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Third-degree burn or a fried egg?
burns 34 (2008) 428–429
available at www.sciencedirect.com
journal homepage: www.elsevier.com/locate/burns
Letter to the Editor
Third-degree burn or a fried egg? Dear Sir,
Hands are involved in more than 80% of all severe burns [1]. Although hand represents less than 3% of the total body surface, burns of the hand are categorized as major thermal injuries. Treatment of hand burns deserves great priority because of the functional and aesthetic significance of the hand. Detailed history taking, application of proper wound care and dressings, initiation of early hand therapy and splinting, appropriate surgical plan including escharatomy, graft and flap coverage, and early postoperative physical therapy are the basics of the modern approach to burned hands. However, interesting or even bizarre examples of folk medicine remedies can be encountered especially in countries where the health organization system is not uniform and well established. Here we report a strange presentation of a 7-year-old child with hot water burn of the upper extremity (Fig. 1). On physical examination, she was awake, alert and her hand was relatively free of pain, plus all the motor, sensory and circulatory signs were noticed to be intact in spite of the
Fig. 1 – Initial presentation of the hand. All necrotic looking parts are fried white part of the egg and the blister formation on the dorsum of the wrist is actually composed of egg yolk.
Fig. 2 – View of the actual superficial thickness burned extremity immediately after washing under water (note the date on the picture).
dramatic appearance of the extremity. While we were ready to alert the surgical team for a debridement or even fasciotomy, a short history revealed that her parents had been wrapping fried egg around the burned limb for the last 3 days prior to admission. After simple washing with tap water, the burn depth was observed to be superficial, thus conservative measures such as splinting and elevation was taken (Fig. 2). In many different cultures, different kinds of folk medicine remedies have been applied for the burn victims. These include herbs like aloe vera, extracts of Calendula, Garcinia morella and many more [2]. In addition to that, products of animal origin including egg and amniotic membranes, honey, pig skin and many others have also been defined. Egg membrane application is common practice of a home remedy, especially in some African cultures. In a retrospective study of the substances used to treat burns in communities in Nigeria over a 2-year period, investigators found that raw egg was the most commonly used first-aid home treatment for 51% of patients [3,4]. In conclusion, this case, once again emphasizes the importance of a careful and comprehensive history in any
burns 34 (2008) 428–429
kind of an injury patient, a burned patient, as is the case. Therefore, every physican should keep in mind the importance of history taking and take into account the possibility of different alternative remedies applied to the patients even it may be challenging in emergency rooms.
references
[1] Germann G, Philipp K. The burned hand.. Fifth Edition, Green’s operative hand surgery, vol. 2, Fifth Edition Churchill, Livingstone: Elsevier; 2005. p. 2159. [2] Sai KP, Babu M. Traditional medicine and practices in burn care: need for newer scientific perspectives. Burns 1998;24(5 (August)):387–8. [3] Olaitan P, Iyidibi E, Olaitan J, Ogbonnaya I. Burns and scald: first aid home treatment and implications at Enugu. Niger Ann Burns Fire Disaster 2004;22:61–3.
429
[4] Oluwatosin OM. Burns in Africa. J Afr Trauma 2004;2(1):1 (Also available at: www.afrjtrauma.com/ Abstract%20Burns%20in%20Africa.htm).
Karaca Basaran* Ahmet Bicer Yahya Beskardes Ismail Ermis Department of Plastic and Reconstructive Surgery, Istanbul University Medical Faculty, Istanbul, Turkey *Corresponding author. Tel.: +90 505 601 10 61 E-mail address: [email protected] (K. Basaran) 0305-4179/$34.00 # 2007 Elsevier Ltd and ISBI. All rights reserved. doi:10.1016/j.burns.2007.07.011
available at www.sciencedirect.com
journal homepage: www.elsevier.com/locate/burns
Letter to the Editor
Third-degree burn or a fried egg? Dear Sir,
Hands are involved in more than 80% of all severe burns [1]. Although hand represents less than 3% of the total body surface, burns of the hand are categorized as major thermal injuries. Treatment of hand burns deserves great priority because of the functional and aesthetic significance of the hand. Detailed history taking, application of proper wound care and dressings, initiation of early hand therapy and splinting, appropriate surgical plan including escharatomy, graft and flap coverage, and early postoperative physical therapy are the basics of the modern approach to burned hands. However, interesting or even bizarre examples of folk medicine remedies can be encountered especially in countries where the health organization system is not uniform and well established. Here we report a strange presentation of a 7-year-old child with hot water burn of the upper extremity (Fig. 1). On physical examination, she was awake, alert and her hand was relatively free of pain, plus all the motor, sensory and circulatory signs were noticed to be intact in spite of the
Fig. 1 – Initial presentation of the hand. All necrotic looking parts are fried white part of the egg and the blister formation on the dorsum of the wrist is actually composed of egg yolk.
Fig. 2 – View of the actual superficial thickness burned extremity immediately after washing under water (note the date on the picture).
dramatic appearance of the extremity. While we were ready to alert the surgical team for a debridement or even fasciotomy, a short history revealed that her parents had been wrapping fried egg around the burned limb for the last 3 days prior to admission. After simple washing with tap water, the burn depth was observed to be superficial, thus conservative measures such as splinting and elevation was taken (Fig. 2). In many different cultures, different kinds of folk medicine remedies have been applied for the burn victims. These include herbs like aloe vera, extracts of Calendula, Garcinia morella and many more [2]. In addition to that, products of animal origin including egg and amniotic membranes, honey, pig skin and many others have also been defined. Egg membrane application is common practice of a home remedy, especially in some African cultures. In a retrospective study of the substances used to treat burns in communities in Nigeria over a 2-year period, investigators found that raw egg was the most commonly used first-aid home treatment for 51% of patients [3,4]. In conclusion, this case, once again emphasizes the importance of a careful and comprehensive history in any
burns 34 (2008) 428–429
kind of an injury patient, a burned patient, as is the case. Therefore, every physican should keep in mind the importance of history taking and take into account the possibility of different alternative remedies applied to the patients even it may be challenging in emergency rooms.
references
[1] Germann G, Philipp K. The burned hand.. Fifth Edition, Green’s operative hand surgery, vol. 2, Fifth Edition Churchill, Livingstone: Elsevier; 2005. p. 2159. [2] Sai KP, Babu M. Traditional medicine and practices in burn care: need for newer scientific perspectives. Burns 1998;24(5 (August)):387–8. [3] Olaitan P, Iyidibi E, Olaitan J, Ogbonnaya I. Burns and scald: first aid home treatment and implications at Enugu. Niger Ann Burns Fire Disaster 2004;22:61–3.
429
[4] Oluwatosin OM. Burns in Africa. J Afr Trauma 2004;2(1):1 (Also available at: www.afrjtrauma.com/ Abstract%20Burns%20in%20Africa.htm).
Karaca Basaran* Ahmet Bicer Yahya Beskardes Ismail Ermis Department of Plastic and Reconstructive Surgery, Istanbul University Medical Faculty, Istanbul, Turkey *Corresponding author. Tel.: +90 505 601 10 61 E-mail address: [email protected] (K. Basaran) 0305-4179/$34.00 # 2007 Elsevier Ltd and ISBI. All rights reserved. doi:10.1016/j.burns.2007.07.011