Biomedical subjects
Publications and source records attributed to C Balakrishnan.
Alopecia of the unburned scalp, the temporary or permanent loss of hair, is a preventable complication. Patients at highest risk of developing alopecia are those with burn encephalopathy and in a prolonged shock state. The occipital scalp is the most common site and localized pressure-induced ischaemia is the likely cause. Frequent head repositioning and use of devices to decrease the pressure effect may decrease the incidence of this complication.
Injury to the respiratory tract from inhalation of steam, although rare, often leads to acute pulmonary insufficiency. The injury to the alveolar epithelium results in increased pulmonary capillary permeability, pulmonary oedema and interfering abnormalities in gas exchange. Vigorous treatment should be instituted in these patients to obtain optimal outcome.
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Burns affecting the foot in a neuropathic patient may be associated with significant functional impairment and prolonged recovery time. Although they occur easily, these injuries are rare. We report two patients with deep burns of the foot following the use of therapeutic footbaths for pressure ulcers in neuropathic patients.
Male spouse abuse seems to be on the increase. Recognition of these injuries is often difficult as patients are reluctant to disclose the aetiology and press charges against the assailant. We identified a similar group of male patients who sustained burns to their external genitalia secondary to spouse abuse.
In most patients with lymphoedema, neither a medical nor a surgical approach can provide a cure. Due to the progressive nature of the disease, it is imperative that every attempt should be made at controlling oedema and preventing infection. As burn injury to the lymphoedematous extremity is associated with significant morbidity, we report a patient with deep burns affecting a lymphoedematous extremity.
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During the 4-year period 1980-1983, we carried out 338 operations for Dupuytren's disease of the hand. Of these 46 (13.6%) had a dermofasciectomy and skin graft for recurrent disease. In this sub-group, 34 patients (10.1%) were operated on by the same senior surgeon (H.G.B.). Only these cases were included in this study. Average follow-up was 100 months (range 80-120 months). It was found that graft durability was good, there was no clinical evidence of recurrence beneath grafts, contracture did not exceed 15 degrees at any joint and two point discrimination in the graft was equal to, or better than, 12 mm in the palm and 8 mm in the digit.
Burns involving skin and subcutaneous tissue are rarely associated with lymphoedema of the extremity due to the intact deep lymphatic system. We report an example of lymphoedema of the lower extremity in a burn patient 6 months after skin grafting.
Neoplastic lesions arising in recent burn scars are apparently quite rare and we could find no report of such an occurrence in the literature. Nevertheless we recently treated a patient with a metastatic adenocarcinoma from the lung in a 3-month-old burn scar.
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