1. 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

2. 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.

3. 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

4. NATURE OF INJURY
• She has sustained this injury accidently by pouring hot
oil.
EXTENT OF INJURY
• 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)

5. DAY 1

6. 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.

7. 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

8. DRESSING
• She has been shifted to burns ward and daily
dressing was done as follows:
 Normal saline - Washing
 Povidine iodine ointment application
 Neosporin with Sofra tuille Gauze
 Closed dressing with Sterile Gauze ,
Pads & Bandages
• Inspite of her routine dressing accidentally she
developed wound infection.

10. LABORATORY EXAMINATION
CULTURE:
Culture positive for
 STAPHYLOCOCCUS AUREUS
 PSEUDOMONAS
 KLEBSIELLA.
SENSITIVITY TEST:
Staph aureus - methicillin resistant.

11. ESCHAROTOMY:
• Wound healing took place and eschar was
formed.

13. 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

14. RECONSTRUCTION
• After routine investigations like
 CBC
 Blood group ( blood transfusion
100ml given)
 BT
 CT
 Hb S Ag
 tridot
she has undergone SPLIT THICKNESS SKIN
GRAFT.

16. 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.

17. 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.

19. DRESSING OVER THE GRAFT
 mupirocin
 Bacti gras
 normal saline wash
DRESSING OVER THE DONOR SITE
 sofra tuille gauze
 mupirocin

20. IMMEDIATE
POST OP

21. DAY 2

22. DAY 10

24. • Patient was discharged on Day
15 advised with a course of
Antibiotics to prevent super added
infection.