Inhalation Score - a Novel Technique for Assessing Severity of Inhalational Burns in Correlation to Bronchoscopic Findings.

Airway edema following burns is a typical occurrence. It poses a threat, independent of percent Total Burn Surface Area (TBSA), to the life of the patient. Fiber optic bronchoscopy is the gold standard in its diagnosis and is preferred if the facilities are present. Its availability remains a problem in the majority of burn centers in developing countries like India. Ascoring system based on clinical findings, if formulated in a manner that reflects bronchoscopy results, may help not only with diagnosis but also with airway management in inhalation burns. One hundred patients suffering from facial burns were included in the study. They were observed clinically and bronchoscopically and airway was managed on the basis of clinical, biochemical and bronchoscopic findings. Fifty patients who showed significant bronchoscopic findings on day 1 were followed up. Clinicobronchoscopic correlation revealed a positive correlation of various clinical variables as well as bronchoscopic grading with subsequent need for endotracheal intubation. Edema of tongue/floor of the mouth and palatal edema showed a positive correlation with subsequent need for tracheostomy. This clinicobronchoscopic correlation was then used retrospectively to formulate the Safdarjung Hospital 'INHALATION' score. This score can be used for predicting impending airway compromise when bronchoscopy facilities are not readily available.

La survenue d'un œdème des voies aériennes est un classique après une brûlure, entraînant un risque indépendant de la surface atteinte. L'endoscopie bronchique est l'examen diagnostique de référence et doit être réalisée si le matériel est disponible, ce qui est problématique dans les pays en développement dont l'Inde. Un score reflétant les données endoscopiques peut aider non seulement au diagnostic mais aussi au traitement des lésions d'inhalation. Cette étude a porté sur 100 patients ayant une brûlure faciale, ayant bénéficié d'un examen clinique et endoscopique et traités selon ces données et celles de la biochimie. La moitié des patients avaient des anomalies endoscopiques au premier examen. Les données cliniques (dont un œdème de la langue, du plancher buccal ou du palais) et endoscopiques prédisaient bien la nécessité d'une trachéotomie. Ces corrélations nous ont permis de développer le score INHALATION de l'hôpital Safdarjung, qui peut permettre de prédire une complication ventilatoire quand l'endoscopie n'est pas disponible.

Changing Trends In Electrical Burns From A Tertiary Care Centre - Epidemiology And Outcome Analysis.

Electrical burn injuries result in significant mortality and morbidity. Most of these injuries are preventable. We conducted a retrospective analysis of various aspects of electrical injuries presenting to our center over a period of 1 year from September 2018 to August 2019. Demographic characteristics of patients along with burn characteristics and associated injuries were analysed. Outcomes including length of hospital stay, need for fasciotomy, amputation, renal failure and mortality were also analysed. A total of 6380 patients presented to our center during the study period, of which 471 (7.38%) had electrical burns. Total burn admissions were 1530, of which 283 (18.49%) patients were admitted with electrical burns. The mean age in our cohort was 25.31±12.76 years and mean TBSA was 29.22±23.81%. The most common cause of electrical burns was occupational (33.3%), followed by those that occurred on the rooftop of houses (31%). A historical comparison with data published from our center in 2011 showed a significant increase in occupational burns (18.72% vs. 33.3%) and rooftop electrical burns (8.21% vs. 31%), and a decrease in agriculture-related (42.46% vs. 9.1%) and domestic electrical burns (26.02% vs. 6.7%). There was also a significant rise in proportion of high voltage injuries (71.23% vs. 86.90%). Logistic regression analysis showed electric contact burn to be a risk factor for fasciotomy and limb gangrene. Risk factors for renal failure were age, percentage burn, electric contact burn and rural residence, and those for mortality were percentage burn and renal failure. Emphasis on preventive strategies, especially against occupational injuries and injuries occurring on rooftops, is necessary to prevent such devastating injuries.

Les brûlures électriques sont responsables d'une morbidité et d'une mortalité significatives, quand la plupart d'entre elles peuvent être prévenues. Nous avons étudié rétrospectivement les brûlures électriques vues dans notre service entre septembre 2018 et août 2019 inclus (données démographiques, caractéristiques de la brûlure, lésions associées, durée d'hospitalisation, aponévrotomies, amputations, défaillances rénales, mortalité). Quatre cent soixante et onze des 6 380 (7,38%) patients s'étant présentés souffraient de brûlures électriques. Deux cent quatre- vingt- trois des 1 530 (18,49%) hospitalisés l'étaient en raison de brûlures électriques. L'âge moyen était de 25,31 +/- 12,76 ans, la surface brûlée de 29,22 +/- 23,81%. La brûlure survenait au travail dans 1/3 des cas, au domicile (sur le toit) dans 31% des cas. Comparativement aux données historiques de notre CTB (datant de 2011), on constate une recrudescence des accidents de travail (qui passent de 18,72 à 33,3%) et de ceux survenant sur le toit du domicile (de 8,21 à 31%) alors que ceux chez les agriculteurs (de 42,46% à 9,1%) et les accidents domestiques (de 26,02 à 6,7%) baissent. La proportion des accidents à haut voltage a augmenté de 71,23 à 86,9%. En régression logistique, la brûlure électrothermique est un facteur de risque d'aponévrotomie et de gangrène de membre. Les facteurs de risque d'insuffisance rénale étaient l'âge, la surface brûlée, la brûlure électrothermique et la ruralité. Les facteurs de risque de mortalité étaient la surface brûlée et la défaillance rénale. Les mesures préventives doivent se focaliser sur les accidents de travail et le risque encouru sur les toits des habitations.

Reconstruction of abdominal wall by whole thigh flap.

Closure of extensive abdominal wall defects can be a very challenging task as there are no known large local or free vascularized flaps available that could cover the entire abdomen. Tensor fascia latae (TFL) has been widely used for abdominal wall reconstruction [Hill HL, Nahai F, Vasocnez LO. The tensor fascia lata myocutaneous free flap. Plast Reconstr Surg 1978;61:517-22]. However, the dimensions of the standard TFL flap limit its use in cases of large full thickness abdominal wall defects. Therefore, we have used an ingenious technique of raising the entire thigh skin as a fasciocutaneous flap (whole thigh flap) based on the concept of fusion of angiosomal territories, to reconstruct such a defect following excision of a large abdominal wall tumour.