Abstract book - ESPRAS

P 1. Management of burn injuries without a burn unit:
Kocaeli experience
Agir H., Dinar S., Sen C., Unal C., Cek D.
Plastic and Reconstructive Surgery Department, Kocaeli Faculty of Medicine,
Kocaeli University, Kocaeli, Turkey
Introduction
Every year more than one hundred burn patients need a standard care of a
burn unit or center in Kocaeli, central city of a densely populated industrial
region of Turkey. However, most of these patients are admitted to general
plastic surgery clinics in the city without a burn unit. University hospital is
the largest tertiary referral center in the region, which drains more than 50%
of these cases per year, and it does not have any burn unit service at all. We
decided to evaluate our results and protocols, besides the particular problems
we have encountered and the solutions we have found since 1996 in this
highly demanding field of plastic surgery.
Material and Methods
We included 108 burn injury patients into our study group who were treated
between May 2002 and May 2004. We scrutinized the medical records and
studied the cases according to their age, sex, etiology, burn percentage, injury
region, surgical treatment, complications and outcome.
Results
Mean age of the patients was 19.7±19.2 with a male: female ratio of 1.45. In
53.7% of the cases, a scald was the cause and 18.5% of the patients were
admitted due to a high-tension electrical burn injury. Head and neck region
was mostly affected in children below 5 years age. Least affected body area
was genitalia. Following emergency unit admission, fasciotomy was applied
in 17 cases. Tracheostomy and escharotomy were done in four and three
patients respectively. Ten patients were directly admitted to surgical
intensive care unit. As for the surgery, STSG was undertaken in 77 patients
whereas local flaps and free flaps were needed in sixteen and eight cases
respectively. Amputation rate for the high-tension electrical burn injury was
25%. Mean hospital stay for all of the patients was 37 days while the average
number of operation per patient was 3.2. In 4% of the patients, severe burn
contractures were developed despite all preventive measures. More than 50%
of the pediatric cases with hand burn injury underwent additional surgeries
for their scar and joint contractures. Most devastating results were obtained
in electrical burn injury group. Mortality rate was 1.8 %.
Conclusion
Most of the plastic surgeons who work in developing countries and treat
burns in their clinics always need to reevaluate and adjust the burn
management principles to their own circumstances. In this study, it may be
concluded that even severe burn injuries can be managed in general plastic
surgery wards with a relatively low mortality and morbidity rate. However, if
the complications, hospital stays and the outcomes in functional and cosmetic
aspects were taken into consideration in comparison to literature, it would be
hardly suggested that burn units were not very essential in burn injury
treatment in third world countries.