient (P = 0.000). The 5 years' prevalence of burn injury was 9.79%. Almost all burn injuries occur at home (97%) and accidental (94.2%), and more than half (56.7%) of the children suffered from the second-degree burn. Almost half (47.1%) burnt 10%–20% total body surface area, and 47.6% have got prehospital first aid interventions and 36.2% received surgical interventions. Almost two-thirds (74.4%) of the children recovered without complication. Six died and four of them were third-degree burn victims and <5 years old. There was a significant statistical association between treatment outcome and age of the patient (P = 0.004). Conclusion: The epidemiology and outcome of burn injury among children were comparable to other developing countries, but the high magnitude was noticed. Public health education and prevention programs may help to reduce the prevalence of childhood burn injury.","PeriodicalId":13336,"journal":{"name":"Indian journal of burns","volume":"28 1","pages":"51 - 56"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44830125","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: Burn injuries constitute a major part of traumatic injuries and most commonly are accidental. They have devastating mental and functional sequelae apart from increased chances of mortality. Knowledge about the prognosis of various burn injuries and the risk factors leading to complications helps treat them. This study was undertaken to document the epidemiological data of burn patients admitted in Pt BD Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India, from January 2019 to December 2019. Materials and Methods: Demographic details including age, sex, cause and nature of injury, associated comorbidities, depth and percentage of body area involved, involvement of the face and suspected inhalation injury, survival, period of survival, and mortality rate were recorded. For the pediatric population, weight for age was taken as an indicator for nutrition. Patients who left against medical advice were excluded from the study. P < 0.05 was considered to be statistically significant. Results: Burn injuries were most common in the age group of 21–60 years. Males were more commonly injured. Thermal injuries were most common (91%), followed by electric burns. Accidental burns were 88%, in 9% alleged history of suicide, and in rest, homicide was suspected. Out of 104 pediatric patients, 50% were undernourished. The mortality among undernourished patients had the odd's ratio of 8.5. The survival rate was 81% overall. It was noted that burns more than 40% total body surface area (TBSA) involvement had mortality of 56.25% and 9.44% in < 40% TBSA involvement (odds ratio 5.95). Face involvement for suspected inhalation injury had increased risk of mortality (odd's ratio 1.68). The most common cause of death was multi-organ dysfunction syndrome from sepsis within 10 days in 78% of cases. Among survivors, the duration of stay was dependent on the TBSA involvement. Conclusion: Pediatric age group, inhalation injury, undernutrition, and thromboembolism are factors which contribute to increased mortality, apart from large TBSA involvement. Initial 10 days need careful monitoring to decrease mortality and initiate early treatment. Limitation: This study has been conducted in a tertiary care hospital. Only referred cases needing hospital care were included in this study. Hence, the data represent only a part of demographic data sustaining burn injuries.
{"title":"Epidemiological study of burn patients admitted in tertiary care hospital in India and associated risk factors: A retrospective observational review","authors":"Krittika Aggarwal, Kuldeep Singh, Bhupender Singh","doi":"10.4103/ijb.ijb_10_20","DOIUrl":"https://doi.org/10.4103/ijb.ijb_10_20","url":null,"abstract":"Introduction: Burn injuries constitute a major part of traumatic injuries and most commonly are accidental. They have devastating mental and functional sequelae apart from increased chances of mortality. Knowledge about the prognosis of various burn injuries and the risk factors leading to complications helps treat them. This study was undertaken to document the epidemiological data of burn patients admitted in Pt BD Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India, from January 2019 to December 2019. Materials and Methods: Demographic details including age, sex, cause and nature of injury, associated comorbidities, depth and percentage of body area involved, involvement of the face and suspected inhalation injury, survival, period of survival, and mortality rate were recorded. For the pediatric population, weight for age was taken as an indicator for nutrition. Patients who left against medical advice were excluded from the study. P < 0.05 was considered to be statistically significant. Results: Burn injuries were most common in the age group of 21–60 years. Males were more commonly injured. Thermal injuries were most common (91%), followed by electric burns. Accidental burns were 88%, in 9% alleged history of suicide, and in rest, homicide was suspected. Out of 104 pediatric patients, 50% were undernourished. The mortality among undernourished patients had the odd's ratio of 8.5. The survival rate was 81% overall. It was noted that burns more than 40% total body surface area (TBSA) involvement had mortality of 56.25% and 9.44% in < 40% TBSA involvement (odds ratio 5.95). Face involvement for suspected inhalation injury had increased risk of mortality (odd's ratio 1.68). The most common cause of death was multi-organ dysfunction syndrome from sepsis within 10 days in 78% of cases. Among survivors, the duration of stay was dependent on the TBSA involvement. Conclusion: Pediatric age group, inhalation injury, undernutrition, and thromboembolism are factors which contribute to increased mortality, apart from large TBSA involvement. Initial 10 days need careful monitoring to decrease mortality and initiate early treatment. Limitation: This study has been conducted in a tertiary care hospital. Only referred cases needing hospital care were included in this study. Hence, the data represent only a part of demographic data sustaining burn injuries.","PeriodicalId":13336,"journal":{"name":"Indian journal of burns","volume":"28 1","pages":"79 - 83"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46340575","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}
K. Ramakrishnan, B. Ramachandran, K. Ravikumar, Sulochana Putli, V. Jayaraman, T. Mathivanan, R. Ravi, S. Gnanamani, M. Babu
Electrical injuries in children are gruesome injuries that result in disabilities and death in developing countries. In this article we present a series of 6 children who were treated for electrical burns. Reconstructive surgery followed by prolonged rehabilitation is required.
{"title":"Electrical injury in pediatric patients – A case series","authors":"K. Ramakrishnan, B. Ramachandran, K. Ravikumar, Sulochana Putli, V. Jayaraman, T. Mathivanan, R. Ravi, S. Gnanamani, M. Babu","doi":"10.4103/ijb.ijb_27_19","DOIUrl":"https://doi.org/10.4103/ijb.ijb_27_19","url":null,"abstract":"Electrical injuries in children are gruesome injuries that result in disabilities and death in developing countries. In this article we present a series of 6 children who were treated for electrical burns. Reconstructive surgery followed by prolonged rehabilitation is required.","PeriodicalId":13336,"journal":{"name":"Indian journal of burns","volume":"28 1","pages":"94 - 97"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48012366","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}
A. Lugga, Bello Sulaiman, L. Ibrahim, Yekinni Abiodun
Burn injuries are rare in the neonatal period. Most of the cases reported in the literature are iatrogenic. We report the case of a 7-h old female neonate who presented with domestic accidental scald burns involving 18% of the total body surface area. She sustained the burns during a traditional bath with hot water. She was resuscitated with intravenous fluid, and urine output was monitored. She was nursed under a radiant heater and was given analgesics and tetanus antitoxin. She had wound sepsis from Pseudomonas species which was successfully treated with intravenous antibiotic (ceftazidime). She also had anemia which was corrected with packed red blood cell transfusion. Wound dressing was done with antibiotic-impregnated gauze until the wounds were satisfactorily healed. She was discharged from the hospital on the 29th-day postburn.
{"title":"Scald burns in a 7-h old neonate: A consequence of traditional hot water bath","authors":"A. Lugga, Bello Sulaiman, L. Ibrahim, Yekinni Abiodun","doi":"10.4103/ijb.ijb_7_20","DOIUrl":"https://doi.org/10.4103/ijb.ijb_7_20","url":null,"abstract":"Burn injuries are rare in the neonatal period. Most of the cases reported in the literature are iatrogenic. We report the case of a 7-h old female neonate who presented with domestic accidental scald burns involving 18% of the total body surface area. She sustained the burns during a traditional bath with hot water. She was resuscitated with intravenous fluid, and urine output was monitored. She was nursed under a radiant heater and was given analgesics and tetanus antitoxin. She had wound sepsis from Pseudomonas species which was successfully treated with intravenous antibiotic (ceftazidime). She also had anemia which was corrected with packed red blood cell transfusion. Wound dressing was done with antibiotic-impregnated gauze until the wounds were satisfactorily healed. She was discharged from the hospital on the 29th-day postburn.","PeriodicalId":13336,"journal":{"name":"Indian journal of burns","volume":"28 1","pages":"101 - 103"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70743659","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: Hyperbaric oxygen therapy (HBOT) is an adjunctive therapy that has been proposed to improve outcome in thermal burns. It involves the therapeutic administration of 100% oxygen at environmental pressures >1 atmosphere absolute (ATA). Methodology: An open, prospective, observational study was conducted for a period of 18 months which included fifty patients who were allocated to either adjunctive hyperbaric therapy in addition to the existing protocol of burn management (Group A) or only existing protocol of burn management (Group B) with daily dressing and debridement. All patients between the age of 18 and 60 years with 15%–60% of second and third degrees of thermal burns were included. HBOT was administered at 2.0 ATA in a “monoplace” chamber for 90 min, 6 days a week. A total of ten sessions were administered to each patient along with conventional treatment. Results: The mean time of wound healing in Group A was 18.96 days, whereas in Group B, it was 43.64 days. The mean number of days of hospital stay in Group A was 32.04 days, whereas in Group B, those were 51.2 days. Similarly, the mean pain score and mean fluid requirement were less in Group A when compared to those of Group B. Conclusion: With our study, we can conclude that HBOT is an effective adjunctive modality of treatment in the management of thermal burns.
{"title":"Evaluation of efficacy of hyperbaric oxygen therapy as an adjunctive therapy in the management of thermal burns","authors":"Naveen Kumar, V. Tiwari","doi":"10.4103/ijb.ijb_25_19","DOIUrl":"https://doi.org/10.4103/ijb.ijb_25_19","url":null,"abstract":"Background: Hyperbaric oxygen therapy (HBOT) is an adjunctive therapy that has been proposed to improve outcome in thermal burns. It involves the therapeutic administration of 100% oxygen at environmental pressures >1 atmosphere absolute (ATA). Methodology: An open, prospective, observational study was conducted for a period of 18 months which included fifty patients who were allocated to either adjunctive hyperbaric therapy in addition to the existing protocol of burn management (Group A) or only existing protocol of burn management (Group B) with daily dressing and debridement. All patients between the age of 18 and 60 years with 15%–60% of second and third degrees of thermal burns were included. HBOT was administered at 2.0 ATA in a “monoplace” chamber for 90 min, 6 days a week. A total of ten sessions were administered to each patient along with conventional treatment. Results: The mean time of wound healing in Group A was 18.96 days, whereas in Group B, it was 43.64 days. The mean number of days of hospital stay in Group A was 32.04 days, whereas in Group B, those were 51.2 days. Similarly, the mean pain score and mean fluid requirement were less in Group A when compared to those of Group B. Conclusion: With our study, we can conclude that HBOT is an effective adjunctive modality of treatment in the management of thermal burns.","PeriodicalId":13336,"journal":{"name":"Indian journal of burns","volume":"28 1","pages":"44 - 50"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42724267","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}
{"title":"Ward ventilation in a burn unit: Food for thought","authors":"Veena Singh, Sarsij Sharma, A. Haq, Neeraj Kumar","doi":"10.4103/ijb.ijb_14_20","DOIUrl":"https://doi.org/10.4103/ijb.ijb_14_20","url":null,"abstract":"","PeriodicalId":13336,"journal":{"name":"Indian journal of burns","volume":"28 1","pages":"113 - 114"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70741950","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}
Dear Editor, We read the publication on “Could serum cytokines serve as predictors in outcome of thermal burn injuries” with a great interest.[1] Babu et al. concluded that “cytokines could serve as predictors for the outcome of thermal burn injuries.”[1] The determination of cytokines might be useful, but there are some concerns. First, the quality control of the laboratory analysis according to clinical pathology principle is necessary. Second, cytokine is not a good biomarker for the cases of burn in the elderly. In elderly patients with burn, the trend of low cytokine level is observed.[2] The other basic biomarkers that might be useful as predictors are creatinine and blood urea nitrogen.[2]
{"title":"Serum cytokines serve as predictors of thermal burn injuries","authors":"B. Joob, V. Wiwanitkit","doi":"10.4103/ijb.ijb_29_18","DOIUrl":"https://doi.org/10.4103/ijb.ijb_29_18","url":null,"abstract":"Dear Editor, We read the publication on “Could serum cytokines serve as predictors in outcome of thermal burn injuries” with a great interest.[1] Babu et al. concluded that “cytokines could serve as predictors for the outcome of thermal burn injuries.”[1] The determination of cytokines might be useful, but there are some concerns. First, the quality control of the laboratory analysis according to clinical pathology principle is necessary. Second, cytokine is not a good biomarker for the cases of burn in the elderly. In elderly patients with burn, the trend of low cytokine level is observed.[2] The other basic biomarkers that might be useful as predictors are creatinine and blood urea nitrogen.[2]","PeriodicalId":13336,"journal":{"name":"Indian journal of burns","volume":"27 1","pages":"116 - 116"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70743045","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}
Aim: To identify perfusion differences between the areas of different depths and to evaluate the potential of portable indocyanine green (ICG) perfusion assessment to determine the likelihood of healing in burns compared with visual assessment. Materials and Methods: This interventional study was carried out at the burn unit and plastic surgery department, from April 2017 to September 2017. A total of 20 patients with superficial and partial thickness burns <15% for whom the burn assessment was done with portable ICG perfusion assessment and visual assessment were included in the study. The results regarding the excision of burn wound and burn wound healing were compared. Results: Of 20 patients, 14 patients did not have any discrepancy with the clinical findings and ICG perfusion assessment. The findings of five patients appeared clinically deep, but perfusion was present which did not require surgical intervention. One patient had patchy perfusion and finally required surgical correction. Conclusion: ICG perfusion assessment appeared to be effective in preventing surgical intervention in patients by differentiating deep to superficial second-degree burns. Proper clinical assessment and ICG perfusion assessment as an adjunct can improve the outcome of burn wound.
{"title":"Portable indocyanine green perfusion assessment: An adjunct to visual assessment in burn wound healing in second-degree burns","authors":"P. Korambayil, P. Ambookan, R. Karangath","doi":"10.4103/ijb.ijb_5_19","DOIUrl":"https://doi.org/10.4103/ijb.ijb_5_19","url":null,"abstract":"Aim: To identify perfusion differences between the areas of different depths and to evaluate the potential of portable indocyanine green (ICG) perfusion assessment to determine the likelihood of healing in burns compared with visual assessment. Materials and Methods: This interventional study was carried out at the burn unit and plastic surgery department, from April 2017 to September 2017. A total of 20 patients with superficial and partial thickness burns <15% for whom the burn assessment was done with portable ICG perfusion assessment and visual assessment were included in the study. The results regarding the excision of burn wound and burn wound healing were compared. Results: Of 20 patients, 14 patients did not have any discrepancy with the clinical findings and ICG perfusion assessment. The findings of five patients appeared clinically deep, but perfusion was present which did not require surgical intervention. One patient had patchy perfusion and finally required surgical correction. Conclusion: ICG perfusion assessment appeared to be effective in preventing surgical intervention in patients by differentiating deep to superficial second-degree burns. Proper clinical assessment and ICG perfusion assessment as an adjunct can improve the outcome of burn wound.","PeriodicalId":13336,"journal":{"name":"Indian journal of burns","volume":"27 1","pages":"90 - 94"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70743674","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: We report a unique association of an ancient Indian custom of postdelivery mother roasting and postpartum psychosis responsible for the causation of major burns. Materials and Methods: A 20-year-old postpartum female reported with 40% second- and third-degree total body surface area burns. The combination of the ancient Indian custom of mother roasting and postpartum psychosis led to these major burns. The conventional treatment of burns in the form of IV fluids, antibiotics, and dressings with silver sulfadiazine creams was carried out. The psychiatrist was consulted, and the antipsychotic medicines were started for an altered behavior. One month after the burns, she developed deep-vein thrombosis with venous gangrene of the left leg for which she required a below-knee amputation. She required 45 days of hospitalization and six surgical procedures in the form of debridement and split-thickness skin grafting. Problems such as hypotension, noncooperation due to the wild swing in the moods were overcome by proper fluid and electrolyte management, an adjustment in antipsychotic medicines, appropriate postoperative care, and chest physiotherapy. Results: One year of follow-up showed good stable scars. At present, she can perform all domestic as well as labor work on the farm, with the help of a below-knee prosthesis. There is no element of psychotic behavior at present. Conclusion: This case report sheds light on an ancient Indian custom of mother roasting and postpartum psychosis and its dangers in contracting severe burn injuries. Challenges posed by postpartum psychosis in the treatment of burns have been discussed.
{"title":"A unique association of an ancient Indian custom of body roasting and the postpartum psychosis responsible for the occurrence of major burns: A case report and challenges posed by postpartum psychosis in the treatment of burns","authors":"H. Saraiya","doi":"10.4103/ijb.ijb_13_19","DOIUrl":"https://doi.org/10.4103/ijb.ijb_13_19","url":null,"abstract":"Introduction: We report a unique association of an ancient Indian custom of postdelivery mother roasting and postpartum psychosis responsible for the causation of major burns. Materials and Methods: A 20-year-old postpartum female reported with 40% second- and third-degree total body surface area burns. The combination of the ancient Indian custom of mother roasting and postpartum psychosis led to these major burns. The conventional treatment of burns in the form of IV fluids, antibiotics, and dressings with silver sulfadiazine creams was carried out. The psychiatrist was consulted, and the antipsychotic medicines were started for an altered behavior. One month after the burns, she developed deep-vein thrombosis with venous gangrene of the left leg for which she required a below-knee amputation. She required 45 days of hospitalization and six surgical procedures in the form of debridement and split-thickness skin grafting. Problems such as hypotension, noncooperation due to the wild swing in the moods were overcome by proper fluid and electrolyte management, an adjustment in antipsychotic medicines, appropriate postoperative care, and chest physiotherapy. Results: One year of follow-up showed good stable scars. At present, she can perform all domestic as well as labor work on the farm, with the help of a below-knee prosthesis. There is no element of psychotic behavior at present. Conclusion: This case report sheds light on an ancient Indian custom of mother roasting and postpartum psychosis and its dangers in contracting severe burn injuries. Challenges posed by postpartum psychosis in the treatment of burns have been discussed.","PeriodicalId":13336,"journal":{"name":"Indian journal of burns","volume":"27 1","pages":"35 - 39"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70741515","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}
Many epidemiological studies have revealed the incidence of axillary contractures next only to elbow contractures as sequelae to burn injury. Even if it may be possible to prevent adduction contracture of the axilla through early splinting and range of motion exercises that counteract the position of comfort, it continues to pose a frequent problem to burn surgeons. In the increasing degree of severity, axillary contractures may involve one or both axillary folds and also involve the hair-bearing dome of the axilla. Unless severe functional disability is present, we recommend a minimum 6-month wait following wound healing to allow for scar maturation to achieve better results. In milder presentations, it may be possible to perform Z-plasties, Y–V plasties, or many other local flaps on isolated axillary bands, with the caveat that if the contractile bands are in the midst of scarring, such linear contractures may only be effectively released and resurfaced with skin grafts. While the innovative use of local skin flaps must be encouraged, we recommend a low threshold of using acceptable thickness skin grafts for coverage. Controversy exists on the best technique for axillary resurfacing in severe cases of axillary involvement. While it is relatively simple and expeditious to release the contracture and cover the extensive defect with skin grafts, it requires meticulous postoperative regimen of splinting and physiotherapy. In selected cases, uninvolved adjacent scapular and back areas allow for many fasciocutaneous and myocutaneous flaps for durable long-term results. Free flaps, traditionally less popular in this region, may be an alternative option if areas adjacent to axilla are also involved.
{"title":"Management of postburn axillary contractures","authors":"R. Ahuja, Pallab Chatterjee","doi":"10.4103/ijb.ijb_18_18","DOIUrl":"https://doi.org/10.4103/ijb.ijb_18_18","url":null,"abstract":"Many epidemiological studies have revealed the incidence of axillary contractures next only to elbow contractures as sequelae to burn injury. Even if it may be possible to prevent adduction contracture of the axilla through early splinting and range of motion exercises that counteract the position of comfort, it continues to pose a frequent problem to burn surgeons. In the increasing degree of severity, axillary contractures may involve one or both axillary folds and also involve the hair-bearing dome of the axilla. Unless severe functional disability is present, we recommend a minimum 6-month wait following wound healing to allow for scar maturation to achieve better results. In milder presentations, it may be possible to perform Z-plasties, Y–V plasties, or many other local flaps on isolated axillary bands, with the caveat that if the contractile bands are in the midst of scarring, such linear contractures may only be effectively released and resurfaced with skin grafts. While the innovative use of local skin flaps must be encouraged, we recommend a low threshold of using acceptable thickness skin grafts for coverage. Controversy exists on the best technique for axillary resurfacing in severe cases of axillary involvement. While it is relatively simple and expeditious to release the contracture and cover the extensive defect with skin grafts, it requires meticulous postoperative regimen of splinting and physiotherapy. In selected cases, uninvolved adjacent scapular and back areas allow for many fasciocutaneous and myocutaneous flaps for durable long-term results. Free flaps, traditionally less popular in this region, may be an alternative option if areas adjacent to axilla are also involved.","PeriodicalId":13336,"journal":{"name":"Indian journal of burns","volume":"27 1","pages":"8 - 15"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70741998","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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