Monday, September 29, 2014

Of Plastic Surgery &the Acute Burn Management

Assisting my medical officer during toilet and suturing of a mixed laceration and abrasion wound over the left eyebrow and deeply contaminated abrasion wound of the left zygoma, I was asked: what do you understand of Plastic surgery?

Without putting the question into much consideration/thought I blurted, 'to preserve one's appearance?'

After a few sentences of how strayed my concept of Plastic was he said, 'in Plastic surgery, we restore as much as the form and function as possible'


Two days ago was my last day in the rotation. At approximately 1 in the evening, the Burn unit received a young boy with 'second and third degree burn over right upper and lower limb, the back with TBSA of 21%' as they put it.

After two weeks in the posting, you'd know in paediatrics population, 21% would require fluid resuscitation. Ok.

First and foremost, let's get you wander into his background:

A was fifteen, soon to be sitting for exam on the 13th of October. He was the middle child, his sister was married and he got a younger brother who was mentally challenged. The parents were both working that Friday, as were any other days. The moment I laid my eyes upon him, he was shaking and I could not help but think - poor kid, he did not deserve this. He seemed like a clean cut of good kids.

Let me make it short by saying on that day, only he and his brother were home. At 10.45 am, he was fixing the two of them breakfast. 'Wanted to fry chicken for me and my brother' said he.
As he was frying, he felt giddy (since he had not eaten) and somehow the frying pan slipped, and the oil splashed onto him, right to the limbs and back.

He tore his cloth at once and yelled for help. No adults were home, remember?
His cry was heard by his cousin who lived next door, and the uncle brought him to a government clinic at 11.15am.

Up to this point:
1. Can I just let it out, for the whole 30 minutes nothing was put on his body, no initial burn management?
2. It was boiling oil for gods sake!
3. And I think you wise and lovely fella can imagine what kind of burn he suffered

So at burn unit, after he was cleaned and all - we did the secondary survey - reassess the extend of his wound. Based on the Lund and Browland picture, I estimated 17%. Lesser than the initial number, but still, more than 10%, uhuh.(then my MO came and reassess, and we concluded it was a total of 16% involved)

What to do when you have burn injury?
1. Get help
2. In the mean time, the most important step being, to run the wound area under a running water for at least 20 minutes. RUNNING here was the KEY. Please eradicate from your minds that soy sauce/canned sweetened milk/immersing the wound into a container mixed with salt helped because well they did not.
Oh darling you can make a difference.
3. During transport, cover the wound with wet cloths - kind of like wet saline dressing trust me it would hurt less. 

(of course there was more to the acute management in burn injury, let's just discuss the things you could do, and rather let us do the rest eh?)

If you arrive like this image below, all I could think of is:
1. escharotomy
2. you would need a skin grafting

Take home message;
1. Be a responsible adult. If you have to be somewhere, at least prepare food for your kids first.
2. Water is magic. Like time, it heals.

Oh kid, let me assure you, you are in good hands. Plastic team motto: to restore the form and function, remember? xx

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