BY

RAMYA.M

GUIDED BY

PROF.DR.S.SOUNDARARAJAN,M.S,Mch

DR.K.MADHANAGOPAL,M.D

DR.M.RAJAGANAPATHY,MBBS

DR.R.DURAI,MBBS

INTRODUCTION

• Burns - one of the most dreadful conditions

encountered in medicine.

• The injury represents an assault on all aspects of the

patient from physical to the psychological.

• The visible physical and the invisible psychological

scar are long lasting and often lead to chronic and

permanent disability.

• Needs correct management requires a skilled

multidisciplinary approach.

HISTORY

CHIEF COMPLAINTS

A 3 year old female baby Narmatha was

brought to Kannan hospital in Cuddalore with the

chief complaints of scalds over the Face, scalp &

Neck

- 1 day old

NATURE OF INJURY

• She has sustained this injury accidently by pouring hot

oil.

• She has presented with burn injury over the face, scalp

and patches of burnt area over the shoulders.

DEPTH OF THE BURN

• THIRD DEGREE BURN(Full thickness burn)

EXTENT OF INJURY

DAY 1

EXAMINATION

ASSESSMENT OF BURNS:

Naramatha had 18% of

burns as per RULE OF

NINES.

OTHER METHODS:

1. The patient’s whole

hand is 1%TBSA and is a

useful guide in small burns.

2. The LUND and

BROWDER chart is useful in

larger burns.

INITIAL CARE AND

RESUSCITATION

• The recommended fluid formula to maintain

electrolyte balance are

lactated Ringer’s

PARK LAND formula:

% of burns x 4 x weight of the baby.

20% x 4 x 15 = 1200ml

50% -- 600ml – 1st 8 hrs

25% -- 300ml – 2nd 8 hrs

25% -- 300ml – 3rd 8 hrs

AFTER 24hrs:

depends on output ---- 1ml/kg/hr

DRESSING

• She has been shifted to burns ward and daily

dressing was done as follows:

• Inspite of her routine dressing accidentally she

developed wound infection.

Normal saline - Washing

Povidine iodine ointment application

Neosporin with Sofra tuille Gauze

Closed dressing with Sterile Gauze ,

Pads & Bandages

LABORATORY EXAMINATION

CULTURE:

Culture positive for

STAPHYLOCOCCUS AUREUS

PSEUDOMONAS

KLEBSIELLA.

SENSITIVITY TEST:

Staph aureus - methicillin resistant.

ESCHAROTOMY:

• Wound healing took place and eschar was

formed.

TREATMENT

Apart from daily dressing systemic antibiotics like

FORCEF(cefuroxime) 500mg iv TDS

METROGYL 25ml iv BD

TOBRAMYCIN 40mg iv BD

FORMIL(ceftriaxone+salbactum) 500mg iv TDS

cefepime 500mg iv TDS

RECONSTRUCTION

• After routine investigations like

she has undergone SPLIT THICKNESS SKIN

GRAFT.

CBC

Blood group ( blood transfusion

100ml given)

BT

CT

Hb S Ag

tridot

PROCEDURE

DONOR SITE:

Upper lateral aspects of thigh

RECIPIENT SITE:

The recipient site must be cleaned from excessive

granulation tissue before grafting

STEP:1 Using DERMATOME/ Humby’s Knife a split

thickness was harvested and meshed using mesher.

STEP:2

• The meshed skin is applied to the wound and fixed

with intermittent suture by using 4-0 ethilan.

• Stapels were put using stapler which was removed

on fourth post op.

DRESSING OVER THE GRAFT

mupirocin

Bacti gras

normal saline wash

DRESSING OVER THE DONOR SITE

sofra tuille gauze

mupirocin

IMMEDIATE

POST OP

DAY 2

DAY 10

• Patient was discharged on Day

15 advised with a course of

Antibiotics to prevent super added

infection.