Lower limb salvage in necrotizing burn wound infection: The role of fibular ostectomy and local flaps in a resource-limited setting - A case report and literature review.

INTRODUCTION: Necrotizing burn wound infections following burn injuries are rare. Literature on these cases is also scarce. These infections are life- and limb- threatening unless properly managed. They also pose significant reconstructive challenge, especially in settings lacking microvascular capability. This report describes a limb preservation strategy for limb-threatening necrotizing infection of the leg that complicated a burn injury. Innovative approach was used, utilizing proximal fibular ostectomy, bipedicled local advancement flap and split thickness skin graft. CASE PRESENTATION: A 26-year-old female patient presented to our burn unit after sustaining a contact burn injury from a burning charcoal to her right lateral leg within three days. On the second day of admission, the patient developed significant changes in the appearance of the wound, leading to the diagnosis of necrotizing myofacitis. Emergent debridements were done with the aim of preserving the limb. Subsequent successful, albeit sub-optimal, reconstruction was also achieved despite the lack of microvascular surgical capability in the burn unit. DISCUSSION: This case report and literature review describes a rare limb-threatening necrotizing burn wound infection. The significant reconstructive challenge posed by the defect was addressed using a simple but rarely described reconstructive technique. The importance of limb preservation in LMIC is also emphasized. CONCLUSION: The goal of preserving a limb can be met by using a simple reconstructive technique, despite the lack of microvascular capabilities.

Unusual sight-threatening complication of scaled burn injury in a pediatric patient: A case report.

INTRODUCTION: Acute ophthalmic complications in burn injury patients are rare. Despite their rarity however, when they do occur, they may result in permanent visual impairment and lifelong disability. Emphasizing the need for vigilance and prompt treatment initiation for a good outcome. CASE PRESENTATION: A 3-year-old girl was referred to our burn unit after receiving 10 days of treatment at a peripheral hospital for scalding burn to her upper chest, face, and scalp. Remarkably, her eyelids were spared from the initial injury. Upon her third day under our care, she began displaying severe sensitivity to light, photophobia, irritability, excessive crying, and frequent itching of the eyes. Upon examination, bilateral conjunctival redness and inflammation, as well as whitish opacity of both corneas with pus in the anterior chambers were observed. Prompt consultation and treatment led to improvement of the symptoms. DISCUSSION: This case report describes a rare case of bilateral endopthalmitis in a burn injury patient with no initial apparent injury to the eyes and emphasizes the importance of vigilance, prompt recognition of the scenario and treatment initiation. Risk factors identified in this patient included compromised immune system due to severe burn, prolonged hospitalization, IV antibiotic use and young age. Other more common risk factors associated with endopthalmitis like direct ocular injury and central line use were absent making the case unusual. CONCLUSION: Despite their rarity severe ophthalmic complications like endopthalmitis can occur in burn injury patients even when least expected. Heightened vigilance, prompt evaluation, multidisciplinary team approach and early initiation of broad spectrum antibiotic treatment is crucial to prevent permanent visual loss and lifelong disability.