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Perineal burn care: French working group recommendations. Burns 2014;40:655–663
burns 41 (2015) 1368–1373
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.elsevier.com/locate/burns
Letter to the Editor Perineal burn care: French working group recommendations. Burns 2014;40:655–663 The Editor, We read the article Perineal burn care: French working group recommendations [1] with interest. Perineal burns are a particularly vexing dilemma for any burn surgeon and the authors are to be commended on their attempt to standardise and improve management of this difficult problem. The use of a faecal management system (FMS), as proposed by Bordes et al. will indeed alleviate many of the problems incurred when managing burns of the perineum. However, we would like to solicit recommendations for specific guidelines for the paediatric population which we manage at the Red Cross War Memorial Children’s Hospital. The average TBSA which was documented in our published institutional series on the use of colostomy in perineal burns (35%) was higher than in these authors review. This may have contributed to a perception that we have a low threshold for performing a diverting colostomy. However, the vast majority of our perineal burn cases are treated conservatively, without recourse to skin grafting or diversion [2]. We have attempted to use FMS, which Dr. Bordes has described previously [3], but were dismayed to encounter two cases of anal sphnicter atomy which resulted in longstanding faecal incontinence [2]. These devices are not licensed for use in children and their off-label use was stopped in our unit after these complications. We look forward to more studies on this neglected area of burn care and welcome guidance from these experienced authors on how their recommendations can be modified to the paediatric population.
Conflict of interest We have no conflict of interest to declare for this letter to the editor.
references
[1] Bordes J, Le Floch R, Bourdais L, Gamelin A, Lebreton F, Perro G. Perineal burn care: French working group
recommendations. Burns 2014;40(4):655–63. http:// dx.doi.org/10.1016/j.burns.2013.09.007. [2] Price CE, Cox S, Rode H. The use of diverting colostomies in paediatric peri-anal burns: experience in 45 patients. S Afr J Surg 2013;51(3):102–5. http://dx.doi.org/10.7196/SAJS.1398. [3] Bordes J, Goutorbe P, Asencio Y, Meaudre E, Dantzer E. A non-surgical device for faecal diversion in the management of perineal burns. Burns 2008;34:840–4. http://dx.doi.org/ 10.1016/j.burns.2007.11.009.
Christopher Price* Heinz Rode Burns Unit, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa *Corresponding author E-mail address: [email protected] (C. Price) http://dx.doi.org/10.1016/j.burns.2015.01.022 0305-4179/# 2015 Elsevier Ltd and ISBI. All rights reserved.
Reply Response to Letter to the Editor: Perineal burn care: French working group recommendations [Burns 2014 40:655–663] To the Editor, We would like to thank Dr Price C et al. for their thoughtful comments on our article published in Burns [1]. We do agree that perineal burns and the potential impact of fecal soiling are neglected and under-studied areas of burn care. This is even more true in case of child burns. As said by Dr Price C, the sole devices actually commercialized to divert feces are not specifically designed for children. As a result, diverting colostomy remains the only procedures when stool diversion is indicated. To date, it would be difficult to establish recommendations to this specific population due to the lack of pediatric data in burn literature. Strategy has to be established according to the local experience. However, we hope that the work we published will stimulate burn caregivers’ community to promote case reports, retrospective or prospective studies on perineal burn
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.elsevier.com/locate/burns
Letter to the Editor Perineal burn care: French working group recommendations. Burns 2014;40:655–663 The Editor, We read the article Perineal burn care: French working group recommendations [1] with interest. Perineal burns are a particularly vexing dilemma for any burn surgeon and the authors are to be commended on their attempt to standardise and improve management of this difficult problem. The use of a faecal management system (FMS), as proposed by Bordes et al. will indeed alleviate many of the problems incurred when managing burns of the perineum. However, we would like to solicit recommendations for specific guidelines for the paediatric population which we manage at the Red Cross War Memorial Children’s Hospital. The average TBSA which was documented in our published institutional series on the use of colostomy in perineal burns (35%) was higher than in these authors review. This may have contributed to a perception that we have a low threshold for performing a diverting colostomy. However, the vast majority of our perineal burn cases are treated conservatively, without recourse to skin grafting or diversion [2]. We have attempted to use FMS, which Dr. Bordes has described previously [3], but were dismayed to encounter two cases of anal sphnicter atomy which resulted in longstanding faecal incontinence [2]. These devices are not licensed for use in children and their off-label use was stopped in our unit after these complications. We look forward to more studies on this neglected area of burn care and welcome guidance from these experienced authors on how their recommendations can be modified to the paediatric population.
Conflict of interest We have no conflict of interest to declare for this letter to the editor.
references
[1] Bordes J, Le Floch R, Bourdais L, Gamelin A, Lebreton F, Perro G. Perineal burn care: French working group
recommendations. Burns 2014;40(4):655–63. http:// dx.doi.org/10.1016/j.burns.2013.09.007. [2] Price CE, Cox S, Rode H. The use of diverting colostomies in paediatric peri-anal burns: experience in 45 patients. S Afr J Surg 2013;51(3):102–5. http://dx.doi.org/10.7196/SAJS.1398. [3] Bordes J, Goutorbe P, Asencio Y, Meaudre E, Dantzer E. A non-surgical device for faecal diversion in the management of perineal burns. Burns 2008;34:840–4. http://dx.doi.org/ 10.1016/j.burns.2007.11.009.
Christopher Price* Heinz Rode Burns Unit, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa *Corresponding author E-mail address: [email protected] (C. Price) http://dx.doi.org/10.1016/j.burns.2015.01.022 0305-4179/# 2015 Elsevier Ltd and ISBI. All rights reserved.
Reply Response to Letter to the Editor: Perineal burn care: French working group recommendations [Burns 2014 40:655–663] To the Editor, We would like to thank Dr Price C et al. for their thoughtful comments on our article published in Burns [1]. We do agree that perineal burns and the potential impact of fecal soiling are neglected and under-studied areas of burn care. This is even more true in case of child burns. As said by Dr Price C, the sole devices actually commercialized to divert feces are not specifically designed for children. As a result, diverting colostomy remains the only procedures when stool diversion is indicated. To date, it would be difficult to establish recommendations to this specific population due to the lack of pediatric data in burn literature. Strategy has to be established according to the local experience. However, we hope that the work we published will stimulate burn caregivers’ community to promote case reports, retrospective or prospective studies on perineal burn