Annals of the MBC - vol. 5 - n' 1 - March 1992


Tryfonas G., Gavopoulos S., Limas C., Z¡outis l., Violaki A., Klokkaris A., Fragos E., Grigoriadis G.

Hippokration General Hospital, Pediatric Surgical Clinic, Thessaloniki, Greece

SUMMARY. During the period from 1981-1990, 281 patients were hospitalized in our clinic, 174 males and 107 females. The age ranged from 2 days to 14 years. In 72% of cases the bums were of second degree and in 28% they were of third degree. The patients were divided into two groups, according to age and burned area. The method of choice was the undressed one. Autografts were used in 76 cases. Homografts, after histocompatibility determination, were used in 4 cases because of the extensive burned area (60-75%). There were 3 deaths and the mean in-patient time was 28 days.

Thermal trauma is second only to car accidents as a cause of death during childhood (1) and it is a very common manifestation in child abuse (2). The majority of cases occur indoors and the main causes in children under the third year of age are hot liquids, especially water, and contact with electrical appliances; in older children flames are the main cause. Since children do not tolerate thermal injury as well as adults, we have to pay special attention to management in order to prevent mortality and to achieve a good functional and cosmetic result.

Material and method
During the last decade 1725 burned children were examined in the emergency department of our clinic and 281 of them were admitted. We used as guides the burned area, the depth (although difficult in assessment at an early stage), the place of burn and, of course, the age.
The classification of burns is shown in Table 1.
Patients with moderate or critical burns and those aged less than two years old were admitted. There were 174 boys and 107 girls and the age ranged from two days to 14 years.


Second degree Third degree


10% 2%


10-20% 2-5%

* Critical

20% 5%

Table I Classification of burns

Burns involving hands, face or feet were classified as critical (Munster A.M., 1980).
The majority of them were less than 6 years old (219), with a peak in the second year of life. The burned area was less than 20% in most of them. The depth was assessed as second-degree in 201 patients and third-degree in the rest.
The first aim of treatment was resuscitation with intravenous fluid administration. Brooke's formula was employed, but it was modified under specific circumstances. The undressed method was the method of choice except when joints and hands were involved, and all patients were nursed in a special ward under invariable conditions of temperature and humidity.
A daily programme was followed with cleansing and the spraying of povidone iodine in droplets. This way of treatment was continued until the burn healed spontaneously or was prepared for grafting by the third week.
In 201 patients who were conservatively treated the burned area ranged from 5% to 30% and the mean in-patient time was I I days. Grafting was needed in 77 patients, as a result of the initial depth or secondary to infections. The burned area mostly ranged between 5 and 35%, although in four cases the burned area covered 60 to 75% (Fig. 1). The mean hospitalization time was 42 days. Autografts were used in all but four patients. In these patients homografts were needed as a result of the extensive burned area and the mother was the donor, after histocompatibility determination.

Five children presented rejections of the grafts due to infections or inappropriate technique. Infections were also the main causes for partial rejections that did not necessitate any further treatment. Hypertrophic scars in 12 patients and dysfunction in 18 were the main problems we faced.

Fig. I Ten-year-old boy after conflagration with spirit. The burned area was estimated at 65%. Fig. I Ten-year-old boy after conflagration with spirit. The burned area was estimated at 65%.

All patients with functional problems were treated surgically. The patients with hypertrophic scars were initially treated conservatively by applying cortisone cream and compressive dressing. This treatment was successful in all but five children, who eventually underwent surgical excision and grafting. Three children with extensive deep bums died, as a result of resuscitation failure in two cases and sepsis in one.

The proper treatment of burns has been the subject of debate and intense research for several years, and the safest and most acceptable method is still controversial. Leaving the burns uncovered is a well-established treatment in many centres. We employ this method, except when a joint or hand is burned, in which case we cover the burned area and change the dressing every three days. The daily programme with cleansing is used in all patients but if the burned area is extensive the patient has a daily bath in a special apparatus. Homografts, which were received from a related donor, such as the mother, after histocompatibility determination, and autografts were used as mesh grafts (Fig. 2, 3). We think that there are two main advantages in employing mesh grafts. It is easier to cover an extensive burned area with a small graft and drainage is easier. Many other methods have been suggested, such as allografts (4), xenografts (5), early excision (6), and the abrasion method (7), in the attempt to achieve the most successful treatment. Good results have been referred by the researchers of these methods. Our experience is somewhat limited because we did not early excision and grafting in the near future aims at employ these methods, as our results were satisfactory reduction of hospitalization stay, as mortality is using the undressed one. Our intention to employ insignificant in our series.

Fig. 2, 3 Covering with mesh graft in a five-year-old girl burned with hot water. Fig. 2, 3 Covering with mesh graft in a five-year-old girl burned with hot water.
Fig. 2, 3 Covering with mesh graft in a five-year-old girl burned with hot water.


RESUME Pendant la période 1981-1990, 281 patients ont été hospitalis&s dans notre service, 174 rn~les et 107 fernelles. Udge variait entre 2 jours et 14 ans. Dans 72% des cas les brélures étaient de deuxi&me degré et dans 28% elles étaient de troisi&me degré. Lcs patients ont ét& divis&s en deux groupes, selon Pdge et la surface brfilée. La méthode de premier choix &tait la m&thode sans pansement. L'autogreffe a ét& utilisée dans 76 cas et I'homogreffe, apr&s la détermination de I'histocompatibilité, dans 4 cas, a cause de la surface brélée &tendue (é0-75%). On a eu 3 déc~s et le temps moyen d'hospitalisation a ét& 28 jours.


  1. Meagher D.P. jr.: Burns, in Swenson's "Pediatric Surgery", 5tb ed., Appleton and Lange, Norwalk, Connecticut, 1990.
  2. Caniano D.A., Beaver B.L.: Child abuse. Ann. Surg., 203: 219-224, 1986.
  3. Munster A.M.: The early management of thermal bums. Surgery, 87: 29-40, 1980.
  4. Leicht P., Muchardt 0.: Allografts vs. exposure in the treatment of scalds - a prospective randomized controlled clinical study. Burns, 15: 1-3, 1989.
  5. 0' Neil J.A. jr.: Comparison of xenograft and prosthesis for bum wound care. J. Pediatr. Surg., 8: 705-709, 1973.
  6. Pietsch J.N., Netscher D.T.: Early excision of major bums in children: effect on morbidity and mortality. J. Pediatr. Surg., 20: 754-757, 1985.
  7. Conzales R.V., Heiss W.H.: Twelve years' experience with the abrasion method for the management of bum wounds in children. J, Pediatr. Surg., 21: 200-201, 1986.


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