Burn Care at the National Orthopaedic Hospital, Enugu: A Comparison of Two 5-Year Periods: January 2012-December 2016 and January 2017-December 2021.

Background and Objectives: The survival rate of patients with burn injuries has increased remarkably owing to the advancements in burn management which has resulted in improved survival rates, shorter hospital stays and decreases in morbidity and mortality rates due to the development of fluid resuscitation protocols, improved respiratory support, infection control etc. This study compares the parameters of burn patients admitted in a tertiary hospital from January 2012 to December 2016 and January 2017 to December 2021. Materials and Methods: This study was at the National Orthopaedic Hospital Enugu, NOHE. It was a retrospective study of patients who presented with burn injuries to the burn unit between the period of January 2012 and December 2021. Results: A total of 771 cases were analysed. Three hundred and twenty-three were seen between January 2012 to December 2016, 448 were seen between January 2017 and December 2021. Flame remained the major cause of burn injuries with 62% occurring in the first 5-year period while 72% occurred in the second 5 years. Adults had more injuries from flames than children, while children had more scald injuries than adults. The highest percentage of Total Burn Surface Area (TBSA) salvaged was 79% in the first 5-year period while 86% was salvaged in the second. Mortality rate in the first and second 5-year periods were 12% and 19%, respectively. Conclusions: Flame burn injuries are the most common cause of burn injuries in adults and children. Mortality was lower in the first 5-year period. A higher TBSA was salvaged in the second 5-year period.

Split Skin Graft Take in Leg Ulcers: Conventional Dressing Versus Locally Adapted Negative Pressure Dressing.

BACKGROUND: Split-thickness skin grafting is widely used in the management of leg ulcers but is fraught with suboptimal take especially in less than ideal wound beds. The use of negative pressure dressing to prepare wound beds is an established practice. However, its use to improve graft survival is yet to be a common practice. We aim to compare quantitative and qualitative split thickness skin graft take in leg and foot ulcers using either traditional wound dressing or negative pressure dressing methods. METHODS: Sixty-two cases were recruited for the study and assigned into two groups of 31 cases each by convenient sampling method. Group A patients had negative pressure dressings in both phases, whereas group B patients had traditional wound dressing in both phases. The percentage skin graft take for both groups, and the pattern of complications were assessed. Results were analyzed using IBM SPSS statistics for windows (version 21.0; IBM Corp, Armonk, NY). Student t-test was used to compare the percentage graft take, whereas Chi-square was used to compare significance of complications in both dressing methods. RESULTS: The negative pressure dressing showed better skin graft take with mean value of 99.2 ± 0.95% compared with traditional dressing with mean take of 89.7 ± 6.44%, which was statistically significant with a P value of <0.001. The complication rate was 12.9% in the negative pressure dressing group and 96.8% in the traditional wound dressing group, showing about 7.5 times more complication in the traditional wound dressing. This is statistically significant with a P value < 0.001. CONCLUSIONS: Negative pressure dressing for split-thickness skin graft contributes significantly to improved split-thickness skin graft take with reduced complication rate as compared with conventional wound dressing method.

A classification system for postburn mentosternal contractures.

HYPOTHESIS: Postburn mentosternal contractures can be clinically classified into 4 major groups based on the location of the contracting band(s) and extent of flexion or extension away from the anatomical position of the neck and jaws. Each group can be further subclassified depending on the width of the contracting segment(s) and availability of surrounding supple skin. DESIGN: Case series. SETTING: Nigerian subregional apex hospital specializing in plastic surgery, orthopedic surgery, and traumatology. PATIENTS: A consecutive sample of 41 patients with postburn mentosternal contractures who underwent surgery between 1997 and 2002 and 4 patients who had not yet had surgery, seen between January and March 2003. Data were obtained from operative records, photographic records, and interview of teams who treated the patients. During data collection, a classification system was devised in which mild, moderate, and severe anteriorly located contractures were designated types 1, 2, and 3, and posteriorly located contractures were considered type 4. Subtypes a through d were included to denote characteristics affecting reconstruction. RESULTS: The classification system was successfully used to classify postburn mentosternal contractures as a guide to management. Sufficient data were available to classify 32 of the 45 patients. The observers were not blinded. CONCLUSION: The classification system is useful in describing severity and guiding reconstructive options, but further study is required before it is used in choice of airway management for anesthesia.