Early Tangential Excision Research Articles

Comparison of outcome of early tangential excision with autografting versus interactive antimicrobial dressing in deep-partial thickness burn patients: A retrospective analysis

BackgroundThe relative effectiveness of early excision and autografting (EG) for deep-partial thickness burns needs to be updated through comparison to initial non-operative (INO) treatment using modern interactive antimicrobial (IA) dressings in a South-Asian burn patient population. ObjectiveTo compare the outcome of early tangential excision and autografting (EG) to initial non-operative (INO) treatment using interactive antimicrobial dressing. MethodsRecords of 106 adult burn survivors with predominantly deep-partial thickness thermal burns of TBSA ≤ 30 % were retrospectively reviewed (53 patients each in EG-arm and INO-arm). EG-arm patients underwent excision and autografting within 7 days. INO-arm patients, who had opted against surgical excision, received interactive antimicrobial dressing (hydrofiber with ionic silver). Outcomes measured include percentage of wound healed on days 14 and 21, days to complete wound healing, duration of hospital stay, complications (on 12 months’ follow-up) and patient satisfaction scores. Patients were analyzed as treated. ResultPatients in each arm had similar TBSA and demographic profiles. In EG-arm patients, 15–20 % of TBSA were grafted on 5.02 ± 0.71 post-burn day. Thirty percent of EG-arm patients required a second session of grafting for the remaining burn wound, which occurred on 6.873 ± 0.34 post-burn day. On the 21st post-burn day the EG-arm, compared to the INO-arm, had a higher percentage of wound epithelization (98.60 ± 4.03, versus 76.16 ± 7.02, P < 0.01), less days to complete healing (17.60 ± 5.83, versus 40.16 ± 9.09, P < 0.01), and shorter hospital stays (19.62 ± 6.85 days, versus 35.56 ± 7.77 days, P < 0.01). Twenty-five (47 %) INO-arm patients underwent delayed grafting on post-burn day 25.42 ± 0.49. The INO-arm suffered significantly more complications, such as hypertrophic scar, dyspigmentation and functional disability (P < 0.05). EG-arm patients were more satisfied than INO-arm patients (P < 0.01). ConclusionWe report superior outcomes in the early tangential excision and autografting-arm as compared to the initial non-operative treatment arm. The dogma of early excision and autografting remains valid despite significant advances in wound dressing materials.

Burn Wounds and Enzymatic Debridement (ED)-Past, Present, and Future.

Excision of necrotic and devitalized tissues of deep burns is key for optimal care of burn injuries. However, the modality of early tangential excision followed by skin grafting proposed by Zora Janzekovic 5 decades ago was not received initially with great enthusiasm. At present, it developed to become the standard of care (SOC) despite the special expertise it necessitates and the general anesthesia it requires in addition to several drawbacks including excessive blood loss, risk of hypothermia, and most importantly potential excision of normal non-burned tissues. Conservative non-surgical selective enzymatic debridement (ED) at present is becoming more popular as an adjunct or even an alternative approach. A systematic review of the PubMed electronic database was conducted to identify all experimental and clinical studies about ED of burn wounds. Additional separate searches were also conducted to identify any reports missed by the initial systematic review. Full texts of 59 reports (42 clinical and 17 experimental studies) were retrieved for analysis. A total of 46 studies (11 experimental and 35 clinical) were about the pineapple extract debriding agent. In total, 23 clinical studies describing promising favorable results with pineapple bromelain-based debridement (BBD) concentrate were published in the last 3 years (2020-2023). Though available evidence is not entirely in favor of replacing the current surgical SOC with BBD, it certainly presents ED as a highly advantageous modality for the management of burn wounds. Newly described keratinase and SN514 also are promising new products. They both still await further investigation before being clinically adopted.

Barriers and prospects for skin grafting in burn treatment across African countries

IntroductionThe current standard management of full-thickness or deep dermal burns is early tangential excision and skin grafting. A conservative approach to deep burns without the option of skin grafting results in delayed wound healing, possibly leading to wound infection and is associated with hypertrophic scarring and increased morbidity and mortality. The aim of this study was to improve the understanding of the management and availability to perform skin grafting for burns on the African continent. It also sought to identify challenges and perceived improvements. MethodsA web-based, structured, closed-formatted, multinational survey was designed to gather information on the current state and availability of skin grafting of burn wounds on the African continent. The questionnaire consisted of 27 questions, available in English and French. It was reviewed within the GAP-Burn collaboration network and sent to 271 health care professionals who had participated in a previous study and had initially been recruited by means of the snowball system. ResultsThe questionnaire was completed 84 times (response rate: 31.0%), of which 3 were excluded. Responses originated from 22 African countries. The majority 71 (87.7%) resulted from countries with a low Human Development Index (HDI), 7 (8.6%) from medium HDI countries. Split thickness skin grafting (STSG) is performed in 51 (63.0%) centers. The majority considers STSG to reduce length of stay (72.8%) and improve scarring (54.3%), yet some indicated that STSG is associated with increased risk of donor site infection (8.6%) and severe bleeding (7.4%). Factors preventing increased grafting included lack of equipment and training. ConclusionSkin grafting is not performed in a significant number of hospitals treating burns. The majority of the staff believe that more skin grafting would lead to a better outcome. Advocacy and improved infrastructure, human resources coupled with introduction to well-structured health coverage for all in African countries could help to better access and affordability in burn care.

Early Tangential Excision and Split-Thickness Skin Graft Reduced Hospitalized Length Stays for Burn Injuries

ABSTRACT Introduction: Burns pose a physical, psychological, health system, and long-term length of stay problem. Surgical treatment of burns is an important intervention in their management. The optimal timing of early tangential excision and split-thickness skin graft varies. Early excision of burned tissue to remove dead tissue and inhibit the inflammatory process decreases the risk of infection. Early excision and grafting of burns is the standard of practice for most major burns. Methods: The research was a cross-sectional study with a descriptive design of secondary data. Burn patients were treated at Dr. Soetomo General Academic Hospital Surabaya, Indonesia, from 2018 to 2022. Inclusion criteria in this study were all patients who underwent early tangential excision and split-thickness skin graft. Achieving statistical analysis and data analysis using SPSS 25 on Windows. Results: A greater amount of time on total body surface area (TBSA) is linked to early tangential excision and split-thickness skin grafts. There are statistically significant variations in the burn area (TBSA 20.5%–30%, P = 0.036 (P = 0.05), TBSA 30.5%–40%, P &lt; 0.001, and burn area (TBSA 40.5%–50%, P = 0.003). The current findings demonstrated that split-thickness skin grafts and early tangential excisions done on burns with TBSA 20% at partial thickness–full thickness depth had statistically significant outcomes, shortening the length of stay for burn patients. Conclusions: An analysis of the current data, burn patients’ duration of stay was reduced when burns with TBSA &gt;20% with partial thickness–full thickness depth underwent early tangential excision and split–thickness skin transplant had statistically positive results.

Переваги тангенціального висічення з одночасною аутодерматопластикою для лікування опікових ран

Burn trauma remains an important health problem, among which thermal burns of the limbs are one of the most common and complex due to the need to restore limb function and reduce aesthetic defects. Early tangential excision with simultaneous autodermoplasty is a complex technique that is also a significant stress for the patient, but it allows achieving all the set goals. Purpose - to evaluate the effectiveness of tangential excision with simultaneous autodermoplasty for treating burn wounds compared to the classical method of treatment. Materials and methods. The study included 24 patients with burns of the upper and/or lower limbs, from which two groups were formed: an experimental group (12 patients) and a control group (12 patients) who were equal in terms of patient sex, age, etiology of burn wounds, affected area. Tangential excision with simultaneous autodermoplasty was applied to patients in the experimental group, while delayed sequential necrectomy, xenoplasty (if necessary), and delayed autodermoplasty were performed on patients in the control group. Results. Patients in the experimental group stayed in the hospital for an average of 10.5±4.5 days, which was almost half as long as in the control group (20.2±3.5 days). The number of surgical interventions in the experimental group was 1.3±0.5 operations, while in the control group it was 2.7±0.8 operations, and the number of general anesthesia procedures in the experimental group was significantly lower (1.3±0.5) than in the control group (4.6±1.1; p&lt;0.05). In the experimental group, the number of dressings for each injury was 4.3±1.6, while in the control group it was almost three times as many (12.7±3.0; p&lt;0.05). The duration of healing of burn wounds in the experimental group was 13.3±4.3 days, which was shorter than in the control group (24.2±3.9 days; p&lt;0.05). The prevalence rate of infectious complications in the experimental group was 21.1% (4 cases), while in the control group it was significantly higher (58.8%). However, the prevalence rate of other complications, such as lysis of skin grafts, was only slightly lower in the experimental group (15.8%, or 3 cases) compared to the control group (29.4%, or 5 cases). 2 (18.2%) burn wounds in the experimental group required secondary reconstruction, while in the control group, 7 (70.0%) wounds required it. Conclusions. Treatment of burn wounds of the upper and/or lower limbs using the method of tangential excision with simultaneous autodermoplasty allows for a reduction in the length of hospital stay, a decrease in the number of surgical interventions, general anesthesia procedures, dressing changes, and ensures faster wound healing, as well as reduces the frequency of complications and the need for secondary reconstruction. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Management of facial burns: an update.

This article reviews literature on the recent progress made on management of facial burns. The discussion focuses on those aspects of the management in which recent studies brought new ideas, and reviews some that failed to change practices in the management of facial burns. Recent innovations and models have been proposed in an attempt to reduce the incidence of unnecessary intubations in patients with burns to the face and with suspected inhalational injury. However, the decision to secure the airway is still a challenging one. A new escharotomy method based on facial subunits principles has been described, while the practice of early tangential excision is still debated in the literature. Tarsorrhaphy without occluding the eyes has also been described in the management of peri-oral burns. Self-retaining and expandable stents for the nose have also been demonstrated to be effective in preventing nasal stenosis. 3D printed face masks have been more recently developed to improve the current wound-care methods used in facial scar management. This article highlights recent developments in the management of facial burns in areas such as acute facial burn care, subsequent wound care and facial scar management. It highlights areas wherein progress has been made, as well as the need for further studies in certain areas.

The Effect of Early Tangential Excision and Split Thickness Skin Graft in Reducing Length of Stay in Burns Patients in Jakarta Islamic Hospital Cempaka Putih

Introduction: Early tangential excision (TE) and split-thickness skin graft (STSG) have increased the outcome in burn patients treated at specialized burn centers. This study was conducted to compare the length of stay (LOS) in burn patients undergoing early TE &amp; STSG and delayed TE &amp; STSG. Method: This is a retrospective cross-sectional study including 42 patients with varied burn degrees, and TBSA admitted to Jakarta Islamic Hospital Cempaka Putih (JIHCP) Burn Unit. Patients were assigned to two study groups, the early TE &amp; STSG group including 32 patients and the delayed TE &amp; STSG group including 10 patients. All data were collected from the medical record and compared between two study groups. Result: The mean of LOS in a group with early TE &amp; STSG was shorter (9.81±6.41 days) than LOS in the delayed TE &amp; STSG group (15.80±5.67 days). The data of LOS between these groups were compared using an independent T-test. The LOS in the early TE &amp; STSG group was significantly shorter than the delayed TE &amp; STSG group (p=0.012). Conclusion: In patients with burn injuries, early TE &amp; STSG is associated with a shorter length of stay than the delayed TE &amp; STSG. Our study indicates that early excision within five days after burn injury is optimal to reduce the length of stay in burn patients.

Contemporary Aspects of Burn Care.

The past one hundred years have seen tremendous improvements in burn care, allowing for decreased morbidity and mortality of this pathology. The more prominent advancements occurred in the period spanning 1930–1980; notably burn resuscitation, early tangential excision, and use of topical antibiotic dressings; and are well documented in burn literature. This article explores the advancements of the past 40 years and the areas of burn management that are presently topics of active discussion and research.

Early tangential excision with guidance of gentian violate application

Background: Uses of gentian violet as a marker to determine burn depth, to facilitate early tangential excision.Patient and Method: A prospective study conducted on eighteen burned patients, they were admitted to Burns and Plastic Surgery Hospital in Sulaimani, with deep second and third degree burn, and they underwent early tangential excision with the guidance of gentian violet and grafting. Incisional biopsy was taken from two patients and sent for histopathology, they resulted in staining of dead tissues and preservation of normal tissues.Results: The mean age of the patients was (23.25) years. (77.7%) were with flame burn and (22.3%) were with scald burn. With the use of our method (55.5%) of patients needed one session and (44.5%) of patients needed more than one session of excision and grafting. The mean of excised and grafted area was (9.97%) TBSA. (77.7%) of patients with good graft take (90-100%), (16.6%) of patients with moderate graft take (50-89%), (5.5%) of patients with poor graft take (

Calcium Homeostasis Comparison in Thermal Burn Patients–Early Tangential Excision and Grafting versus Conservative Management

Introduction With the advent of better burn wound management protocols, early excision and grafting, increased number of burns patients are surviving and entering the struggle of prolonged rehabilitation. Calcium homeostasis and its influence on bone mineralization plays an important role, but it is adversely influenced by the proinflammatory state in burns, leading to hypocalcemia and paradoxical hypercalciuria which, in turn, leads to excessive bony resorption and pathological fractures. The role of early excision in the overall metabolism of calcium is being investigated in the study. Method This study was undertaken in a tertiary level government-run hospital from February 2018 to August 2019. A total of 28 patients with second degree thermal burns were included. For all patients, fasting serum parathormone levels along with various serum electrolytes like Ca 2+ , Mg 2+ , PO 4 3- and urinary calcium levels were serially measured from day of admission to 2 months. The first group of 14 patients (Group A) underwent early tangential excision and skin grafting, whereas another 14 patients (Group B) underwent conservative management. All categorical variables were analyzed with the help of Chi square test. A p value of < 0.05 was considered statistically significant. Result There was a statistically significant improvement in serum parathormone and other electrolytes’ levels in the tangential excision group. Similarly, urinary excretion of calcium also showed favorable results in the group. Conclusion Early tangential excision and grafting in burns plays an important role in maintaining serum parathormone and calcium levels, leading to prevention of hypercalciuria and optimization of other factors affecting calcium homeostasis.

Total intravenous anaesthesia with tumescent infiltration anaesthesia without definitive airway for early excision and skin grafting in a major burn - A prospective observational study.

Background and Aims:Patients with major burns posted for early tangential excision and skin grafting pose peculiar challenges for anaesthesiologists. The purpose of the study was to assess safety and efficacy of total intravenous anaesthesia (TIVA) with tumescent infiltration anaesthesia (TIA) for these burn procedures.Methods:This observational single-arm study was conducted on 48 cases of a tertiary centre burn unit, requiring early tangential excision and skin grafting between third and fifth days of burn injury. TIVA was administered using a combination of intravenous (iv) infusion of injection dexmedetomidine and iv boluses of fentanyl, ketamine, propofol, midazolam and paracetamol. TIA was administered in burn wounds after aseptic preparation. Spontaneous breathing was maintained with oxygen supplementation. Haemodynamic and respiratory monitoring was done intraoperatively every 15 minutes and for 6 hours postoperatively. Modified Aldrete's score was calculated at 10 minutes after completion of surgery. Statistical analysis was done using statistical package for the social science software (version 16). Descriptive statistics were used for quantitative variables.Results:Baseline mean HR was 106.95 ± 11.17 bpm (beats per minute). HR settled at 73.17 ± 6.97 bpm during the intraoperative period. The baseline mean arterial pressure (MAP) of 82.42 ± 10.04 mmHg was maintained at 81 ± 7.32 mmHg during the intraoperative period. In all, 95.8% achieved early recovery with mean modified Aldrete's score of ≥9 at 10 minutes post-surgery. There was no episode of apnoea or desaturation.Conclusion:TIVA in combination with TIA minimally interferes with homeostasis and promotes early recovery in patients undergoing early excision and grafting in major burns.

Demographic Characteristic Of Burn Mortality And Its Relation To Tangential Excision At Burn Unit Of Cipto Mangunkusumo National General Hospital

&#x0D; &#x0D; &#x0D; &#x0D; Background: Burn injury is considered as major problem because of high mortality and morbidity. One of the several managements to decrease the mortality rate is wound excision. This study aimed to describe the characteristics of burn mortality in our burn unit and its association with timing of tangential excision.&#x0D; Method: We collect data of burn patients who died in 2016 at Burn Unit of Cipto Mangunkusumo Hospital. We investigate the association of mortality and timing of tangential excision. The data were compared with other studies from online databases.&#x0D; Result: Thirty-four burn patients died at RSCM Burn Unit from January - December 2016. 13 patients underwent early tangential excision, the rest had delayed or no tangential excision. Only length of stay (LOS) has statistically significant result. The early tangential excision group has significantly longer median LOS (p=0.003) compared to delayed tangential excision. From five relevant studies, three studies had higher mortality in early tangential excision group compared to delay group but fewer complications and shorter LOS. Two studies reported a significant reduction in mortality in early tangential excision group while culture positive wounds were more frequent in the delay group.&#x0D; Conclusion: Mortality in our patients in early tangential excision group is fewer than the delayed one. The early tangential excision group has longer length of stay compared to delay tangential excision. Although there are pros and cons from the literature review, we suggest that early tangential excision should be done in burn patients.&#x0D; &#x0D; &#x0D; &#x0D;

Autologous platelet rich plasma - an adjunct to early tangential excision and grafting in burns

Aim: To affirm that autologous platelet rich plasma is a useful adjunct to early tangential excision and skin grafting to enhance wound epithelization rates and improve scar quality.

Glucocorticoids suppress fibroblast apoptosis in an in vitro thermal injury model

The wounds of full- and deep partial-thickness burns result in hypertrophic scars and lead to skin contracture more severely than those of superficial partial-thickness burns. Therefore, preventing burn progression may help improve the aesthetic and functional outcomes after healing. Although a number of studies have focused on elucidating the underlying mechanisms of and preventing burn wound progression, it is still difficult to rescue burned dermis unless early tangential excision is performed. To investigate the underlying mechanisms of and prevent cell death of heat-injured fibroblasts, we developed an in vitro experimental model of heat-injured fibroblasts. We confirmed that heating at 55°C for 30s caused fibroblast necrosis immediately after heating, whereas heating at 46°C for 30s induced apoptosis 24h after heating. We also found that the supplementation of 100ng/ml betamethasone to the culture medium after heating decreased the number of apoptotic cells and increased that of live cells. Our studies suggest that glucocorticoids suppress apoptosis of heat-injured fibroblasts and may be useful for preventing burn wound progression.

Burn Wound Bacteriological Profiles, Patient Outcomes, and Tangential Excision Timing: A Prospective, Observational Study

Because infection can thwart burn healing, microorganisms, their susceptibility patterns, and the effect of tangential excision timing on outcomes of burn patients were examined. A prospective, observational study was conducted that involved 318 patients with deep second-degree burns from a gas explosion treated in Xinxiang, Henan, China between January 2009 and December 2016. Patient demographic data, culture and antimicrobial susceptibility test results, and outcome variables (resuscitation fluid volume, signs of shock, body temperature, heart rate, and time to wound healing) were analyzed. Outcomes were compared among patients who had early (<24 hours), middle (2 to 7 days), and late (> 7 days) post burn excision. Bacterial culture and drug sensitivity data were available for 314 of the 318 persons with burns >10% of total body surface area (TBSA). Of the 486 bacterial isolates, 330 (67.9%) were gram-negative and 156 (32.1%) were gram-positive. The number of isolates and resistance to third-generation cephalosporins increased over time. Patients having early tangential excision had significantly lower heart rate (P <.05) and reduced time to healing (P <.01) than patients in the middle or late excision group. Early tangential excision was found to be safe and to facilitate healing.

Comparison of Laser Doppler Imaging (LDI) and clinical assessment in differentiating between superficial and deep partial thickness burn wounds

Purpose of presentation/studyTo compare the accuracy of Laser Doppler Imaging (LDI) and clinical assessment in differentiating between superficial and deep partial thickness burns to decide whether early tangential excision and grafting or conservative management should be employed to optimize burn and patient management. Study periodMarch 2015 to November 2016. Methods/procedure detailsNinety two wounds in 34 patients reporting within 5days of less than 40% burn surface area were included. Unstable patients, pregnant females and those who expired were excluded. The wounds were clinically assessed and LDI done concomitantly Plastic Surgeons blinded to each other’s findings. Wound appearance, color, blanching, pain, hair follicle dislodgement were the clinical parameters that distinguished between superficial and deep partial thickness burns. On day 21, the wounds were again assessed for the presence of healing by the same plastic surgeons. The findings were correlated with the initial findings on LDI and clinical assessment and the results statistically analyzed. Results/outcomeThe data of 92 burn wounds was analyzed using SPSS (ver. 17). Clinical assessment correctly identified the depth of 75 and LDI 83 wounds, giving diagnostic accuracies of 81.52% and 90.21% respectively. The sensitivity of clinical assessment was 81% and of LDI 92.75%, whereas the specificity was 82% for both. The positive predictive value was 93% for clinical assessment and 94% for LDI while the negative predictive value was 59% and 79% respectively. ConclusionsPredictive accuracy of LDI was found to be better than clinical assessment in the prediction of wound healing, the gold standard for wound healing being 21 days. As such it can prove to be a reliable and viable cost effective alternative per se to clinical assessment.

Steel Wool-Aided Dermabrasion of Deep Partial-Thickness Burns.

Early tangential excision of the burn wound is essential for removal of necrotic tissue and promotion of burn wound healing process. However, the depth of the burn wound is not easily assessed during the tangential excision performed by hand-held dermatomes, and it may be possible to excise unburned vital dermis unnecessarily, which aids in primary epithelization of the burn wound by adnexal structures. We herein present early clinical results of steel wool-aided dermabrasion in patients with deep partial-thickness burns. This is a retrospective case study of 23 consecutive hospitalized patients with deep partial-thickness burns. All of the steel wool-aided dermabrasions were performed under general anesthesia within 48 hours after injury. Patients were excluded from the study if the admission was not within 24 hours after injury, and if the burn wound was entirely superficial partial- or full-thickness. Thirteen male and 10 female patients with a mean age of 26.2 ± 17.1 years were enrolled in the study. During the follow-up period, all of the patients had burn wounds primary epithelized on postburn day 15.1 ± 1.8, without any complications. None of the patients exhibited a mortal course, and redebridement or skin grafting of the previously dermabraded deep partial-thickness burn wounds were not required in any of the patients. Steel wool-aided dermabrasion is an easy, cost-effective, and reliable technique for the treatment of deep partial-thickness burns, which provides complete removal of necrotic tissue, preserves the vital dermis, reduces the requirement for skin grafting, and decreases length of hospital stay.

Early experience with tangential excision and skin grafting of deep dermal burns of the hand among diabetics and nondiabetics

Introduction: Deep dermal injury of the hand should have a special management because it has a high potential to affect the functional capabilities of the hand. This study was established to measure the outcome of managing these special types of patients and comparing their outcome with nondiabetics. The goal was to intervene and cover the wound within a time limit of Patients and Methods: Between the period of November 2011 and October 2013, we managed a total number of 12 patients with deep dermal burn to the hands in the Burn Unit at King Fahad General Hospital, Jeddah . Four patients were insulin-dependent diabetics, and eight were nondiabetics. An early tangential excision and skin grafting was done in these patients within 14 days of injury. Results: All 12 patients were male. The average age was 45 years. The average total body surface area (TBSA) burnt was 35%, with a range of 2-65%. Four patients were insulin-dependent diabetics, whereas eight patients had no medical comorbidity. Two of the diabetics had an isolated hand burn, and the other two had 30% and 50% of TBSA full-thickness burn, respectively. The graft take was satisfactory among the patients with no difference between the diabetics and the nondiabetics. The grafted hands underwent physiotherapy following the procedure. Satisfactory outcomes were seen among all the grafted hands, with near return to full function. Conclusions: Tangential excision is recommended during the first 5 days postburn to reduce the risk of infection and graft loss. Diabetic patients do not behave differently from nondiabetic patients in their response to graft take, wound healing, and return to work.

OPTIMIZATION OF RESULTS AND TREATMENT TIMING OF DEEP DERMAL BURNS IN CHILDREN

Untreated deep dermal burns in children are the cause of long-term treatment and severe cicatricial deformities, resulting in poor cosmetic results and greatly impairing functional outcome. The problem of optimizing the results and timing of treatment of deep burns in children in recent years has become particularly urgent. We observed 1853 children with III-A degree burns. Some of the children's burns healed spontaneously, which led to the development of scar deformities during the first six months after injury. Risk factors for their development, depending on the patient's age and location of the lesion, are pointed out. Other children underwent early tangential excision of eschar. The analysis of the treatment results showed that the use of early surgery in children with deep dermal burns can reduce treatment time, as well as significantly to improve the cosmetic and functional outcomes of trauma.

Socio-economic burden of burns: How do the families of patients cope?

Introduction: A majority of burn injuries in India occur amongst women, primarily in the lower and lower middle class population. The cost of burn treatment is high and the burden is increased because of the poor penetration of medical insurance amongst this unfortunate population. Aims: To study the socio-economic impact burn injuries have on the families of the patients. Materials and Methods: The study was performed using a formulated questionnaire. Twenty-five patients who had been admitted in the burns ward and discharged after treatment in 2011-12 were included in the study. The patients/attendants of the patients were interviewed telephonically and the responses were taken from the patient and/or their attendants and results were studied. Observations: All the patients were female. Amongst the 25 patients studied (n = 25), the average age was 29.44 years, with an average total burn surface area of 32.32%. Average overall expenditure was Rs 89,000 (approx. US$ 1750) of which in the early tangential excision and grafting group (n = 8), the expenditure was Rs. 60,000 (approx. US$1150); in the late grafting group (n = 6), it was Rs. 2,25,000 (approx. US$4320); whereas in the conservative management group (n = 11), it was Rs. 35,863 (approx. US$690). None of the patients were covered by medical insurance. Non-institutional loans and/or sale of assets were required by all respondents to bear the costs. Conclusions: The socio-economic burden of burn injuries is very high and government support is the need of the hour. In patients needing surgery, early tangential excision and grafting has a significant cost-benefit advantage.