Dr Chandini Perera1, Dr John Vanderwood2
1Surgical Unit, National Hospital Of Sri Lanka, Colombo, Sri Lanka,
2Severe Burn Unit, Royal North Shore Hospital, St Leonards, Australia
Severe-Burns are common in low-middle-income countries with limited resources for care. In Sri-Lanka there are only eight beds for management of adult severe-burns for 21million people and grossly inadequate. There is no isolation or intensive-care facility for management. However despite these resource-constraints selected cases of severe-burns do survive. There are broadly two types; accidental and intentional. The difference between these extensive burns is depth. The intentional-burn with accelerant has a larger percentage of full-thickness burns compared to the purely accidental-burn where despite the extent most areas are partial-thickness and indeterminate-depth. In our experience with accidental-burns, provided there is no infection will often heal despite a lack of donor-sites and often require limited-excision and grafting.
Without critical-care and limited donor-sites, management of full-thickness extensive-intentional-burns is `conservative-management’. Surgery is often delayed due to lack of skin-substitutes and a skin-bank. Standard-protocols for fluid-management, inhalation-injury, dressings and surgical-intervention are not used. We wish to present two cases of burns over 60%TBSA with minimal donor-sites to illustrate techniques:
- Modified fluid resuscitation
- Non-Ventilatory care for inhalation-injury
- Rotational antiseptics dressings for wound-colonization
- Special surgical techniques for wound-closure
These patients illustrate salvage of burns with contracture-free outcomes is possible in resource-poor countries. It cannot be done by implementing standard-protocols that are applicable in developed-countries. Incidence and number of patients, far outweigh the resources-base comparable to developed-countries. There is a need for further study and research in techniques to salvage severe-burns and how to design courses for the management of such burns in low-middle-income countries.
Dr. Chandini Perera, headed the only adult burns unit at the National Hospital of Sri Lanka trainer for burns and chronic burn reconstruction (plastic surgery) Hospital of Sri Lanka for last 17 years. Main interest is acute burn reconstruction i.e. advanced grafting techniques that prevent contracture, and minimise need for rehabilitation