INTRODUCTION:
Burns trauma is as old as the discovery of fire in the history of
mankind. Eye lid burns are more common among the eye traumas.
They induce different effects on the ocular structures, depending
on the type of burns. The eyelid plays a vital role in protecting
vision, which is the most important sensation. No doubt the eyelid is
compared to a mother protecting a child amidst all circumstances- day
in and day out. Eyelids are delicate, complicated in their anatomy and
physiology. Eye lids are more prone to be damaged in the effort to save the eyeball.
No day passes without winking of the eye. The eyelids do their
function involuntarily without our knowledge, yet they can co-operate
with us in-voluntary closure also. In ocular burns in an effort to save
the eyeball the lids take the toll. Ocular burns injury can be in the
form of acid burns, thermal burns or hot liquid.
This is a study of injury of the eyelid due to burns and the
effect of early intervention to restore the normal anatomy in retaining the function of eye.
AIM OF THE STUDY:
1. To evaluate the efficacy of the collagen application immediately on admission, & early release and skin
grafting for the prevention of ectropion in upper eyelid burns.
2. Release incision and apply collagen on admission in III degree flame burns and acid burns and early STSG within 6 days for upper eyelid.
OBJECTIVE:
1. To find out the simple procedure to prevent (or) minimize problem in acute phase of upper eyelid burn.
2. To find out the optimum reconstructive procedure.
3. To find out post operative complication and factor to prevent.
MATERIALS AND METHODS:
In our study we have included 20 patients with deep partial
thickness and full thickness upper eyelid burns cases examined &
admitted at Burns, plastic & Reconstructive surgery department
Kilpauk medical college and hospital Chennai- 10, between
September 2006 to March 2009. A detailed history was taken with
reference to the presenting complaint of the patient, the cause and
duration and any previous treatment taken for it.
All patients underwent through clinical examination. Both eyes
are examined, properly documented and photographs are taken.
Inclusion Criteria:
1. Patients with deep partial thickness and full thickness upper eyelid burns.
2. Eye lid burns with less then 50 % of the total body surface area burns,
3. Upper eye lid burns with out major corneal complications are included.
4. Upper eyelid burns due to flame burns and acid burns.
Exclusion Criteria:
1. Upper Eye lid burn with more then 50% of the total body surface area burns.
2. Upper Eye lid burn with Epidermal and superficial partial thickness burns.
3. Upper Eye lid burn Patient with associated systemic disease like Diabetes, Hypertension, and severe systemic illness.
4. Upper Eye lid burn with age less then 13 and age more then 60 are excluded.
5. Upper Eye lid burn with previous ocular surgery.
6. Upper Eye lid burn with severe respiratory burns.
Eyelid burns early release and collagen sheet applied on admission and on 6th post burn day split thickness skin graft was applied. The split thickness skin grafts used for early grafting.
OBSERVATION:
Total number of burn patient treated: 4819. 20 cases of upper eyelid burns were selected for release and
grafting. 17 cases were flame burns and 2 cases were acid burns one case of scalds injury.
All cases that were taken up for study were free from co morbid conditions like diabetes mellitus, IHD, renal, liver pathology. All cases taken up for study were present with the complaints of
inability to open the eyelid because of edema. Symptoms of corneal irritation conjunctival congestion were noted in 18 cases. There was no limbal ischemia even in acid burns. Anterior chamber, pupil, fundus were normal in all the cases. There was no punctual obstruction or cicatrisation. All cases were evaluated by ophthalmologist. In all our cases because of oedema of eyelid initial evaluation of vision was not
possible. All cases were under systemic antibiotic cover, anti inflammatory and analgesics. All cases had topical antibiotic eye drops All the procedures were done under IV anesthesia. Donor site of skin graft was upper arm in 10 cases and thigh in 10 cases. 100% skin graft take in 17 patients. Donor site healing was completed in 10days no donor site morbidity was observed.
CONCLUSION:
1. Release incision and collagen application on the day of amission for deep partial thickness full thickness and chemical upper eyelid burn and early split thickness skin graft within 6-10 days prevent the post burn cicatricial ectropion.
2. It is a simple procedure to prevent the post burn cicatricial ectropion.
3. This procedure definitely prevent the period of wound inflamation and further complications.
4. This procedure optimize the eyelid function.
A deep partial thickness and full thickness burn of the eyelids
will lead to development of contraction and cicatricial ectropion and
subsequent exposure keratitis, followed by blindness. For this reason
deep partial and full thickness eyelid burns should be grafted as early as possible.
The role of surgery in the treatment of those complex injury
continue to evolve to incorporate refined concepts of tissue
preservation, wound bed preparation and early attention to functional
and aesthetic parameter. Social reintegration, psycho social support,
and new pain control strategies have dramatically improved the
quality of life for our patients during and after the acute course of
care. In eyelid burn early release and grafting improved the ocular function
