Burns are not by any means easy to treat. At the Government Kilpauk Medical College, the apex burns treatment institution in the State, where the best outcomes can be expected, the rate of survival is between 30 and 40 per cent.
Survival depends on the nature of the burns, extent of burns, and infection, says V. Jayaraman, plastic surgeon, and former head of the plastic surgery department at the college. Despite the vast advances in the treatment of burns, survival still largely depends on these factors. In Vinodhini’s case, though she seemed to be recovering quite well, death came of hypoprotenimia, or a drastic reduction of protein in the body, Dr. Jayaraman says. This is a consequence of the burns, he explains. In her case, it caused respiratory failure, leading to death.
Types of burns
Burns can broadly be categorised on the basis of the cause: fire, chemicals or electrical. With fire and electric burns, there are immediate system complications, but in case of chemical burns (acid) these effects set in at a much slower pace, because the first damage is to the skin. The acid, depending on its concentration, can penetrate the skin, and even burn up the fat, he explains.
The severity of burns is decided based on how much of the body surface area has been subjected to them. A certain percentage is assigned – if there are burns on the head, it makes for 9 per cent; each side of the neck is one per cent, the trunk and the back of the body are 18 per cent each, and so on. “Any case of burns of over 40 per cent, we classify as very serious; and in deep burns, even 30 per cent pushes the case to the danger zone,” Dr. Jayaraman says.
While application of the collagen membrane help healing in case of superficial burns, if the burns are deeper, surgery is the only option, he adds. In these cases, reconstructive surgery is done, using grafts from unburned, fleshy portions (such as thighs). “Sometimes, when the damage has been extensive, entire systems will have to be reconstructed, perhaps over a period of several years, with multiple surgeries,” he adds. And still, scars will remain.
Dr. Jayaraman admits that outcomes are definitely better at specialised centres in the west, but one of the main reasons is that the burns themselves are not as in-depth as in India. “In India, the reasons are often stove bursts, acid burns (either suicides or homicidal attacks) – where the burns are deeper, and affect the respiratory tract,” he says. Also, levels of infection are likely to be higher in government hospitals, where regulation of visitors and crowds still continues to be a challenge.
Support systems to maintain victims on ventilators, and the help of dedicated staff nurses, help increase survival rates tremendously, he adds.