Incidences of malignancy in chronic burn scar ulcers: experience from Bangladesh.

Malignant transformation on any scar tissue is known as Marjolin's ulcer. Most cases of Marjolin's ulcer reported so far occur in post-burn scars but not all ulcers that occur in post-burn scar are malignant. One hundred and forty cases of chronic non-healing ulcers in post-burn scar were included in this prospective observational study. The study was conducted in the Department of Burn and Plastic Surgery Unit of Dhaka Medical College Hospital. Mean age of the patients was 40.63±18.44 with a range from 12 to 75 years. Two third of the patients were male. All patients underwent excision biopsy and coverage with either split thickness skin graft or flap. Histopathological analysis of the resected specimen revealed malignancy in 46 cases and pseudoepitheliomatous hyperplasia in four cases and verruca plantaris in one case. The rest of the cases were chronic non-healing benign ulcers. All 46 cases of Marjolin's ulcer were squamous cell carcinoma with a mean latency period of 26.73 years. The commonest site of chronic ulcer was in the lower extremities (n-80, 57%), and malignancy was also found to be more common there (n-18). The most common type of burn was flame burn (68.57%). The Marjolin's ulcers were significantly larger in size than benign ulcers, and were mostly exophytic or ulcerative in appearance whereas benign ulcers were mostly flat. A non-healing ulcer in a post-burn scar should be addressed promptly because of its potential to develop into a malignant ulcer. Emphasis should be given to early surgical treatment of deep partial to full thickness burns to prevent scar formation, particularly over joints, and thus reduce the risk of development of Marjolin's ulcer.

Management of acid burns: experience from Bangladesh.

Acid burn injuries in Bangladesh primarily occur as a result of intentional attacks although there are incidences of accidental acid burns in industry, on the street, and at home. A total of 126 patients with acid burns, 95 from attacks and 31 from accidents, were studied from July 2004 to December 2012. A diagnosis of acid burn was made from history, physical examination and in some cases from chemical analysis of the patients' clothing. Alkali burns were excluded from the study. In the burn unit of Dhaka Medical College Hospital, we applied a slightly different protocol for management of acid burns, beginning with plain water irrigation of the wound, which effectively reduced burn depth and the requirement of surgical treatment. Application of hydrocolloid dressing for 48-72 h helped with the assessment of depth and the course of treatment. Early excision and grafting gives good results but resultant acid trickling creates a marble cake-like appearance of the wound separated by the vital skin. Excision with a scalpel and direct stitching of the wounds are often a good option. Observation of patients on follow-up revealed that wounds showed a tendency for hypertrophy. Application of pressure garments and other scar treatments were given in all cases unless the burn was highly superficial.

Assault by burning in Dhaka, Bangladesh.

Assault by burning in Dhaka, Bangladesh, occurs in a variety of forms, resulting from various causes and motives. A total of 311 cases of intentional burns from the Burn Unit of Dhaka Medical College Hospital from April 2004 to May 2011 (6 years) were studied by retrospective and prospective observational review. The majority of victims (68%) were female. Concentrated sulphuric acid was the most commonly used chemical for attack. Disfigurement was the principal complication (mortality, 4%). Dowry-related issues, divorce and other marital quarrels were frequent backgrounds for assault by burning. Kerosene oil was used to ignite 78 girls or young women, most often related to conflicts over dowry (mortality 97%). A total of 102 victims (32%) in all burn groups were attacked because of dowry-related issues. Intentional contact burns were often inflicted on domestic servants. Although physical morbidity and mortality were not reported in contact and other types of burns, psychological disturbances were reported in all victims. A few victims had been assaulted prior to receiving burns, and fractures and deformities were also present on examination at the time of presentation for burn treatment. Ophthalmic injury, with frequent visual impairment, was very common in cases of chemical attack. Legal and social support for victims and their families are frequently inadequate to compensate for losses. Clearly, more attention in our community should be focussed on the prevention of burn assaults, adequate compensation and medical care for victims, as well as speedy retribution for perpetrators.