Research Article | Open Access

¹Senior Resident, Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
²Professor & Registrar (Academic), Head of IT Wing and Telemedicine, Department of Plastic Surgery & Telemedicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India

*Corresponding author: Ravi Kumar Chittoria, Professor & Registrar (Academic), Head of IT Wing and Telemedicine, Department of Plastic Surgery & Telemedicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India

Abstract

---

Electric burns are known for difficulty in healing and wound management. There is a lack of growth factors in these chronic wounds and needs to be supplemented with adjuvant therapy that allows for faster healing we have used the JIPMER burns manual to allow the management to be protocol based.
Keywords: Burns- manual, Electric burns, protocol
Abbreviations: JIPMER: Jawaharlal Institute of Postgraduate Medical Education and Research

Introduction

---

Adult wound healing is divided into three stages: the inflammatory phase, proliferative phase, and remodelling phase. The three stages have to occur in conjunction to result in wound healing. Wound bed preparation is a novel concept and can be summarized using T.I.M.E with T for tissue: non-viable or deficient. I for infection/inflammation, M for moisture balance. E for epidermis which was changed to E for an edge [1]. Large wounds often require a graft or flap for wound coverage, which requires wound bed preparation. Protocol-based management helps to streamline the management and decrease the incidence of pitfalls.

Materials and methods

---

This study was conducted in the Department of Plastic Surgery at a tertiary care centre after getting the departmental ethical committee approval. Informed written consent was taken from the patient. The details of patient in the study were a 14-year-old female without any known comorbidities with a history of accidental electric burns from the low voltage source and sustained circumferential 3rd to 4th-degree burns over the scalp frontal region (figure 1) We used the manual for burns management (Annexure 1) in electric scalp management and have found it to be useful.

Results

---

The wound bed showed good granulation tissue and showed healing (figure 2). Using the burns manual to manage such complicated cases helped to make the management evidence-based and with minimal flaws.

Discussion

---

Burn injury is a major cause of trauma to the human body, with a long healing period. The mortality rate of burn injury has decreased with new treatment modalities, but secondary infections and prolonged healing periods still affect the mortality rates. Many therapeutic methods are available to affect wound healing such as the topical application of insulin, growth factors, negative pressure-assisted wound closure, oxidized regenerated cellulose/collagen, hyaluronic acid conjugated with glycidyl methacrylate or gelatine dressings.

There are various guidelines for the management of burns including the ABC management, emergency management, treatment and rehabilitation including the ISBI [2], WHO [3], Australian guidelines [4], US guidelines [5], however, there is no single burns manual for the management of burns patients. However, all these guidelines direct on how to manage the burns patient, which can be confusing and cumbersome. We have made JIPMER burns manual to allow for a ready-reckoner so that the doctor gets direction on what has to be done next when faced with a problem during the management. JIPMER burns manual was made in the year 2015 after compiling the various international guidelines. It is a 12-page document. The manual contains the following headings- A. Management of a New Patient on Arrival B. IV Fluid Regimen C. Catheterization D. Maintenance fluid E. Investigations F. Following Discharge against Medical advice G. Following the Death of the patient H. Following Discharge I. Pre-operative J. Following Operation (Major/Minor) K. Rounds L. Emergency Duty M. Daily check We have tried to include all the problems encountered by a surgeon/plastic surgeon in burns management in our proforma for proper assessment and care. Proforma based management helps not to miss any important findings or investigations. It also helps to maintain a checklist which can be a guide through the investigations and management. It also helps to keep track of the various treatment options and advice given at previous visits. However, it has to be used as a guide. It has to be individualised to each patient and the condition in which they present. In government hospitals where there are various residents taking care of one patient, it helps to keep track of the stage of management. The checklist for the surgeon in the peri-operative period will ensure that all the standard protocols are followed, which helps both in effective patient care and streamlining of the support staff for increasing efficiency. It will help not only in the management of patients but also help in more easy access to information in case the patient needs to be referred to another centre. It also helps in maintaining a data bank for future analysis and publications.

Conclusion:

---

We have used JIPMER burns-proforma and found it to be useful. The study was done on a single patient and needs a large population-based study to apply in practice.

Declarations
Financial support and sponsorship: None.
Conflicts of interest: None.
Disclosure: None

References

---

1. Frykberg RG, Banks J. (2015) Challenges in the treatment of chronic wounds. Adv Wound Care (New Rochelle). 4(9): 560-582. [PubMed.]
2. ISBI Practice Guidelines Committee, Steering Subcommittee, & Advisory Subcommittee. (2016) ISBI Practice Guidelines for Burn Care. Burns: journal of the International Society for Burn Injuries. 42(5): 953-1021. [PubMed.]
3. WHO/EHT/CPR. 2004 reformatted. (2007) WHO Surgical Care at the District Hospital. 2003. [Ref.]
4. First aid management of adult burns. (2020). [Ref.]
5. ABLS Provider Manual. (2018). [Ref.]