Abdomen
Burns of the abdomen are common but are not likely to cause contractures unless they extend to the groin area (see chapter lower extremity). However, larger areas need to be grafted as shown in this example. For patients that are living remotely, like this example in Tanzania, it can be difficult to get the surgical care needed but the grandmother of this child succeeded.
Medical history
This example shows the case of a 5-year-old female patient from Tanzania. Her clothes started to burn when she was playing too close to the fire. The grandmother took the child directly to a nearby clinic by motorcycle. The clinic referred to a district hospital; however as they had no tools to perform skin grafting, she was transferred to the regional hospital, Haydom Lutheran Hospital.
Physical examination
Upon admission, an estimated 8% full thickness burn was observed on the abdomen and chest, with no signs of dehydration or poor feeding status.
Conservative management
The patient's burn wounds were initially treated with silver sulphadiazine cream and daily soaking. Due to a lack of blood donors and financial constraints, an early excision and grafting strategy were not possible. After three weeks of soaking, a clean wound was achieved.
Surgery
Under general anesthesia, the contaminated granulation tissue was scraped off the surface of the wound, and a split skin graft was taken from the upper legs. The skin was meshed with a scalpel and then sutured in place on the burn wound. To protect the wound, Vaseline gauzes with tetracycline were applied.
Postoperative care
After the skin graft, both the donor and acceptor sites were treated with a combination of tetracycline ointment and Vaseline gauzes. These were then covered with dry gauzes and secured with a circular bandage. The wound was inspected after 4 days. It is important to avoid covering the wound in too many bandages, which could lead to a greater chance of infection. The patient and their parents were advised that friction is a major cause of losing the skin graft. After four weeks, the patient was discharged with 100% take of the graft.
Outcome
In this case the take of the graft was 100 percent. However, keep in mind that friction and infection are major causes of failure. (Photo 6)
Lessons learned
In Haydom, Tanzania, the medical team uses a combination of Vaseline gauzes and tetracycline to protect skin grafts. While infection is not a frequent occurrence, it can happen. To detect early signs of infection, the team uses a technique called the "sniff test." If a bad smell is detected, the bandage is removed. If no smell is present, the dressing is left in place for an additional five or six days. Care must be taken when removing the dressing, as it should be soaked in clean water to prevent damage to the skin graft.
