Case Description

A 1-year-old male toddler arrived in emergency services with burns on the right hand. A detailed history by his mother revealed the cause of burn to be scalds due to accidental hand immersion in a bucket of hot water at home. Immediately after the burn, some antibiotic ointment was applied over the affected hand and he was rushed to a nearby primary health care facility. In the dispensary after a formal survey, some antibiotic ointment was applied over the burnt area and dressed with sterile cotton gauze.

On presentation at our emergency, the child was restless and febrile with a temperature of 100.8 Fahrenheit (F). A quick general survey was done, and tetanus immunization was administered. A through local examination revealed second degree deep dermal burn on the right hand involving both the dorsal [Figure 1a] and palmar aspects [Figure 1b]. Under Ketamine anesthesia, the affected hand was washed thoroughly with normal saline and all blisters debrided. No fasciotomy was deemed necessary. Silver sulfadiazine cream (SSD) 1% was applied evenly over the burnt hand and dressing done with sterile cotton gauze pads and bandaged. Oral antibiotic and paracetamol were given after the child was fully conscious.

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The next day the child was again restless. He had two spikes of fever, highest being 102.4 F. Intravenous fluids and precautionary antibiotics were started. The dressing was soaked, and we observed dirt over the soaked area probably due to surface contact with surroundings by the anxious child. The child was again taken to the operating room for dressing change. After removing the soaked dressing, the SSD cream was washed off with normal saline. The entire area was again covered with SSD cream [Figure 2a]. This time the wound with the antibiotic on it was covered a No. 6 latex sterile surgical glove. [Figure 2b] The subsequent pictures of wound healing are shown from Figures ​Figures33 and ​and44.

Subsequent dressing changes were done on alternate days. We recorded normal temperatures of the child after second dressing change. The child allowed dressing change without any anesthesia after fourth dressing. The child was discharged from the hospital on the 12th day. Regular hand physiotherapy was advised to the parents during the day and malleable splint [Figure 2c] was given for the night to avoid any post burn contracture formation. The child has been on regular follow up for two months now. The progress of wound healing has been shown at day 11 on both palmar [Figure 3a] and dorsal aspect [Figure 3b]. All his wounds have healed satisfactorily on palmar aspect [Figure 4a] and dorsal aspect [Figure 4b] at day 18. Parents are continuing massage therapy and splintage as suggested to them.

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