P. Arumugam, H. Walia, Bhagyashri Talele, S. Sharma
Burn injuries, especially electrical burns, can lead to significant soft-tissue damage. A delayed sequela of both electric burn and firecracker injury is arterial rupture. The initial phase is characterized by occlusion of small vessels. Large vessels are prone to aneurysm formation due to medial necrosis. This can result in unanticipated bleeding, which can lead to loss of the limb or even be life-threatening. We are presenting here two cases treated in our burns department for electrical burns and firecracker injury involving the lower limbs. Both these patients presented with delayed vascular complications, which were successfully managed and limbs salvaged. We are presenting these cases to emphasize that timely intervention leads to better outcomes.
{"title":"Arterial rupture: A delayed sequela of burn injury","authors":"P. Arumugam, H. Walia, Bhagyashri Talele, S. Sharma","doi":"10.4103/ijb.ijb_13_20","DOIUrl":"https://doi.org/10.4103/ijb.ijb_13_20","url":null,"abstract":"Burn injuries, especially electrical burns, can lead to significant soft-tissue damage. A delayed sequela of both electric burn and firecracker injury is arterial rupture. The initial phase is characterized by occlusion of small vessels. Large vessels are prone to aneurysm formation due to medial necrosis. This can result in unanticipated bleeding, which can lead to loss of the limb or even be life-threatening. We are presenting here two cases treated in our burns department for electrical burns and firecracker injury involving the lower limbs. Both these patients presented with delayed vascular complications, which were successfully managed and limbs salvaged. We are presenting these cases to emphasize that timely intervention leads to better outcomes.","PeriodicalId":13336,"journal":{"name":"Indian journal of burns","volume":"28 1","pages":"98 - 100"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42254671","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}
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}
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}
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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