Plastic Surgery/Burn

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Question
Burn
Burn  
Dr

Two days ago my 8 month old son accidentally spilled hot water on his thigh. I put him under cold water immediately and rushed him over to the hospital (I live 5 min away). He is being treated with Silver sulfadiazine and we are attending hospital everyday to have his dressing changed. Although he is in some discomfort when dressings are changed, he is perfectly fine and happy otherwise.

I am attaching a photo of the burn yesterday and today - I would be grateful if you could let me know if you think it is healing well, approximately how long you think it will take to heal and whether it is likely to scar. Nurses have been very vague when I have (repeatedly) asked. I have also increased the amount of protein and vitamin A&E in my son's diet and have continued breastfeeding (which i was weaning him off).

Sorry for the ramble but I am beside myself with worry!!!! Thanks

Answer
These are second degree burns, should heal in 2 weeks. Silver sulfadiazine covered by non-adherent tulle [like a net] of Jelonet or similar products is the usual treatment. The main problem will be retaining the dressing on a baby's thigh; it usually slips and the upper margin of the slipped dressing will rub on the raw area causing pain and making that area deeper.
I usually recommend dressing change once in 2-3 days as frequent disturbance of wound is not desirable. The challenge therefore is retention of dressing. I recommend reinforcing the top part with hypoallergenic some adhesive tapes such as Durapore or Mefix. This will prevent slipping. It is also important to overlap the jelonets so that no part of burn touches the bandage directly. If available, larger sizes of Jelonet are preferred for this reason [40x10 cm].
I do not recommend any chemicals or antiseptics for cleaning, only normal saline. It is not necessary to remove the blister membrane. It is usual for babies to cry during dressing and then be peaceful later. He is not suffering much pain however.
If persistently cranky, it may be because the dressing has slipped.
keep it away from urine soakage. Have one emergency set of dressings and silver sulfadiazine cream at home to deal with such emergencies so that you can do the dressing change yourself; i am sure you have learnt enough by now.
After healing, i recommend using a silicon patch to reduce scarring. He is likely to experience itching, ask for a prescription anti-histaminic, trim his nails while asleep.
Antibiotics are not needed and no special nutritional supplements other than breast and top ups are needed.

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Mohan Rangaswamy

Expertise

I am a certified plastic surgeon with special interest on aesthetic surgery, practising in Dubai, U.A.E. dealing with patients form diverse nationalities. You can address questions to me on body and facial aesthetic surgery (liposuction, breast surgery, nose corrections, eyelid surgery, fat injections, botox and fillers) as well as reconstructive surgery. I also have experise in the area of peripheral nerve surgery such as carpal tunnel syndrome and other nerve entrapments. I would especially welcome queries from net-surfers from this part of the world.

Experience

I have 17 years experience in reconstructive plastic surgery and over 12 years in aesthetic surgery. After qualifying as a general surgeon, I was fortunate to work in a unit that did complex reconstructive surgery and general surgery as well. This spurred my interest in plastic surgery as a career as the possibilities seemed to be amazing and limitless. This was the era when microsurgery and flaps captured our imagination. I further acquired formal training in Plastic surgery, burns, maxillofacial and hand surgery. this was followed by a training apprenticeship in aesthetic surgery. In my practice as a plastic surgeon, I do more aesthetic work now and am keen on developing minimal invasive surgery. I am a member of the Association of Plastic Surgeons of India, International Society of Aesthetic Plastic Surgeons, Royal college of Physicians and Surgeons, Glasgow, U.K.

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Professional: Plastic and Reconstructive surgery journal, Acta Tropica, European journal of OB & Gyn etc.

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