Background: Pseudomonas aeruginosa is an important cause of hospital acquired infection especially in patients admitted in critical care units such as intensive care units and burn care units. Because of its considerable potential to become resistant to important anti-pseudomonal agents, infection of burn wounds by P. aeruginosa, especially by multi-drug resistant (MDR) strains has become a major problem. Aim: This study was carried with an aim to determine the antimicrobial resistance pattern and prevalence of MDR P. aeruginosa infection among burns patients at a tertiary care center. Materials and Methods: This cross-sectional study was carried out from June 2013 to July 2014 in microbiology laboratory of a tertiary care center. In this study, 102 nonrepetitive clinical samples from patients admitted in burn unit were collected and the isolates were identified by conventional phenotypic methods. The antibiotic sensitivity testing of all P. aeruginosa isolates was done using Kirby-Bauer disc diffusion method and the results were interpreted according to the Clinical and Laboratory Standards Institute guidelines. Results: Out of 102 clinical samples, P. aeruginosa was isolated from 56 (54.9%) samples. Out of these 56 isolates, 43 (76.8%) isolates were MDR. Majority of the isolates were resistant to amikacin (73.2%), gentamicin (84%), tobramycin (75%), ceftazidime (76.79%), ciprofloxacin (71.4%), cefepime (64.6%), piperacillin (80.36%) and imipenem (61%). Conclusion: The prevalence of P. aeruginosa infection in patients admitted in burns unit was found to be 54.9%. This study showed an increased prevalence (76.8%) of MDR P. aeruginosa infection in burn patients.

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Background: Burns are a common injury in developing countries creating a major public health problem and are associated with significant morbidity and mortality. Our aim was to study the epidemiology of various demographic characteristics, their outcome and prevention. Materials and Methods: All acute burn cases admitted to the burn unit of Sheri-Kashmir Institute of Medical Sciences, ( tertiary care referral centre in Kashmir, India) over a period of 2 years (2010-2011) were investigated. The registration data regarding various demographic characteristics, mode of burn injury, time of presentation after burn and associated risk factors and illness. Assessment of burn wound was done regarding site, affected body surface area, degree, depth, severity of injury and complications. Data were collected and analyzed statistically. Results: Patient's ages ranged from 1 to 65 years with a mean age of 24.2 ± 7.6 years. The most common class of the population burnt were school going children (32.70%) followed by housewives (19.10%). Eighty percentage of patients belonged to rural areas and 20% to urban areas. Flame burns were more common in females (52.1%), electric burns were more common in males (93.3%) and scalds were more common in children (64.3%). Most of the burns were accidental (96.4%). 64.5% of patients reported within 24 h to hospital. 56.3% of patients had mixed degrees of burns, and 22.7% had third degrees of burns. Mortality was 11.8% and most common causative agent responsible was flame. The outcome was significantly associated with mode of injury, degree, depth, extent, causative agent and gender. Conclusions: This study provides important aspects of burn injuries for medical and nonmedical healthcare workers. The majority of burns are accidental seen in school going children, housewives and linemen of Power Development Department as a result of scalds, flame and electric burns respectively. Measures should be taken regarding awareness and education programs about burn prevention to reduce morbidity and mortality associated with it.

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The incidence of postburn pruritus is reported to vary between 80% and 100% and the persistence of itching leads to disabling symptoms such as sleep disturbance, anxiety, and disruption of daily activities. Recently, a few small randomized controlled trials by investigators have focused our attention to the neurobiology and molecular mechanisms of the postburn pruritus and the role of centrally acting agents in its treatment. It is now recognized that the central nervous system develops aberrant autonomous activity that causes maintenance of pruritic symptoms into a chronic state. This practical review on the topic aims to rationalize and simplify the current treatment options, through emerging and available evidence, to enable the physician to make an even better informed choice. While antihistamines and massage therapy will continue to be effective first-line strategy for most clinicians, the promising results in controlled studies obtained with gabapentin/pregabalin to ameliorate pruritic symptoms in a predictable fashion in burns patients have caused a paradigm shift in the therapeutic approach. Tailoring the drug therapy to the severity of symptoms leads to more successful therapy of this vexing malady and current evidence supports the use of gabapentin/pregabalin in patients with moderate to severe postburn pruritus (visual analog scale score >5) as the first line, even if as an "off label" indication. Other treatment modalities like doxepin, ondansetron, or transcutaneous electrical nerve stimulation may have applications on a case to case basis. However, massage therapy should continue to be an adjunct with all other modalities.

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Aims and Objectives: To evaluate the impact of comorbidities on the outcome of burn injuries. Materials and Methods: A retrospective analysis of 108 patients, treated between August 2010 and July 2013, was carried out. All patients were admitted, assessed and managed. The medical notes on 72 patients with comorbidity (Study group) were analyzed and matched with 36 other patients, without comorbidities (Control group), according to age, gender, and interval time between injury and admission. Information regarding types of burn injuries, depth of burn, comorbidities, operative procedures and final outcome were noted. Results: Patients were evaluated in terms of their duration of stay in the hospital and mortality. The comorbidities that influence these factors are renal disease, liver disease, cancer, pulmonary disorders, cardiac disease, obesity, peripheral vascular disorders, alcohol abuse, smoking and neurological disorders. Conclusion: It was found that the associated comorbid conditions influence the outcome of patients, injured due to burn, in terms of the duration of their stay in the hospital and mortality.

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Post-burn neck contracture (PBC) is one of the most common burn sequela. These contractures affect the patient significantly causing both functional limitations and esthetic disfigurements. Hence, the reconstruction of this area is a challenge to surgeons who must choose a technique, which restores the function and also improves the esthetic appearance. Aims: The aims of this study are to provide a simple classification of PBC and offer surgical solutions for each section of our classification. Materials and Methods: This retrospective study was carried out on 140 patients with PBC neck who were classified according to the functional defect and the anatomical type of scar. Results: We offer a simple classification system for PBC neck depending on the degree of contracture into mild, moderate and severe and also according to the type of the scar into linear, band or broad type.

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Introduction: Thermal burns could prove dreadful to humankind. The morbidity and mortality is the interplay of intraneous and extraneous factors. Multidisciplinary approach plays a cardinal role in managing this catastrophe. This study is carried out to analyze the oxidative stress in thermal burns, its implications in management, and the significance it carries with it. Materials and Methods: This prospective study was carried out in 30 patients from January 2016 to December 2016. Quantitative analysis of oxidative stress and total antioxidant capacity was done on postburn day 3 and every 5 days thereafter. Results: The quantitative oxidative stress level was high, and antioxidant capacity was low in patients who had higher percentage total body surface area burn and predominant deep burn with temporal analysis. The patterns were strikingly different in patients who had mortality with patients who survived. Discussion: Thermal burn releases reactive oxygen species which causes profound changes in internal and external milieu. This alters the physiological response to treatment and impresses on the morbidity and mortality of the patient. Conclusion: Thereby, it could be construed that oxidative stress along with tailored intervention, timing of treatment, and recalcitrant attitude to treatment methodology has a significant role in determining the outcome of burn patients.

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Introduction: A majority of burn injuries in India occur amongst women, primarily in the lower and lower middle class population. The cost of burn treatment is high and the burden is increased because of the poor penetration of medical insurance amongst this unfortunate population. Aims: To study the socio-economic impact burn injuries have on the families of the patients. Materials and Methods: The study was performed using a formulated questionnaire. Twenty-five patients who had been admitted in the burns ward and discharged after treatment in 2011-12 were included in the study. The patients/attendants of the patients were interviewed telephonically and the responses were taken from the patient and/or their attendants and results were studied. Observations: All the patients were female. Amongst the 25 patients studied (n = 25), the average age was 29.44 years, with an average total burn surface area of 32.32%. Average overall expenditure was Rs 89,000 (approx. US$ 1750) of which in the early tangential excision and grafting group (n = 8), the expenditure was Rs. 60,000 (approx. US$1150); in the late grafting group (n = 6), it was Rs. 2,25,000 (approx. US$4320); whereas in the conservative management group (n = 11), it was Rs. 35,863 (approx. US$690). None of the patients were covered by medical insurance. Non-institutional loans and/or sale of assets were required by all respondents to bear the costs. Conclusions: The socio-economic burden of burn injuries is very high and government support is the need of the hour. In patients needing surgery, early tangential excision and grafting has a significant cost-benefit advantage.

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Introduction : This study was carried out in the Department of Burns, Plastic and Maxillofacial Surgery, Safdarjang Hospital, New Delhi. Aim : The aim of this study was to assess the psychological status of patients with facial burn scars and to assess the quality of life (QOL) of these patients. Materials and Methods : The study was performed on 20 patients who were interviewed to assess depression (psychological status) and QOL. The assessment of depression was carried out using Beck's depression inventory, which has been translated into Hindi for use. The depression based on this questionnaire was graded into present or absent and further into mild, moderate and severe if present. QOL was assessed using the World Health Organization (WHO) QOL index questionnaire. The QOL was assessed to determine the environmental well being, adjustment to social relations, psychological well being and physical health and level of independence. The assessment of the patients was compared with the general population of similar socioeconomic strata. Results : The study showed presence of depression in all the studied subjects, with more females in the moderate and severe group of depression and more males in the mild group of depression. QOL assessment revealed significant derangement of psychological well being and social interaction in all subjects, but the physical abilities and environmental interaction were comparable to the normal subjects. Further, it is concluded to carry out larger and well-designed studies in burn and trauma patients to establish a protocol for assessment and management of post-traumatic stress disorders.

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Introduction: In the majority of pediatric burns mortality and morbidity results from simple domestic accidents that are preventable. Aim: A prospective study of pediatric burns was carried out at our burns unit to outline the epidemiology and management of the pediatric burns problem. Materials and Methods: Epidemiological data collected included age, sex, seasonal variation, place of burn, family size, economic status, period of time between the accident and admission to hospital. The cause and mode of burns, management of burns, relationship between mortality and age, cause and extent of burn was also noted. Results: A total of 72 pediatric patients of burns were admitted to our unit over a 3 years period. The highest incidence of burns was seen in the period of winter months between October and March. Males were affected more commonly as compared with females. The majority of the burns occurred at home. Most of the patients belonged to the low socio-economic strata and were members of medium or large size families. The most common type of injury was scald burns in children under 6 years of age and flame burns in the older children (6-12 years). The overall mortality was 13.88%. Conclusions: Burns injuries could be prevented by improving the home environment and socio-economic living conditions. Prevention can be achieved by education of adults as well as children about preventable aspects of burns.

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Introduction: Electrical injuries represent a special type of thermal injury, with a patho physiology depending on the voltage, current flow and resistance of the skin. Electrical injuries can produce significant morbidity and long-term sequelae. Aims and Objectives: This study is a comprehensive institutional review of database of patients with electrical injuries, from initial resuscitation through final impairment ratings. Materials and Methods: The study period was for 5 years from January 2008 to December 2012. All Patients admitted in burns ward with electrical injury are included in the study. A proforma was used to collect details. Procedures needed, their timing, final impairment ratings, and return to work were recorded. The results are quantified in terms of incidence of various complications incidence of amputations, mortality rate, disability incidence, etc. Result and Analysis: Electrical injuries can produce significant morbidity despite relatively small burn sizes. Electrical injuries occur in young males and leads to high incidence of upper extremity amputations, resulting in long period of unemployment and extensive new job training and rehabilitation. Patients require early operative procedures for prevention of further injury. Timely reconstructive surgery may improve final function and return to productivity. Work site accident, which is an important cause is largely preventable.

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Aim: The aim of the present study is to evaluate various prognostic factors in burn patients and predict prognosis and mortality of patients on the basis of prognostic factors. Materials and Methods: A study was conducted on 10 adults, total body surface area burns of >40% (40-90%) sequential thermal burn admissions at Burns Center. Blood samples were drawn from day of admission to discharge. Results and Statistics: (1) Fatal outcome in four patients, persistent serum cholesterol <100 mg%. (2) The difference in cholesterol values in patients with fatal outcome and survivors was significant. On comparing median cholesterol values for non-survivors and survivors on post-burn day-7, there was statistically significant difference (P = 0.039) by Mann-Whitney U-test. Serum cholesterol was significantly lower in fatal cases. (3) Infection or sepsis in patients correlated with the presence of toxic granules, toxic vacuoles on peripheral smear, raised total leukocyte count and low values of serum cholesterol. (4) Echinocytes (spiculated red blood cells [RBC]) were seen in all patients. In four patients, they persisted from post-burn day 4 until death. Progressive decrease in echinocytes, which correlated with rising cholesterol values was seen in survivors. Conclusion: Poor outcome in burn patients is related to persistently low serum cholesterol, high serum triglyceride and presence of echinocytes, toxic granules, toxic vacuoles and high white blood cell counts or vice-versa.

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Objective: Prevention of nosocomial infection in burn patient is a major challenge. Endogenous flora or the colonizers of the surrounding environment are the main source of infection in this group of patients. Continuous monitoring of infection in burn patients is necessary to evaluate the source and pattern of distribution of microorganisms. The study was planned to assess the bacteriological and antimicrobial resistance profiles of burn patients in our intensive care unit (ICU). Materials and Methods: Wound swabs from 100 consecutive burn patients were collected on days 1, 4 and 7 of admission to the burn ICU. Environmental samples were also collected from the surroundings of burn ICU and studied for the bacteriological and anti-microgram profiles. Results: Acinetobacter baumanni, Pseudomonas aeruginosa remained the major isolates from the wound swabs. Acinetobacter baumanni and Staphylococcus aureus found to be the common isolates from the environmental samples. In both the instances the strains were found to be multidrug resistant (MDR) type. Majority of the environmental colonizers were isolated from sink, bed cradle and patient's bed. Conclusion: In this study, colonizers of the environment appeared to play a major role in causation of nosocomial infection in burn patients. Hence, periodic monitoring and assessment should be done to strengthen the infection control practices in burn unit.

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Background: Diwali is an occasion when many people get injured or burnt. Most of the data on morbidity profile of the communities is the hospital-based and there is a lack of community-based surveys. Materials and Methods: The present study was a cross-section survey conducted in the resettlement colony of Gokalpuri, Delhi, after Diwali in the month of November and December, 2013. A total of 406 households were interviewed with questions on demographic details, any injuries suffered post-Diwali and the treatment sought thereafter. Results: In the population of 1826 surveyed, only 148 (8.1%) suffered from any problem this Diwali. Majority of the participants (105; 70.9%) had respiratory complaints ranging from mild cough and wheeze to asthmatic attack while 24 (16.2%) suffered burns on any part of the body. Eighty four (56.7%) people who suffered any problem post-Diwali didn't do anything for the problem, rather left it to get well on its own. Only 32 persons had gone to health center for treatment. Conclusion: In the current study, prevalence of post-Diwali morbidity was 8.1%. The observed prevalence in the current study is much higher than that reported in a hospital based retrospective study by Tandon et al. from Delhi which collected data from 2002 to 2010 and where the incidence was one patient with firecracker-related injury per 100,000 population of the city.

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Background: Burn injuries account for a significant cause of mortality and morbidity amongst the Indian population. Since prevention is more important than the treatment of such injuries, this study was undertaken to find out the exact epidemiological determinants of such injuries and thus to try and formulate effective preventive strategies. Aims and Objectives: To find out the epidemiological characteristics of burn patients in a tertiary care hospital. Materials and Methods: A Cohort review of patients admitted over a period of 3 years from January 2010 to September 2013 in the burns unit of our institute. Data were collected from hospital admission books which included age, sex, religion, Total body surface area burns, location, mode of burn and the cause of burns. Data were entered in MS EXCEL software and analysed. Results: There are 3179 patients included in the study. The mean age of patients was 28 years (SD=14.7 years) and overall male to female ratio was 0.6. The percent of Total body surface area for burned patients ranged between 1% and 100% and maximum number of patients were admitted with 30 to 50 % burns (27.5%) The median hospital stay was 5 days. There was a significant association between Total body surface area burns and hospital stay (P<0.001). 7.3% patients were discharged from the hospital after successful treatment. 1733 (54.51%) deaths were recorded. Death rate was higher amongst females as compared to males. Mortality rate was highest in age group of 12–26 years. There was a significant correlation between Total body surface area burns and mortality (P<0.001). Death rate was highest amongst patients with suicidal burns as compared to accidental and homicidal burns.75% patients died within 5 days of hospitalization. Conclusion: High mortality rate amongst patients is a major concern in the present scenario of health care towards burn injuries.

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Ear is a very prominent part of the face after nose and eyes especially in Indian subcontinent where in both the males and females it adorns a variety of ornaments to beautify the face. However, because of limited functional importance of external ear the burns of the ear are often neglected. More often, isolated burns of the ear are very rare. They are usually involved with facial burns and therefore inhalational injuries. Overall management of burns to improve survival takes precedence over the management of just the burned ear. Therefore, neglected ear burns can lead to cosmetic deformity which can vary from minor to very severe. Giving due importance to this small structure can prevent a lot of morbidity during the acute phase and deformities later on as a sequel of burns. Correction of those deformities and giving a normal shape to the ear can be a very daunting task because of the intricacies involved in framing the cartilage and inadequate soft tissue availability in the surrounding area. This article emphasizes on the steps which can be taken from the first postburn day to avoid complications like chondritis, chondral abscess, and various other deformities because in a patient surviving burn injury, the quality of his or her life will be determined by the degree of these deformities.

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Introduction: The aim of the reconstructive burn surgeon is to remove all the scar tissue in the affected area and resurface the area with supple tissue, which allows proper movement of the neck and is esthetically pleasing. We present our series of 10 patients of burn neck contracture, primary and recurrent, who were treated with free flap reconstruction. Patients and Methods: A retrospective review of all the data of the patients was done and the demographic data, preoperative and postoperative examination findings, surgery offered, results and follow-up details were tabulated and analyzed. Results: All the flaps survived completely. Two flaps showed postoperative congestion on day 1 and were taken to the operating room to be reexplored. All patients showed marked improvement in the degree of neck extension, lateral flexion, and rotation which remained unchanged with successive follow-ups. Conclusion: The results of free flap reconstruction of the burn neck contracture area appear to be better than other methods in terms of functional and esthetic restoration of the normal anatomy. The postoperative morbidities for the patient are also reduced and patient comfort is enhanced. The authors feel that in centers where microsurgical expertise is available, the patients of burn neck contractures may be offered the option of complete scar excision and free flap reconstruction as a primary option instead of scar release and split skin grafting.

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Aim: To analyze the profile of acute thermal burn patients admitted to intensive care unit of a tertiary burn care center in India. Materials and Methods: Acute thermal burn patients admitted to the burn intensive care unit during June, August and December 2011 representative of summer, monsoon and winter season were included in this study. Observations: Overall 416 patients were admitted during this period. A total of 162 patients fulfilled the study criteria. Females outnumbered male victims. Patients in the age group of 20-40 years were most affected. Burns in females involve greater total body surface area (TBSA). Liquefied petroleum gas stoves, kerosene oil stoves and kerosene oil lamps are the most common causes of burns reporting to our center. Average distance travelled by patients to reach this hospital was 69.4 kilometers. Ten percent of the female thermal burn victims were pregnant and 3% were lactating. Discussion: An education program is needed to make the population aware of various etiological factors causing burns and their prevention. Safer means and practices should be adopted in kitchen. Local health care facility should play a major and proactive role in managing burns. Burn care needs to be decentralized for better management.

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Background: A large number of burn injuries in India go unreported; injuries are largely preventable but still burn injuries lead to deformities and contractures limiting optimum and normal functioning of the individual. Materials and Methods: A community based cross-sectional study was conducted in the rural village of Phanda block. A house-to-house survey was conducted and the interview technique was employed to collect the data. Results: A total of 756 households with 3,677 population were surveyed. There were total 309 (8.4%) patients with burn injuries during the last 6 months. Majority of the patients were females (54.7%). Out of the total domestic burns, 71.3% occurred in the kitchen. Conclusion: Burn injuries are a serious public health problem. These injuries are preventable through design and promotion of more aggressive prevention programs especially for flame injuries occurring in the home environment.

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Introduction: The incidence of electrical accidents has increased, due to use of electricity in the house hold, institutions and industries. Electrical injuries can cause extensive disFigurement to that of significant functional disability and sometimes can be fatal due to cardiac events and therefore the patients need to be closely monitored in an ICU set up. Management of electrical burns patient requires a team work of surgeons and physicians. Materials and Methods: This retrospective study was conducted between January 2007 and December 2012 in the Burn Unit of Sri Devaraj Urs Medical College, Kolar, Karnataka, a rural tertiary care center of South India, to assess the demography, degree of disability and loss of life due to electrical burn. Result: We had 47 patients of electric burns admitted in our center. Most of the accidents leading to the electrical burn injuries could have been prevented. Conclusion: Prevention is possible by increasing public awareness through primary education among the rural people and by taking adequate precautions such as the use of personal protective equipments (insulated gloves and footwear.) and following national electrical codes.

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Background: Burns are the third most common cause of mortality in children and adolescents. It is also a major cause of morbidity and mortality in individuals of all age groups, particularly in individuals living in the developing countries. Objective: The objective of this study is to determine the causes of extensive burn injuries in our population, sex, age, distribution of extensive burn injuries by years, duration of treatment, the methods of treatment and mortality. Materials and Methods: In this retrospective study, we retrospectively analyzed data of 69 patients during the 4-year period between January 2008 and January 2012, with extensive burn injuries admitted to the ICU-University Clinical Center of Kosovo. Among them, 53 patients were males and 16 were females with a male to female ratio of 3.3:1. Conclusion: The high rate of transferring patients for treatment abroad to other countries of 28.9% and high mortality rate of extensive burns in our country with 11 cases (15.9%) is a reflection of lack of burn care in our department.

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Background: Injuries and deaths from burns are a serious, yet preventable health problem globally. This paper describes burns in a cohort of children admitted to the burn's ward of Victoria Hospital, BMCRI, Bengaluru, India. This 3 years study was of the consecutively admitted patients from August 2008 to July 2011. Information was collected using a protocol-specific data collection sheet. Descriptive statistics (percentages, medians, means, and standard deviations) were calculated, and data were compared between age groups (and other criteria as indicated in comments). Findings: During the study period, 900 children were admitted with 280 (31.1%) girls and 620 boys (68.9%). The peak age of occurrence was between 1 and 4 years (44.7%). The peak period of occurrence is between August and October (41.5%). The majority of children 411 (45.6%) suffered scald burns. Closely following is the group of accidental thermal burns involving 375 (41.7%) children and 96 (10.7%) children sustained electrical burns. There has been an alarming rise of suicidal thermal burns in the pediatric population. Conclusion: Toddlers are most at risk for sustaining severe burns when their environment is disorganized while adolescents act on impulse. Burns injuries can be prevented by improving the home environment and socioeconomic living conditions through the health, social welfare, and education and housing departments apart from reducing stress levels of older children. It is high time that we introspect into the social support system of the country with regard to its addressing the emotional needs of the adolescent group and stress management strategies that are available to these youngsters who are giving up on life so easily.

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Background/Purpose: With the remarkable progress in the field of burns treatment, the outcome of extensive burns improved significantly. The increased likelihood of survival of a burn victim heightens concerns for potential psychological morbidity. Our aim of this study was to find out the magnitude of depression in burn patients, quality of life (QOL) in cases as compared to control, the correlation between depression and QOL, and the predictive factors for QOL in burns. Materials and Methods: The study sample comprised of 60 patients with burn between ages of 18 years and 65 years seeking consultation for reconstructive surgery. An equal number of healthy controls of similar age and sex were also enrolled to make a comparison group. Participants were assessed for the presence of depression and QOL by using patient health questionnaire (PHQ-9) and World Health Organization quality of life-BREF scale, respectively. Result: Depression was found statistically significant in burn patients as compared to control. 28.33%-mild, 25%-moderate, 23.33%-severe, and 15%-moderately severe as compared to control, where 86.67% of study sample had no features of depression (P < 0.001). The overall QOL was found significantly lower (32.75 ± 10.33 vs. 69.44 ± 10.87) (P < 0.001). A significant inverse fair correlation existed between the PHQ-9 and QOL. Lower QOL in burn patients positively associated with multiple factors like female patients, the involvement of exposed part, facial burn, etc. Conclusion: The high prevalence of clinically significant depression and lower QOL of in burn reconstruction patients and their relationship with body image suggest the importance of the routine psychological screening and the treatment of patients seeking reconstruction surgeries.

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This article tells the story of the making of collagen sheets as dressing material in India. The thought process behind the science and the methods of usage of collagen sheets have been deliberated upon. Versatility of collagen based dressings is approved by most of the surgeons and plastic surgeons for burn injuries. There have been no adverse reactions by way of allergy, or anaphylaxis. Collagen dressings are very cost-effective, less labor intensive, but the person who uses must understand the nuances thoroughly, before starting to use. It is better to learn all about the membrane prior to using it.

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Facial burns commonly involve the eyelids. The eyeball as such is usually protected due to the blink reflex, bell's phenomenon, and protective movements of arms and head. Ocular sequelae are seen secondarily due to retraction of the burned eyelids which leads to drying of cornea and its subsequent ulceration and perforation. Permanent visual impairment is rare if prompt management is done. Superficial lid burns usually heal spontaneously and can be managed conservatively with ophthalmic antibiotic ointments, artificial tears. However, in deeper burns, early surgical intervention in the form of eschar debridement or release of contracted lids and resurfacing defects with split skin grafts can prevent secondary corneal damage. This review article elaborates the principles of management of acute ocular and periocular burns as well as the long-term management of eyelid burns.

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Radiation dermatitis is the commonest side effect encountered during definitive radiotherapy. Radiation depletes the basal cell layer of skin and initiates a complex sequence of events leading to dose-dependent acute or late sequelae. The incidence and severity of radiation dermatitis depends upon multiple patient and treatment related factors. With the use of megavoltage radiation and implementation of conformal radiotherapy, the incidence of severe radiation dermatitis has reduced significantly. Treatment interruptions due to severe reactions may affect outcome. Prevention and management of radiation dermatitis requires a multidisciplinary approach. For acute radiation dermatitis, maintaining hydration which will eventually promote epithelialization is the key; while for moist desquamation, prevention of infection and facilitation of epithelialization are important. Barrier dressings like human amniotic membrane and hydrocolloid dressing are useful as they prevent trauma and infection, trap moisture, and thus facilitate healing. Late radiation dermatitis presenting as a difficult to treat long standing chronic radionecrotic ulcer is seen rarely in the current practice. Radionecrosis refractory to hyperbaric oxygen therapy (HBOT) may require surgical intervention to restore function and alleviate pain. Although there is lack of robust data to define strict policies for management of radiation dermatitis, the current practices are based on institutional protocols and personal experiences.

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