A comparitive study between placental extract versus silver sulfadiazine in 20-40 % fresh flame burns and scalds

INTRODUCTION: Around the world burns are a major cause of health problems as the problem lies not only with the immediate cause but as the patient survives he has to carry the physical and psychological morbidity associated with it. 95% of deaths due to burns have been reported in middle and low socioeconomic countries. Ever since man had found out about fire, burn injuries have existed the earliest documentary evidence seen in the Ebers Papyrus. Since then various people have proposed several different methods to treat burn injuries. Susrutha of India during ancient times had classified and described Burns into four categories .He also used honey as antiseptic to treat burn wounds. Dupuytren, the famous French surgeon wrote at the beginning of the 19th century that “burns had been the object of one of the most bizarre treatment methods”. The Egyptian’s treated burns by incantations and a mixture of gum, goat’s hair and milk from women who had given birth to child. Chinese and Japanese used extract of tea leaves. Hippocrates suggested the use of warm vinegar and solution of oak bark. Celsus described use of honey and Galen prescribed vinegar. Rhazes used ice cold water. Humans have always depended on fire either to prepare food or for warmth, but fire being a double edged sword is associated with injuries which have been one of the earthly evils. So it is this fire which is both blessing and scourge to mankind. Burns are tissue injuries resulting from direct contact with flames, hot liquids, chemicals, and electricity or radiation .Most commonly skin is injured. Skin loses its function as a barrier to injury and infection and as a regulator of temperature, fluid loss and sensation. Pathologically burn injury causes coagulative necrosis to tissues. Rarely, burn injures the deeper tissues and vascular structures. Heat is transferred to the tissues by conduction from contact with hot liquids and solids and convection of hot gases over the skin. (Flame, radiation) or from a sudden release of great energy as in electric arc or explosion. Burn injury carried a poor prognosis in the past. With the understanding of the patho physiology and advances in fluid resuscitation and early excision of the burns wound, survival of the patient improved in recent times. AIM OF THE STUDY: The aim of the study is to analyse and compare placental extract and silver sulfadiazine application in 20-40% fresh flame burns and scalds to compare the efficacy of both the drugs in 1. Wound healing. 2. Wound infection 3. Contracture 4. Hypertrophic scar 5. Better patient compliance 6. Cost effectiveness. MATERIALS AND METHODS: Study Population: The patient attending the emergency services and subsequent admission as in-patient (Age range of 13-70) with 20-40% fresh flame burns and scalds in CMCH. Study Period: September 2011 to November 2012. Study Design: Randomised control prospective study. • Soon after the patients are admitted in the ward, detailed history taking will be followed in all the cases. • Patients with disease which delays wound healing like diabetes melitus, tuberculosis, anaemia, organ failure, immuno compromised status, and previous drug intake etc will be noted. • Thorough clinical examination of the patients will be made and percentage of body surface area involved will be recorded according to the rule of 9. patients admitted with 20 – 40 % burns are randomised into two groups. • Both the groups were carefully selected to match as closely as possible for age, sex and burns surface area. CONCLUSION: In this study of 94 patients with the following conclusions have been arrived: Incidence is higher among females than males. The Peak incidence occurs in the age group of less than 40 years. Pseudomonas aeruginosa and staphylococcus were the most commonly incriminated organisms in burn wound infection. Placental extract has better patient compliance. Placental extract is cheaper and cost effective. Placental extract is effective in burns wound healing. Both silver sulfadiazine and placental extract are not effective against development of hypertrophic scar and contracture. Further studies may be required to know about the effect on preventing late complications in burns using placental extract