378 Surgical Treatment of Perineal Burns in Children of Middle Income Country

Abstract Introduction Perineal burns have a high rate of contamination that can lead to prolonged hospitalizations, sepsis and death. In Peru, a middle-income country, the frequency of scalds by immersion in hot liquids is high. The most affected age group is 1 to 4 years old with TBSA burned more than 15%, compromising buttocks, upper thighs, lower back and genitalia. Prolonged exposition to high temperatures results in deep partial thickness or full thickness burns. Accidents happen at home, where families in poverty live in one single/multipurpose room. The frequency of these cases in our Burn Unit made us to change the approach we had for perineal burns, finding the first week after admission as the best timing for a successful treatment. Methods A case series of 23 patients with perineal burns, admitted to the Children’s Burn Unit in Lima, Peru over one year period, treated with early (during first week after admission) surgical debridement and either partial thickness skin grafts (SG, n=12) or xenograft (XG, n=11) as the first surgery performed. Patients were kept in prone position for 5 days; Foley catheter was placed in all patients. Data was collected retrospectively from clinical records. Demographic data, mechanism of burn injury, Intensive Care Unit (ICU) days and hospital days, number of surgeries and procedures needed before discharge were examined. Results The mean (±SD) age was 3 ± 1.37 years; male/female ratio was 1.5. Ninety one percent of burns were caused by hot liquids, 78% of them by immersion. Mean TBSA burned was 32% ± 18%. Areas involved were buttocks (100%), upper thighs (95 %), lower back (95%), and genitalia (43%). Surgery was performed in average 4.2-± 2.8 days after admission. The mean ICU days was 9.6 ± 1.4 days and 25 ± 20.4 days for SG and XG groups, respectively. Mean hospitalization days ranged from 21.7 ± 8.5 days for the SG group and 35.4 ± 18.3 days for the XG group. The mean number of surgeries was 1.9 ± 1 and 4.3 ± 2.9 for the SG group and XG group respectively. An average of 8.4 ± 2.7 and 17.8 ± 14.7 procedures for dressing changes under anesthesia were performed for SG and XG groups, respectively. Conclusions Early surgical treatment and immediate SG in children’s perineal burns caused by immersion although can be considered as an aggressive alternative, might be the best treatment and timing for perineal burns by immersion. Adopting it may result in less ICU days, less surgeries and procedures, with less costs of