BURNS AND PLASTIC SURGERY UNIT

Description

Burns and Plastic Surgery Unit is among the speciality departments established in Kiruddu Referral Hospital. The Unit is located on the fourth floor of the main Hospital building.It comprises two modalities; Burns and Plastic surgery with a total In-patient bed capacity of 60 for patients’ admission.

The unit is open 24 hours daily with a professional and dedicated team of staff that consists of Senior Consultant Plastic Surgeons, Medical Officers Special Grade, Medical Officers, Clinical Officers, Nurses, Anaesthiologists and Anaesthetists, physiotherapists, occupational therapists and nutritionists. We care for over 60 patients with burn injuries monthly with an average hospital stay of 45 days depending on extent of burn injury and other factors affecting wound healing.

MAJOR CAUSES OF BURNS IN UGANDA;

According to burn injury cases received in the Burns unit at Kiruddu Referral Hospital, over 55% of extensive burn wounds are due to flames mostly started from open burning flames from candles and locally made winked-lamps (Tadooba). These flames often ignite mosquito nets and mattresses. About 40% of the burn cases are scalds from hot liquids mostly hot water, bean soup, and hot cooking oil. The rest 5% are almost evenly distributed with chemical burns taking slightly a higher incidence to electric and/or arch burns, and contact burns usually occur due to a predisposing comorbidity such as a seizure disorder or alcohol intoxication. Radiation burns are very rare.

PREDISPOSING FACTORS TO BURN INJURY

1. Low socio-economic status makes it hard for families to afford better and safe lighting and cooking equipment.
2. Almost all chemical burns are criminal cases especially due to marital infidelities and land wrangles.
3. Over crowdedness in a small home. Most flame burns occur among big families renting single or double rooms.
4. Comorbidities such as seizure disorders, alcohol intoxication
5. Suicidal attempts with or without mental illness.
6. Life style for example alcoholism, smoking.
7. Mob injustice. The public takes matters in their own hands to punish criminals or suspects by pouring fuel on them and setting them on fire

CRITERIA OF ADMISSION

Patients are assessed from our emergency room to determine whether they need admission or not. We admit burns patient either in Burns (Holland) ward or Intensive Care Unit (ICU) depending on severity and/or extent of burn injury. We consider the percentage of Total Burnt Surface Area (TBSA), depth of burns sustained, presence or possibility of inhalation injury, and burns to some critical areas of the body like face. The following burn injuries meet the criteria for admission to Burns (Holland) ward.

• ? 10% TBSA in children
• ? 15% TBSA in adults
• Third and fourth degree burns
• Burns to the face, hands, joints, feet, perineum.

The following burn injuries are admitted in ICU.

• ? 20% TBSA in children
• ? 25% TBSA in adults
• Inhalation injury

MANAGEMENT OF BURNS AT OUR CENTRE

We have an emergency team available throughout the day and night that receives all burn patients.

Our patients are not received and assessed from Assessment and Emergency centre on Ground floor, however, they are sent directly to us on Level 4 in the Burns Unit.

We receive all burns as emergencies until deemed out of danger.

Immediate management

On arrival to our unit; We assess for ABCDEFGH. We ensure an open airway and cervical spine stabilization

1. Adequate Breathing and chest wall movement
2. Circulation and haemostasis
3. Disposal and disability limitation
4. Exposure and environmental control
5. Fluids and feeding
6. General body examination as for any other patient
7. Home or hospital.

We resuscitate our burns patients with intravenous fluids preferably Ringers Lactate. We calculate the fluid required for resuscitation in first 24 hours of burn injury using Parkland method and run half of it in the first 8 hours then  the remaining half is given in the next 16 hours. We also supplement it with the daily body fluid requirement or maintenance fluid.

Manage pain with analgesics.

1. We then dress the burns with Silver Sulphadiazine cream. Our dressings are sterile procedures and dressing is done in layers from moist on the burn wound to dry outwards. We routinely start with a layer of moist Silver Sulphadiazine impregnated sterile gauze, followed by another layer of dry sterile gauze and lastly with a layer of pads (cotton wrapped in gauze) then secured with crepe bandaging.
2. Pass a urethral catheter to monitor fluid balance and regulate fluid intake.
3. Pass NGT tube to aid in feeding.
4. Start on prophylactic antacids to prevent development of Curling’s ulcers.
5. Start on a prophylactic course of antibiotic.
6. Do a complete laboratory work up.

SURGEONS

1. Dr. Kalanzi Edris Wamala
2. Dr. Alenyo Rose

ACHIEVEMENTS IN 2019-2020 

1. Our fellowship program has expanded to attracting people from East and Central Africa including countries like Zimbabwe, Tanzania, DR Congo, Ethiopia, Rwanda. 
2. We currently have 5 Fellows specializing in Plastic Surgery. 
3. Two successful surgical camps were conducted in November and December 
4. We acquired new surgical instruments and equipment like an Electric dermatome, and a patient monitoring equipment. 
5. Extension of wall oxygen and suction devices in all the wards 
6. Part of the waiting area was partitioned into an In-patient dressing room, nurses’ changing room and an Out-patient clinic. 
7. Electric Dermatome (left) and a Battery Dermatome (Right) used to harvest split thickness skin to cover granulated wounds.