Therapeutic Plasma exchange therapy in Burns.

Severe burn injury affects the body in many devastating ways, the most severe being systemic inflammatory response syndrome. This results in a myriad of effects like increasing capillary permeability, thereby fluid loss. It also causes a surge in inflammatory mediators like interleukin (IL)-6, which further increases the capillary leak and fluid loss. This results in refractory hypotension in patients despite adequate fluid resuscitation. Plasma exchange has been used in the management of a number of illnesses with a significant inflammatory component, and, therefore can be considered to have a role in burn injury. In our article, we would like to share our experience of using therapeutic plasma exchange therapy in burn patient.

Role of Burn Blister Fluid in Wound Healing.

Blisters are characteristic finding of second-degree superficial burns. Varied opinions for the management of burn blisters are available in literature. Most accepted one is to puncture it in a sterile way, keep the overlying skin as a biological cover, and over that put a moist sterile biological dressing. Fluid in the blister is ultrafiltrate of the plasma, which is rich in proteins such as immunoglobulins, various cytokines, prostaglandins, and interleukins. This fluid is pro-inflammatory, and the evidence regarding its effect on wound healing is varied. Instead of drainage, the burn blister fluid can be aspirated and immediately sprayed over the other areas of the same wound. We found this method feasible as an adjuvant therapy for second-degree superficial burn wounds. In this case report, we share our experience of the same.

Role of Phenytoin in Diabetic Foot Ulcers.

Of the complications of diabetes mellitus, foot ulcers are the most dreaded complications, as they can progress at an alarming rate and can be very difficult to treat. Various modalities have been described in the treatment of diabetic foot ulcers. One such modality of phenytoin therapy uses the disadvantage of the drug, that is, gingival hyperplasia to the advantage of wound healing. We hereby report a case of diabetic foot ulcer managed with injection phenytoin sprayed topically over the wound.

Autologous Platelet-rich Plasma Enriched Pixel Grafting.

Autologous platelet-rich plasma contains concentrated platelets after graded centrifugation, which has various applications. Skin grafting is an age-old procedure, which has been used for wound coverage. But the healing process is longer and may be difficult, depending on the wound site, skin defect size, and patient comorbidities, and is difficult to be carried out in patients who have limited donor sites, such as in burns or those who are not fit for long procedures. Hence, pixel grafting can be used in these areas. Platelet-rich plasma can be used to aid the graft take, and thereby decreasing patient morbidity and improve the surgeon's efforts.