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Background: Treatment of perineal burns is complicated by the local bacterial environment and irregular contour anatomically. Purpose: The aim of this study is to know management and adequate treatment for the reduction of complications of perineal burns. Method: Thirty-three patients were included in this retrospective study who were treated by surgical treatment of perineal burns at the department of surgery, Hangang Sacred Heart Hospital, Hallym University during 3 years from 1993 to 1995. Result: Age distribution showed that highest incidence of age groups was between one and five years old(10 cases : 30.3%). The most frequent cause of perineal burn was scalding burn(20 cases : 60.6%) and most patients(21 cases: 63.6%) were lesser affected than 20% extent of burn. Depth of burn was mostly between superficial second degree and deep second degree in 11 cases(33.3%) and above third degree in 11 cases(33.3%). Most frequent accompanied burn area was genitalia(17 cases : 51.2%) followed by buttock(13 cases : 39.4%), back(8 cases : 24.2%) and only perianal area was 3 cases(9.1%). Treatment was done that only topical chemotherapy was performed in 15 cases(45.4%), split thickness skin graft in 15 cases(45.4%), full thickness skin graft in 1 case(3.0%), local flap in 2 cases(6.1%). Duration from operation to diet was that 4-5 days in 7 cases(38.9%), 1-3 days in 6 cases(33.3%). The most frequent duration of hospital stay was between 36 and 42 days(14 cases: 42.4%), followed by above 43 days(12 cases 36.4%). Diverting sigmoid colostomy in two cases were performed. Associated diseases were senile dementia(3 cases ' 9.1%), paraplegia(2 cases : 6.1%), seizure(1 case : 3.0%), mental retardation(1 case : 3. 0%), and others. Postburn complications were hypertrophic scar(6 cases : 18.2%), joint contracture(4 cases : 12.1%), urinary tract infection(3 cases : 9.1%), testicular loss(2 cases : 6.1%), anal stenosis(2 cases 6.1%), urethral stricture(2 cases : 6.1%), irritation dermatitis(2 cases : 6.1%), pyoderma(2 cases : 6.1%), impertigo(1 case : 3. 0%). Conclusion: Most of perineal burns are occurred in children or physically hadicapped persons. Therefore, patients with perineal burn wound present a complex array of clinical problem. All peirineal burn wounds should be carefully managed and an aggressive surgical approach is mandatory occasionally.
Background: Despite recent advances in intensive burn care, the mortality and morbidity of septicemia in burn patients are still high. To reduce the mortality due to burn sepsis, more efficient and effective systemic approach is required. Purpose: The object of this study is to assess the mortality and morbidity of septicemia according to various factors and to identify the causative microorganisms of septicemia. Method: We evaluated 113 septicemia cases among 2190 burned patients admitted to the Burn Unit in Hangang Sacred Heart Hospital from 1996 to 1997 retrospectively and used x2-test for statistical significance. Result: The overall incidence of septicemia was 5.2%(113/2,190) with the highest rate of 40.8%(20/49) in 70-79% total burn surface area(TBSA). The mortality of the septicemia patients was 47.8%(54/113) with the highest rate of 83.3%(15/18) in 90-100% TBSA. The most frequent agent causing septicemia was Staphylococcus aureus in 37.0%(57 cases), followed by Candida spp. 19.5%(30 cases), Pseudomonas spp. 16.2%(25 cases), Acinetobacter spp. 13.0%(20 cases), Enterococcus spp. 11.7% (18 cases), etc. The mortality rate was 45.0%(9/20) in Acinetobacter septicemia, while 38.6%(22/57) in Staphylococcus septicemia. The causative microorganisms frequently identified were Pseudomonas spp.(84 cases) and Acinetobacter spp.(58 cases), Staphylococcus aureus(39 cases) and Pseudomonas spp.(25 cases), and Staphylococcus aureus(27 cases) and Acinetobacter spp.(26 cases) from wound swab, catheter tip, and sputum cultures respectively. Candida septicemia(30 cases) were mostly identified from catheter tip culture(21 cases). Conclusion: Well equipped burn intensive care unit and the full-time commitment of individuals skilled in all facts of bum therapy are required to reduce the incidence of septicemia and death.