An evaluation of the role of systemic antibiotic prophylaxis in the control of burn wound infection at the Lagos University Teaching Hospital.

A prospective study was carried out on 61 patients to evaluate the role of systemic antibiotic prophylaxis in the control of burn wound infection. The patients were randomised into three groups: group 1 (n=21) received ampicillin and cloxacillin; group 2 (n=20) received erythromycin and genticin and a control group (n=20) received no systemic chemo prophylaxis. The burn wounds were similarly managed. Wound colonisation was determined from surface wound swab cultures and wound infection was determined from wound biopsy cultures and histopathology. The colonisation time (days) for the groups was 2.90+/-0.92, 3.15+/-0.77 and 3.05+/-0.83 for groups 1 and 2 and the control, respectively. The commonest organism isolated from contaminated wounds was Staphylococcus aureus. Wound infection was established in 5.70+/-1.70, 5.75+/-1.62 and 5.6+/-1.90 days for group 1, group 2 and the control group, respectively. There was no significant difference between wound infection time of control and group 1 nor was there such difference between the control and group 2 (P>0.05). The commonest organism infecting burn wounds in all the groups was Pseudomonas aeruginosa followed by S. aureus. There was however a significant difference between the treatment groups and the control (P<0.05) with regard to the percentage of infected wounds that grew P. aeruginosa, compared to those that grew S. aureus. It was concluded that systemic antibiotic prophylaxis is of no value in controlling burn wound sepsis, and might even favour the growth of P. aeruginosa in the burn wounds.

Burn care in Africa: reducing the misery index: the 1993 Everett Idris Evans Memorial Lecture.

Burn care in Africa is hampered by inadequate facilities, inadequate infrastructure, and inadequately trained staff. Burn units with burn teams are few. Burn injuries carry a high mortality rate with delayed healing and high complication rates among survivors. Most burns occur in the home from flame and scalding, and children are more affected than adults. Burn sepsis is mostly from staphylococci and pseudomonas. Various studies on epidemiology, sepsis, protein metabolism, and repigmentation indicate methods of prevention and improved care, including greater resort by surgeons to skin grafting, which speeds healing and both prevents and treats scarring, contractures, and depigmentation. Governments, industries, and entrepreneurs are exhorted to promote burn prevention, research, improved care, and rehabilitation, particularly through the establishment of burn units with burn teams, to reduce the misery and suffering caused by the high mortality and morbidity from burns in Africa.

Bacterial flora of burn wounds in Lagos, Nigeria: a prospective study.

A prospective study of burn wound sepsis was carried out on 31 consecutive patients with fresh burns. Wound swab cultures were assessed at weekly intervals for 5 weeks. The study revealed that while 96.7 per cent of burn wounds were sterile on admission, bacterial colonization reached 80.6 per cent within the first week after admission. Although the Gram-negative organisms, as a group, were more predominant, Staph. aureus (38.2 per cent) was the most prevalent organism in the first week. It was however surpassed by Pseud. aeruginosa from the second week onwards. Anaerobes were conspicuous by their absence. Similarly, beta-haemolytic streptococcus was not isolated from any patient. Proteus mirabilis was unusually preponderant, forming 19.4 per cent of all isolates. The antibiotic sensitivity pattern showed resistance of most of the organisms to ampicillin. Only 15 per cent of staphylococci were sensitive to cloxacillin. Most of the organisms cultured (93.5 per cent) were sensitive to ceftazidime.

Associated congenital abnormalities in Nigeria children with cleft lip and palate.

This is a prospective study of 106 patients with cleft lip and or palate seen over a 5 year period between January 1981 and December, 1985 at the Lagos University Teaching Hospital. Thirty of these patients (28.3 percent) have other associated congenital anomalies which lies within the range of 3 percent to 63.3 percent reported by other authors. The associated anomaly rate was 19 percent in cleft lip only, 35 percent in cleft lip and palate and 28 percent in cleft palate only. All the associated anomalies in the cleft lip cases were single and simple. On the other hand, the multiple and more complex associated anomalies occurred in patients with cleft plate alone and cleft lip and palate combined. Three syndromes were recognised in patients with cleft palate and two in patients with cleft lip and palate.

Surgical experience in the management of multiple neurofibromatosis in Nigerians.

Thirty patients with neurofibromatosis were treated by the Burns and Plastic Unit of the Lagos University Teaching Hospital during a seven year period from December, 1979 to December, 1986. Their ages ranged from 3 to 53 years. The indications for surgery were impairment of function in 66.6 percent, cosmetics in 20 percent, ulceration in 6.7 percent and malignancy in 6.7 percent. There was profuse bleeding during and after surgery in virtually all patients. Post operative infection was common and wound healing was generally poor. However, hypertrophic scars and keloid formation were not observed in spite of the poor wound healing and closure of some of the wounds under tension.

Flame burns disasters from kerosene appliance explosions in Lagos, Nigeria.

A study of 55 cases of burns admitted to the Lagos University Teaching Hospital in the month of March 1984 revealed that 96 per cent were caused by flame burns due to explosions that occurred during the use of kerosene appliances for cooking and lighting. Thirty-four (62 per cent) were children, while 21 (38 per cent) were adults. In each of seven families, two or more people were affected. The overall mortality was 44 per cent, of which the larger contribution of 30 per cent was in children. By comparison, in the two preceding months there was a total of 17 and 20 burns admissions respectively. The mortality rate was 16 per cent while in March 1983 there was no death among the six paediatric admissions. Investigations showed that the explosions occurred due to petrol contamination of the kerosene before delivery to the domestic users. Appropriate precautions by kerosene suppliers and users, and health education can help prevent similar disasters in the future.

Maternal stress, superstition and communicative behaviour with Nigerian cleft lip and palate children.

This study examines, through video recordings and interviews, superstitions held by families of children with cleft lip and palates (CLP) and the mothers' communicative relationship with them. 10 CLP children, 10 non-cleft (NC) children and their mothers, were the subjects. Evil spirits were cited as the dominant cause of the cleft. Husbands or the extended family blamed the mother for the defect in 70% of the homes. Negative family support was evident in 6 of the families. Mothers of CLP children were indulgent with them, but afforded them less autonomy than did mothers of NC children. There was also more linguistic sensitivity between mother and CLP child than within the control group, perhaps facilitating language development in the CLP children. Mothers were, however, withdrawn in relation to children with unrepaired cleft lips. Family education and counselling were recommended.

Cephalometric findings in a normal Nigerian population sample and adult Nigerians with unrepaired clefts.

Cephalometric values have been established for twenty adult Nigerians, three adults with unrepaired unilateral cleft lip and alveolus (UCLA) and two adults with unrepaired unilateral cleft lip and palate (UCLP). Normal values for SNA and SNB were 85.5 degrees +/- 3.5 and 82.7 degrees +/- 3.2 respectively, and the mean ANB values were 3.1 degrees +/- 0.8. The cephalometric data for unilateral cleft lip and alveolus (UCLA) subjects whose clefts were not repaired until adulthood did not differ significantly from normal controls. However, in two adults with unrepaired unilateral cleft lip and palate (UCLP), the SNA values were less than normal controls and the ANB values were reduced to negative levels. Bimaxillary protrusion of the incisors appears to be a normal feature in Nigerians. There appears to be inhibition of maxillary growth in UCLP patients but not in UCLA cases.

Burn injuries in Lagos.

Eighty-nine cases of burns admitted to the Lagos University Teaching Hospital during an 8-year-period (1968-75) have been studied. The age incidence ranged from 1 day to 54 years. Fifty cases (56.2 per cent) occurred in children below the age of 15 years. Thirty-nine (43.8 per cent) were adults, aged 15 years and above. Sixty-three cases (70.8 per cent) were domestic accidents. There was a mortality rate of 13.5 per cent. There was severe morbidity in the surviving cases, the average admission period in 73 cases being 37 days and the average total healing time in 57 cases being 54 days. The most troublesome late complications were contractures, hypertrophic or keloid scars and failure of repigmentation. Gram-negative bacteria accounted for 64 per cent of the incidence of wound sepsis. Health education has an important role to play in the prevention of burn accidents both in the home and in industry. In particular, it is suggested that cooking above floor level and closer supervision of children should reduce the incidence of domestic burns in younger children, while stricter factory inspection, with rigorous enforcement of industrial safety laws, should reduce the incidence of industrial burn accidents in the working adult population.

Repigmentation after burn injury in the guinea-pig.

The normal process of repigmentation of small partial- and full-thickness burn wounds in the guinea-pig has been studied visually, and by light microscopy and transmission electron microscopy of biopsy material, at various stages of healing. Repigmentation proceeded apace with re-epithelialization and occurred progressively from the periphery to the centre of the wound or scar. There was an initial lag period of 1 to 2 weeks post burn during which the melanocytes and melanin content of the regenerated epithelium were below or around normal control levels. Thereafter, the melanocytes and melanin were above normal levels and correlated with hyperpigmentation of the scar epithelium. Electron microscopy at 6 and 7 weeks post burn also confirmed the increased melanogenic and cytochrine activity of the melanocytes during this phase of burn healing.

Mafenide acetate concentrations and bacteriostasis in experimental burn wounds treated with a three-layered laminated mafenide-saline dressing.

A laminated wound dressing was developed to deliver mafenide acetate to granulating wounds. This study, using mafenide acetate cream (11.2%) and isotope dilution of 14C-labeled mafenide, has established the peak concentration and decay time for mafenide in the saline layer over the wound. Pseudomonas inhibition under identical concentrations was studied. Peak concentrations of 1,200 mg per deciliter of saline were observed after 2 hours. These levels decayed to 400 mg after 10 hours. Remoistening the dressing was required to achieve the peak and duration just mentioned. Pseudomonas inhibition of 88% of discs was present at 1,200, 800, and 700 mg concentrations. This dropped to 44% at 550 mg and 0 at 400 mg. The effective anti-Pseudomonas period was, therefore, 6 hours.