Case of the Week: 6th August

August 6, 2018

This is unfortunately another distressing case with some images that people may find upsetting...

 

This is about Ismail, a 4 year old boy. He was playing in the kitchen when a hot thermos of tea fell and landed on him, burning his left hand and wrist, chest and knee. He was brought to Kivunge Hospital where he has been receiving treatment for the past 2 weeks. 

 

Medics classify the severity of burns according to the percentage of surface area of the body affected, but also how many layers of skin the burn has affected. We divide the latter into superficial, where the skin is inflamed but there are no blisters that form. A bad sunburn would be considered a superficial burn and these burns usually heal within 6 days and will not scar. Then there are partial thickness burns, which can be further classified into superficial and deep. These have affected several layers of skin and there are often very thick blisters that develop. Some of these will heal, but will leave the skin a lighter or darker colour than before. Some of the deeper ones will scar and can take many weeks to heal. Full thickness burns have burnt through all layers of skin and will only heal with surgically applied skin grafts. 

 

Ismail sustained burns to approximately 13% of his body. Some of these were superficial partial burns, but a large amount of them, especially over his knee, were deep partial thickness.

Burns are not only extremely painful injuries, but need daily dressing change which are also very distressing and painful for the patient, and unfortunately, the majority of patients that we see with burn injuries are under the age of 5. There are additional concerns that the wounds may get infected and some of the deeper burns, as they heal, will contract and shrink as scar tissue forms (contractures). This can be incredibly detrimental if this happens over a joint as may reduce the ability of that child to use the joint properly in the future. 

 

Thanks to funding from one of our key donors, HIPZ is currently in the process of setting up a new initiative to try and improve the management of burn injuries in children such as Ismail. We are trying to spread the message into the community of ways that burn injuries can be prevented. We are trying to improve burns management whilst patients  they are in hospital and to ensure that we have a constant supply of the specialist dressings that the children need and in time, trying to set a referral programme for specialist surgical care. 

 

There is some light for Ismail though. His burns are healing well and there is no evidence of infection. He remains in good spirits and we have discovered that he is a big fan of peek-a-boo! He is also our first patient that we have referred from Kivunge for a physiotherapy assessment. As his burns have affected his wrist and knee, he is at risk of contractures forming but hopefully the therapy team will work with him and his family on a plan to try and reduce this from happening. He remains our star patient and will continue to monitor his progress.

 

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