Clinico-Pathological Correlation and Assessment of Burn Wounds

INTRODUCTION: Trauma can be defined as bodily injury severe enough to pose a threat to life, limbs, and tissues and organs, which requires the immediate intervention of specialized teams to provide adequate outcomes. Burn wound biopsies classified as to the depth of infections,confirm the frequent occurrence of bacterial, fungal and viral infection in burn wounds and also provide document for the importance of increasing severity of infection on successive biopsies. Burn wound biopsy can distinguish microbial colonization from invasive infection which can guide patient’s treatment. AIMS AND OBJECTIVES: 1. The study is designed to analyse the clinicopathological profile of burn patients with wound sepsis. 2. To carry out histo pathological assessment of burn wounds and burn wound infections. 3. To correlate histo pathological findings with the clinical findings. MATERIALS AND METHODS: The present study was conducted in Thanjavur Medical College, Tamil Nadu. 132 patients with varying extent of burns, starting from 30% of Total Body Surface Area (TBSA), were studied prospectively over a period of two years from September 2012 to September 2014. All the relevant demographic, clinical and laboratory data required were obtained from clinical records. Serial wound evaluation along with general condition of the patient, serial wound swabs for culture and sensitivity and biopsies were taken. OBSERVATIONS AND RESULTS: The maximum number of patients comprised of age group 21-30 years (37.88%). The commonest cause of burn was flame burn (93.93%) followed by scald (2.27%), chemical burn (2.27%) and electrical burn (1.51%) respectively. Maximum cases had burns in the range of 30-40% TBSA (24.24%). This was followed by burns in the range of 41-50% (15.15%), 51-60% (12.88%), 71-80% (12.88%), 61-70% (12.12%), 81-90% (11.36%), 91-100% (11.36%) TBSA respectively. Patients having burn more than 60% TBSA had 100% mortality when followed up. The evaluation of degree (depth) of burn was found to be more accurate by histological assessment than by clinical assessment. It was seen that maximum number of cases had deep burns followed by mixed or indeterminate type of involvement. Presence of bacterial growth on the surface as well as in the eschar and sub-eschar tissue was seen in most biopsies. This represented ‘colonization’ and not true ‘invasion’ which was seen as presence of bacteria in the adjoining viable tissue. The microbiological studies revealed that Pseudomonas is predominant organism isolated from burn wound followed by Klebsiella, Proteus, Staphylococcus and Escherichia coli in decreasing order. There was a good correlation between surface swab culture reports and tissue biopsy culture reports as far as the type of organism isolated from the burn wound is concerned. However the surface swab culture reports showed growth in almost all cases, which was probably due to surface contamination. Whereas tissue biopsy culture reports showed positive findings (82.5%) mostly in cases with suspicion of infection. This finding suggested that tissue biopsy culture is a more reliableindicator of wound infection than surface swab culture where chances of contamination are more. The calculation of bacterial load per gram of tissue, done in 45 cases, showed positive results (count>105 ) in 35 cases and all the 35 cases went into septicemia. CONCLUSION: Thus we concluded that, biopsy of the burn wound plays an important role in proper assessment of burn wound and in making accurate diagnosis. It not only helps in identifying the healing potential of a burn wound but also helps in detecting burn wound infection/sepsis, if aided by proper microbiological assessment