Fungal infection profile in burn patients at a tertiary care centre of India

Background: Burn patients are at high risk of infections and burn wound infection is one of the most important factor responsible for their morbidity and mortality. Burn patients have increased incidence of fungal infection in comparison to others. Fungal infection is difficult to diagnose because it has similar symptoms like bacterial infections. Common fungal organism causing burn wounds infections are Candida sp., Aspergillus sp., non albicans Candida, Zygomycetes etc.Methods: This prospective study was carried out in Department of Burn, Plastic and Reconstructive Surgery, J.N.M.C.H., Aligarh Muslim University, India from December 2015 to June 2017. Patients having 20 to 60% body surface area involvement with more than 5 years of age with no comorbidity were included in this study.Results: In our study, total 126 patients were included, 9 male patients (18.37%) were found fungal culture positive whereas 14 females (18.18%) were culture positive. 12 patients (9.52%) were found to be positive for Candida albicans, 6 patients (4.76%) were Aspergillus flavus positive, 3 patients (2.38%) were positive for Non Candida albicans and 2 patients (1.59%) were positive for Aspergillus niger.Conclusions: Fungal burn wound infections are one of the most common cause of late onset morbidity and mortality in burn patients. So, high level of suspicion and tissue culture are essential in making early diagnosis and treatment. Judicious use of antibiotics are also necessary for decreasing its incidence

Postburn neck contracture reconstruction by interval skin grafting

Introduction: Delayed burn wound healing, due to lack of proper initial treatment, especially in deep partial-thickness and full-thickness burns leads to the formation of burn scar contracture. Because of the loose tissue in the anterior neck and also due to habitual and ignorant use of a pillow in burnt patients during the postburn recovery phase, contracture of the neck is a common sequela. Many reconstructive modalities have been described in the literature which include skin grafting, pedicle flap with or without expansion, and free flap. Keeping the esthetic concern in mind, we modified the method of contracture release and skin grafting into two stages. Materials and Methods: This is a prospective study conducted on 15 patients with extensive postburn contracture of the neck during the period ranging from January 2020 to August 2021. Results: In our study, 80% of the patients were females. The mean age was 25.9 years. The number of type 2 and type 3 neck contractures was 7 and 8, respectively. The mean duration of contracture was 8.26 months. Graft loss was the only complication seen and that too was < 10% in all cases (mean - 4.46). At 6 months, mandibular border and thyroid bulge were distinctly visible, and cervicomental angle was within the normal range (mean - 110.46) giving a youthful and appealing esthetic appearance. The mean of the Patient and Observer Scar Assessment Scale score was 2.06 for the observer component and 3 for the patient component. Conclusion: Interval skin grafting can be undertaken following postburn neck contracture release for better functional and esthetic outcomes

The Role of Platelet-Rich Plasma in Reducing Pain, Pruritis, and Improving Wound Healing of Skin Graft Donor Site

Background Wound healing is a dynamic and complex process. Therefore, no single agent can efficiently mediate all aspects of the wound healing process. Split-thickness graft has become a workhorse of plastic surgery for wound or raw area cover. In this study, we evaluate the effectiveness of autologous platelet-rich plasma (PRP) on the donor site and its effect in pain, purities, and epithelization. Materials and Methods This is a prospective study. A total of 15 patients were included who underwent split skin grafting for burns, trauma, or post-tumor excision raw area. PRP was prepared using standard described procedure. The donor site raw area after harvesting split-thickness graft was measured and the surface area was divided into two equal halves. One half was dressed using PRP and the other half was dressed using paraffin gauze piece only. The dressings were changed weekly for 3 weeks. Observation We found significant reduction in severity of pain and pruritis in the PRP group as compared with control group. Epithelization was faster in the PRP group on day 7 and 14, but the overall healing time was nearly the same by day 21. The side-by-side dressing thus show a definite improvement in the post-split-thickness skin graft wound care and PRP as a good dressing alternative. Conclusion Autologous PRP is very effective adjuvant in management of skin graft donor site. Its role in relieving pain and pruritis over donor site significantly improves patient's discomfort postoperatively. It helps in early and painless wound healing. However, we recommend for larger clinical study for better understanding of the efficacy of this blood product

Inferiorly based thigh flap for reconstruction of defects around the knee joint

Background: Soft-tissue defects around the knees are common in injured limbs and in the same injury the leg is often involved and the thigh is spared. Furthermore due to pliable and relatively lax skin, we have used inferiorly based thigh flap to reconstruct defects around knee joint. Aims and Objectives: The aim of this study is to evaluate the use of inferiorly based thigh flap to cover soft-tissue defects over the proximal one-third of the leg, patellar region, knee, and lower thigh. Materials and Methods: This study was conducted during the period between October 2011 and February 2013. Inferiorly based anteromedial thigh fasciocutaneous flap was performed on 12 patients and inferiorly based anterolateral thigh fasciocutaneous flap on four patients. The sites of the soft-tissue defects included patellar regions, infrapatellar region, upper one-third of leg, lower thigh, and over the knee joint. Results: Patients were evaluated post-operatively in terms of viability of flap, the matching of the flap with the recipient site, and donor site morbidity. All the flaps survived well except one which developed distal marginal flap loss, one in which wound dehiscence was noticed, and two in which mild venous congestion was observed. Venous congestion in two patients subsided on its own within 3 days. One patient with wound dehiscence achieved complete healing by secondary intention. Patient who developed distal flap loss required debridement and skin grafting. No appreciable donor site morbidity was encountered. Skin colour and texture of the flap matched well with the recipient site. Conclusions: The inferiorly based thigh flap is a reliable flap to cover the defect over proximal one-third of the leg, patellar region, knee, and lower thigh