Atlas Lâm Sàng Về Quản Lý Và Điều Trị Bỏng (Clinical Atlas of Burn Management)

Clinical Atlas of Burn Management
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Fig. 9.8: Scars in brown skin shows an erratic behavior. At
times even the deep burn scars shows hyperpigmentation in
some areas and hypopigmentation in others as seen in this
case
Figs 9.10A and B: (A) Postburn hypertrophic scar in
forearm. (B) Shaving of the hypertrophic tissue with Humby’s
knife till the nonfibrotic deep dermis is reached which has
the normal reticular framework
Figs 9.10C and D: (C) Thin split thickness graft applied
over the shaved area (D) One month postoperative picture
showing well-settled graft
Fig. 9.9: Hypertrophic scar following deep burns showing
hypopigmentation because of destruction of melanocytes in
the deeper layers of epidermis and dermis which are burnt
A
B
C
D

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Fig. 9.11A: Severe post acid burn deformity of face due to
wounds healing by lateral flexion contracture of neck which
is pulling the nose and upper lip and everting the lower lip.
There is loss of contents of right orbit and eyelids with the
conjunctiva pulled down almost to the middle of the cheek
and similarly the lower lip is pulled over the chin
Fig. 9.11B: The loss of neck extension and inability to open
the mouth makes normal intubation for release of contracture
impossible in this patient. The patient has to be intubated
using fiberoptic bronchoscope
Fig. 9.11C: Neck released under general anesthesia after
fiberoptic intubation. Note the amount of release achieved
regaining the cervicomental angle. Complete release of neck
contracture removes the extrinsic pull on all facial structures
including lips, chin and even lower lids

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Fig. 9.12A: Another patient with severe postburn
mentosternal contracture with completely everted lower lip
and microstomia. The scar over neck and chest is severly
hypertrophied and is also pulling the breasts together
Fig. 9.12B: Lateral view of the same patient showing the
loss of the cervicomental angle
Fig. 9.12C: Complete release achieved only with release of
the contracture without excision of the scar. The grafts are
well-settled
Fig. 9.12D: Profile of the same patient showing a very
good cervicomental angle

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Fig. 9.13A: Contracture of neck, both axilla and breasts in
continuity. Ideally neck and axilla cannot be released
simultaneously because postoperative maintenance of the
hyperabducted shoulder for axilla release and hyperextended
position for neck is difficult and will antagonize each other
Fig. 9.13B: Neck released and skin grafted
Fig. 9.13C: Release of left axilla at the same sitting by
using a flap of surrounding skin to cover the defect. Since
skin graft is not used to cover the defect in axilla, splintage
in abduction is not required
Fig. 9.13D: One month following release of neck showing
a satisfactory cervicomental angle in the same patient

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Fig. 9.14A: 6-year-old boy with severe contracture of
neck with ectropion of lower lip and microstomia
Fig. 9.14B: Lateral view of the same boy showing the lip
almost touching the chest
Fig. 9.14C: As soon as the contracture is released a large
defect is created extending from the manubrium sterni to
the lower lip. Such severe contractures if not released early
can affect the growth of mandible and lead to deformities of
the spine also
Fig. 9.14D: Split skin graft applied to raw area

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Fig. 9.14E: Timely release of the contracture has restored
the full movement of the neck and allowed bony growth to
occur normally as seen in this 1 year postoperative picture
Fig. 9.14F: Lateral view of the same patient—a good
contour of neck has been achieved
Fig. 9.15A: Postburn contracture neck with lots of
hypopigmentation in the scar over the chest and neck
Fig. 9.15B: Late postoperative picture of the same
patient with well-settled grafts and good lip seal

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Fig. 9.15C: Profile view of the same patient. All contractures
have to be released till the neutral line and the ends of the
incision line should be fish tailed to prevent recontracture of
straight line scar
Fig. 9.16A: Contracture of axilla with marking for Y-V
plasty technique of release of the contracture band
Fig. 9.16B: Six months following release showing full
range of movement achieved
Figs 9.17A and B: (A) Contracture of elbow, wrist and
hand in a 3-year-old. (B) one month following release of
both elbow and wrist in a single stage restoring full function
in hand and arm. Postoperative massage, splintage and
pressure garments are essential to prevent recontracture
A
B

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Fig. 9.18A: Axillary contracture involving both anterior and
posterior folds. Simple release and grafting would require
prolong postoperative splintage
Fig. 9.18B: Contracture released and parascapular
flap raised
Fig. 9.18C: Parascapular flap transposed into the defect
in axilla and donor area skin grafted
Fig. 9.18D: Two months postoperative picture with full
abduction possible. The advantage of inserting a flap into a
released axilla is that postoperative splintage can be avoided
especially in case of children in whom compliance is a problem

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Fig. 9.18E: Another view of the same patient
Fig. 9.19A: Dorsal contracture of hand following
spontaneous healing of deep burns on dorsum. There is
flexion at wrist joint, hyperextension at MCP joints with flexion
at PIP joints of all fingers. If such contractures are released
within 6 months then capsulotomy is not required and
therefore only skin graft suffices. But if not released early it
can lead to permanent joint changes and will require
capsulotomy and hence a flap cover
Fig. 9.19B: Lateral view of same hand
Fig. 9.19C: Volar aspect of the hand showing reversal of
metacarpal arch. If these deformities are not corrected timely
they get fixed and end in a nonfunctional hand

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Fig. 9.19D: Dorsal aspect of hand after release and skin
grafting for the dorsum and V-M plasty for all web spaces
Fig. 9.20A: Bilateral severe dorsal contracture of hands
with thumb embedded in the dorsum and fingers coming
almost to the wrist joint. These are very difficult contractures
to treat because the joint deformities get fixed
Fig. 9.20B: Attempt has been made to release one hand in
first stage with split thickness grafting of the dorsal defect.
However, capsulotomy and distant flap cover would be a
better option to get proper release
Fig. 9.20C: Groin flap cover given over the dorsum of
hand after capsulotomy of all MCP joints

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Fig. 9.21B: Release and split skin grafting done bringing
the nipple areola complex to its normal position and allowing
the breast tissue to develop
Fig. 9.22A: Another severe contracture of both breasts which
has been released and grafted. Note the amount of release
attained bringing both breasts to normal level.
Hypopigmented patch over the right breast at the site of
nipple areola has been excised and grafted also
Fig. 9.22B: One year later both breasts seen developing
with normal size and contours
Fig. 9.21A: Contracture of bright breast and groin pulling
the nipple areola complex down, almost till the umbilicus,
due to burns sustained in childhood. The severe contracture
prevents the development of the breast so it is important to
release it before puberty is attained

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Fig. 9.22C: Lateral view of the same patient showing
normal position of both breasts
Fig. 9.23A: Postburn linear contracture band extending from
shin to dorsum foot (Courtesy: Dr N Jithendran, Global
Hospital, Hyderabad, Andhra Pradesh, India)
Fig. 9.23B: Contracture band released by Z: plasty only
Fig. 9.24: 25-year-old boy with contracture elbow with
growth retardation of forearm and hand due to burns
sustained in childhood. The scarred skin with the severe
contracture prevented the growth of the forearm bones as
well as long bones of hand

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Fig. 9.25A: First web space contracture in both hands
Fig. 9.25B: Marking of Y: V release of the web space
Fig. 9.25C: Volar aspect showing the marking of
long limb of “Y”
Fig. 9.25D: Web contracture released and flap inset in the
deepest part of the newly created web. Split skin graft is
applied to the defect on either side of the flap

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Fig. 9.25E: Late postoperative picture showing a good
web space with full abduction possible
Fig. 9.26A: Postburn flexion contracture of all fingers
Fig. 9.26B: Release of contracture in all fingers by
multiple Z-plasties achieving complete release
Fig. 9.27A: Mild contracture band in first web space

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Fig. 9.27B: Release by multiple Z-plasties
Fig. 9.28A: Severe scarring on dorsal aspect of thumb
and skin over the first web with contracture of the same
Fig. 9.28B: Linear releasing incision given and first dorsal
metacarpal artery flap marked
Fig. 9.28C: The flap is easily transposed into the defect
with grafting of the donor area

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Fig. 9.29A: Neglected extensive burns in a child healed
spontaneously by arms adhering to chest leading to severe
contractures of bilateral axilla
Fig. 9.29B: One side released at a time. Note that the
release extends all the way down to the trunk laterally.
Because of normal skin present in the upper part of axilla a
flap could be raised from it and transposed into the released
axillary floor. Split skin graft applied to defects created on
either side of the flap on upper arm as well as the chest and
trunk
Fig. 9.30A: Flexion contracture extending from posterior
axillary fold, across elbow and extending to the wrist. Burns
were sustained in childhood and allowed to heal
spontaneously. The contractures restricted the movements
at all joints preventing the normal functions
Fig. 9.30B: Axilla, elbow and wrist released simultaneously
in one sitting. But because of the long duration of contracture,
the underlying musculotendinous units, ligaments and joint
capsule were also contracted, therefore a complete release
could not be achieved at elbow and wrist

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Fig. 9.30C: Skin graft applied to raw areas created at elbow
and wrist. Posterior axillary fold contracture could be released
by multiple Z-plasties. A good postoperative splintage and
physiotherapy can only help in further straightening of the
joints
Fig. 9.31A: Neglected burns to both lower legs and feet in
a 2-year-old child which were made to heal spontaneously
lead to dorsal foot contractures which will inhibit the growth
of the foot as the child grows and also causes difficulty in
walking and wearing shoes because of arch deformities
Fig. 9.31B: Marking for simple transverse releasing incision
at the point of maximum contracture. Though it seems that
on achieving full release a flap cover may be required, one
has to be prepared for a flap cover over dorsum of foot
Fig. 9.31C: Three weeks postoperative picture showing
completely released contracture. K-wire used for maintaining
the corrected metatarsophalangeal joint position for first toe

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Fig. 9.32A: Bilateral groin and perineal contractures
almost burying the penis under the contracting fold of skin
Fig. 9.32B: Release of groin as well as perineal contractures
leaving raw areas which can be grafted. Postoperative
splintage for minimum of 9 to 12 months will prevent
recontracture
Fig. 9.33A: Hypertrophic scar on forearm and dorsum hand
with extension contracture of hand in a child. The MCP
joints of all fingers are in hyperextension
Fig. 9.31D: On release of majority of these contractures it
is found that complete release can be achieved without
opening any joints or exposing tendons. Therefore, split skin
graft application usually suffices

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Fig. 9.33B: Early release of contracture has the advantage
that the deformity of the fingers does not become permanent,
the collateral ligaments are still lax so capsulotomy is not
required and hence instead of a flap cover simple grafting of
the dorsum and forearm gives a good result
Fig. 9.34A: Very severe perineal contracture
Fig. 9.34B: Bilateral tensor fascia lata flap dissected and
transposed into the defect created after release. The flaps
will prevent recontracture formation and will make
postoperative splintage unnecessary
Fig. 9.34C: Two months after release without using any
postoperative splintage

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Fig. 9.35A: Extension contracture of all toes making it
difficult for the patient to wear shoes. The scar is also
hypertrophic and hypopigmented over the dorsum of the
foot because of healing taking more than 3 weeks
Fig. 9.36A: Ectropion of all four lids (left more than right)
with opacification of cornea on left. There is hypopigmented
scarring over rest of the face and nose
Fig. 9.36B: Release of all four lids achieving full closure
of both eyes
Fig. 9.35B: Postoperative picture of same foot after excision
of hypertrophic scar, release of dorsal contracture and skin
grafting of defect

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Fig. 9.37B: Release of the contracture of the digits bringing
out the buried little finger and skin graft applied on the defect
created
Fig. 9.38A: Dorsal contracture of hand with fixed extension
deformity of the MCP joints. Capsulotomy of the MCP joints
is necessary to release the contracture completely
Fig. 9.38B: Free medial arm flap dissected for cover of
the defect on dorsum of hand
Fig. 9.37A: Postburn contracture of fingers. The little
finger is not visible and is apparently buried in the scar

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Fig. 9.38C: Flap placed over the defect created after release
of dorsal contracture and capsulotomy. Vessels of the flap
and dissected radial vessels are shown
Fig. 9.38D: Medial arm flap inset after anastamosis of the
vessels. A distraction apparatus used for maintaining and
increase the flexion at the MCP joints
Fig. 9.38E: Late postoperative picture of the same hand
Fig. 9.38F: The full functions of the hand are restored

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Fig. 9.38G: Patient is able to perform the different
functions postoperatively
Fig. 9.39A: Postburn extension contracture of hand with
hypopigmented scarring over forearm as well as dorsum of
hand
Fig. 9.39B: Distally-based radial forearm flap being raised
without the radial artery. It is based on the anastomosis
between the major vessels at the wrist. Scarring of the forearm
skin does not prevent us from lifting this fasciocutaneous
flap
Fig. 9.39C: Same flap transposed into the defect on dorsum
of hand after capsulotomy at MCP joints to achieve full
release

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219
Fig. 9.40A: Groin flap in situ over wrist after debridement
of dead tissue following electric burn which exposes the
tendons and neurovascular bundles
Fig. 9.40B: Late postoperative picture of the same patient.
Groin flap has been the workhorse flap for such defects
Fig. 9.40C: Nerve repair is still required in many of these
cases because of primary nerve damage due to passage of
electric current
Fig. 9.40D: Cable grafts used to bridge the long gap
between the damaged nerve ends

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Fig. 9.41B: Same patient after removal of expander and
advancing the expanded skin to cover the alopecic area as
well as the sideburns
Fig. 9.42A: Postburn scarring of almost half scalp and face.
Tissue expansion of normal scalp was the only way to restore
the hairy scalp
Fig. 9.42B: Fully expanded tissue expander in situ
Fig. 9.41A: Post acid burn scarring of scalp and face with
loss of ear and sideburns. Tissue expander placed in subgaleal
plane in the adjoining normal scalp and expanded
Tissue Expansion

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Fig. 9.42D: Hair restored in the scalp after removal of
expander and advancing expanded skin
Fig. 9.42C: Expanded scalp after removal of the expander
Fig. 9.43A: Postburn scarring of left side abdomen and
chest leading to left breast contracture with loss of nipple
areola complex. Two expanders in place–one on right side
of abdominal wall and another one in the back on the left
side
Fig. 9.43B: Immediate postoperative picture. Expanded skin
advanced laterally and a new umbilicus is created in the
process

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Fig. 9.44A: 6-year-old boy with postburn scarring and
alopecia scalp. Tissue expander in place
Fig. 9.44B: Anterior hairline restored after advancing
expanded skin with no residual deformity
Fig. 9.45A: Extensive postburn alopecia extending from
the forehead to the vertex posteriorly
Fig. 9.43C: Late postoperative picture showing some scar
remaining in the inframammary area. Since the scar was
very extensive it could not be removed in a single stage and
requires another stage of expansion after six months

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Fig. 9.45C: Large tissue expander in place under hair
bearing scalp
Figs 9.45D and E: Lateral view after removal of expander
and advancing the expanded hair bearing skin
Fig. 9.45B: Lateral view of the same patient
Fig. 9.45D
Fig. 9.45E

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Fig. 9.46C: Full expansion achieved in both expanders
Fig. 9.46D: Late postoperative picture with almost all the
scar excised and patient returned to his short hairstyle
Fig. 9.46A: Postburn hypopigmented scarring of right side
face and scalp with alopecia right scalp. The boy used to
keep his hair long in order to cover the bald area
Fig. 9.46B: Two tissue expanders used for correction, one
placed in adjacent normal scalp and another one in neck

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Fig. 9.47A: Well-settled mature scars on lower face which
are visible because of hyperpigmentation. Tissue expander
placed in the neck prior to removal of scar
Fig. 9.47B: Postoperative for the same patient
Fig. 9.47C: Lateral view showing complete removal of
scar and good cervicomental angle restored

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Fig. 9.48A: Old case of electric contact burn over anterior
abdominal wall for which excision of dead muscles followed
by mesh repair of the defect and skin grafting over the healthy
muscles was done. Ten years later the mesh got exposed at
two places. Two tissue expanders were placed on either side
of the grafted skin for coverage of the defect
Fig. 9.48B: Preoperative picture showing the expander
being removed
Fig. 9.48C: Immediate postoperative picture after removal
of exposed mesh and maximum scar possible and advancing
the expanded skin to cover the defect. The remaining scar
will require another sitting of expansion

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Fig. 9.49A: Subtotal loss of nose following deep burns with
extensive facial scarring, loss of right eye and artificial eye
in situ. The forehead skin cannot be used because it is severely
scarred
Fig. 9.49B: Arm tube is a good option in such cases
Fig. 9.49C: Arm tube inset on to nose. Though it appears
bulky initially but it requires serial thinning after complete
inset
Fig. 9.49D: Final photo after division and
inset of arm tube

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Fig. 9.51: Deep burns on sole of foot healed by dressings
and flexion contracture of big toe. The patient has difficulty
in walking and also in wearing any kind of footwear. It can
be corrected by release and grafting on plantar aspect of
foot
Fig. 9.52A: 15-year-old hypopigmented postburn scar
underwent repeated breakdown ultimately forming a non-
healing ulcer on the shin. Biopsy proved it to be a squamous
cell carcinoma—Marjolin’s ulcer
Fig. 9.50A: Another case of a 11-year-old boy who suffered
electric burns by high-tension wire falling on his face leading
to loss of right eye, loss of superior half of nose with exposed
nasal cavity and cataract formation in left eye
Fig. 9.50B: Since the forehead was normal in this patient,
forehead flap was the best option for reconstruction of upper
nasal defect

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Fig. 9.52B: Wide excision of the ulcer and split skin grafting
was done as there was no bony and periosteal involvement
Fig. 9.53A: Another case of Marjolin’s ulcer (Squamous
cell carcinoma): Biopsy proven, arising out of postburn scar
in popliteal fossa region
Fig. 9.53B: Defect following wide excision of the growth—
3 to 4 cm margin of normal skin should be excised to get a
good clearance
Fig. 9.53C: Excised specimen of the growth

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Fig. 9.53D: Undersurface of the excised specimen showing
that in depth the excision goes till one layer beyond the growth
Fig. 9.53E: Split skin grafting of the defect
Fig. 9.54: Large squamous cell carcinoma in old postburn
scar contracture extending from above the groin to lower
thigh. The patient died due to cachexia and other
complications before any surgical intervention could be done
Fig. 9.55A: Postburn scarring chest with loss of nipple
and areola left side

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Fig. 9.55E: Two weeks postoperative picture of
same patient
Fig. 9.55B: Marking for nipple reconstruction. The
shaded areas to be de-epithelialized
Fig. 9.55C: Alternate normal and de-epithelialized areas.
The de-epithelialized areas are closed with sutures after pulling
up the central island of skin and undermining the normal
skin wedges
Fig. 9.55D: Immediate postoperative picture showing newly
formed nipple and grafted areola. The graft for areola taken
from labia majora

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Fig. 9.56A: Postacid burns stenosed nostrils
Fig. 9.56B: Marking for starplasty to open both the nostrils
Fig. 9.56C: Immediate postoperative picture after
interposition of skin and mucosal flaps
Fig. 9.56D: Late postoperative picture
showing patent nostrils

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Figs 9.57A to C: Line diagrams showing the starplasty procedure step by step
(Procedure is an innovation from the author’s unit)
Fig. 9.57A
———: Incisions in skin;
----------: Incisions in mucosa
Fig. 9.57B
A′, B′, C′, D′: Mucosal flaps
Fig. 9.57C: A, B, C, D: Skin flaps

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Fig. 9.58B: Excision of the hypertrophic scarring done with
release of the ectropion lip along with opening of the stenosed
nostril by starplasty procedure
Fig. 9.59A: Postburn constricted ear deformity with a
preauricular band
Fig. 9.59B: Preauricular band released and defect
covered with superiorly based postauricular flap
Fig. 9.58A: Small child with severe postacid burn
scarring of face with ectropion of lip

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Fig. 9.61: A four postadjustable collar is a better alternative
to a soft cervical collar as it provides a rigid splintage to the
neck
Fig. 9.62: Tailor made pressure garments for the chest,
abdomen and neck as well as cervical collar help in early
maturation of hypertrophic scars from deep dermal burns
Fig. 9.63: Pressure garment for face
Fig. 9.60: It is essential to use a soft cervical collar after
release of neck contracture in order to prevent recontracture

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Fig. 9.65: Abduction splint for axilla following release of
contracture has to be used throughout the day for at least 6
months followed by night splintage for another 3 months to
prevent recontracture
Fig. 9.66: Shoulder exercises
Fig. 9.67: Equipment for physiotherapy of shoulder joint
and elbow
Fig. 9.64: Pressure garment and extension splint for forearm
and wrist for hypertrophic scarring on flexor aspect of both

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Fig. 9.68B: Tailor made pressure garments for both hands
can prevent these scars from hypertrophy which can otherwise
lead to deformities in the fingers because of contraction of
the scars
Fig. 9.68A: Deep dermal burns of hands healed in
15 days but showing intense hyperemia

Radiation Burns 10

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240
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Fig. 10.1A: Post MRM reconstructed breast received
radiation and developed acute radiation dermatitis (radiation
burns) in the 4th week. The cutaneous element of LD flap
was however, unaffected. (Courtesy: Dr Sandeep Mehta,
Rajiv Gandhi Cancer Institute & Research Centre, New Delhi,
India)
Fig. 10.1B: Same case as in Figure 10.1A, healing
commences spontaneously in the 5th week.
Fig. 10.1C: Progress in healing after radiation reactions
(radiation burns)
Fig. 10.1D: Complete re-epithelialization after radiation
induced desquamation at the end of the 5th week in the
case shown in Figure 10.1A

Radiation Burns
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241
241
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241
Fig. 10.2: Acute radiation ulcers. Case of cancer of buccal
mucosa—right. Cheek commando done and reconstructed
with PMMC + reconstruction plate. Patient developed
carcinoma lip which was treated with Brachytherapy showing
healed burns caused by brachycatheters. (Courtesy:
Dr Sandeep Mehta, Rajiv Gandhi Cancer Institute &
Research Centre, New Delhi, India)
Fig. 10.3A: Radiation ulcer due to spontaneous breakdown
of skin below axilla 5 years after receiving radiation following
Breast conservative surgery for carcinoma breast (Courtesy:
Dr Sandeep Mehta, Rajiv Gandhi Cancer Institute &
Research Centre, New Delhi, India)
Fig. 10.3B: Nonhealing radiation ulcer of same patient
treated by wide local excision and latissimus dorsi
myocutaneous flap cover
Fig. 10.4A: Postradiation dermatitis with gross edema during
treatment of squamous cell carcinoma of vulva. (Courtesy:
Dr Sandeep Mehta, Rajiv Gandhi Cancer Institute &
Research Centre, New Delhi, India)

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Fig. 10.4B: Same patient treated by radical vulvectomy
and rectus abdominis myocutaneous flap cover
Fig. 10.5A: Nonhealing radiation ulcer following
radiotherapy given postmastectomy right side to a 50-year-
old diabetic patient
Fig. 10.5B: Transverse rectus abdominis myocutaneous
(TRAM) flap raised following excision of the ulcer
Fig. 10.5C: TRAM flap inset into defect

Radiation Burns
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243
243
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243
Fig. 10.5D: Three months postoperative picture of
the same patient
Fig. 10.6A: Another patient developing radiation burns and
subsequent necrosis following radiotherapy postmastectomy
left side
Fig. 10.6B: Contralateral pectoralis major muscle flap used
to cover the wound but the muscle flap necrosed probably
due to the effect of the radiation
Fig. 10.6C: Nonhealing radiation ulcer following loss of
the pectoralis major flap

Clinical Atlas of Burn Management
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244
244
244
Fig. 10.6D: Opposite normal breast tissue mobilized to
cover the defect in the same patient subsequently
Fig. 10.6E: Opposite breast flap raised
Fig. 10.6F: Three months postoperative picture of the
same patient showing completely healed wound
Fig. 10.7: Acute radiation necrosis following postoperative
radiotherapy for squamous cell carcinoma scalp. (Courtesy:
Dr Sandeep Mehta, Rajiv Gandhi Cancer Institute &
Research Centre, New Delhi, India)

Index
245
245
245
245
245
A
Abnormal blood gas values 56
Accidental burn 4
Acid
burns of face and shoulder 84
trickle marks 176
Acinetobacter boumannii 163
Acute
radiation dermatitis 240
radiation
necrosis 244
ulcers 241
renal failure 124
Adult sustaining flame burns 3
Aminoglycoside 106
Arterioles 37
B
Blast injury 5
Bone matrix 131
Bundles of fibrocollagen in
dermis 40
Burn
depth 13
wound infection 102
C
Calcaneovalgus deformity of foot 196
Candida albicans 122
Capsulotomy 237
Carbapenems 106
Carcinoma breast 241
Carotid vessels 141
Cellulitis 126
Chemical burns 9
Chondral abscess 181
Chondritis 184
Circumferential full thickness
burns 60
Classification of burns 14
Cobblestone appearance 11
Compartment syndrome 11
Contact
electrical burns 63
injury 141
Index
Contralateral pectoralis 243
Cracker burn 43
Cutaneous radiation syndrome 12
D
Dead muscles 142
Deep
burns of face 10
chemical burns of face 20
dermal burns 11, 13, 25, 78, 80
in lower leg 26
of lower limb 91
on dorsum of hand 27
frictional burns 189
hydrochloric acid burns 174
partial thickness burns 20
sulphuric acid burn 170
Definition of burns 2
Disseminated intravascular
coagulation 104
Distension abdomen 106
E
Ecthyma gangrenosum 106, 107
Ectropion 171, 188
Electric
burns 6
contact burn 11, 51, 134, 164
flash burn 11
injury in lower leg 27
transformer 11
Epidermal
burn on thigh 21
growth factor 76
hyperplasia 40
Epithelial buds 25
Erythema 12
Escharotomy incisions 60
Extensive accidental burns 19
F
Fasciotomy 11
Fasciotomy incision 134
Femoral vein 126
First degree burn 21
on lower leg 21
Fixed erythema 12
Forearm muscles 132
Friction burns 15
Front of trunk 45
Full thickness
burns 20, 29
scalds 60
G
Gastrocnemius muscle 156
Gracilis myocutaneous flap 150
Granulation tissue 91
H
Head and neck 45
Healing burn wound 35
Hemorrhaghic bullae 110
Homicidal
acid burns of face 166
burns 19
deep acid burns 16
Humby’s knife 197
Hypertrophic scar 15, 40
Hypoalbuminemia 90
Hypoproteinemia 91
I
Incisions in
mucosa 233
skin 233
Inhalation injury 53
K
Keloid 184
kerosene pump stove 16
Klebsiella 111
KOH staining 118
L
Large squamous cell carcinoma 236
Laryngopharyngeal edema 171
Laser burns in axilla 15