1372
burns 41 (2015) 1368–1373
grafts in the presence of Staphylococcal infection can be traced back to earlier publications in 1963 [2]. Treatment of melted skin grafts with antibacterial dressings, oral antibiotics, topical steroids and combinations of these are all recognised in practice. However, there is limited evidence published in the literature and no established guidelines on the optimal management of the condition. Matsumura et al. described successfully salvaging 27 out of 29 melted skin grafts over a 4-year period with systemic antibiotic therapy and local wound care [1]. In a series of 28 paediatric patients, Aikins et al. identified that resolution of skin graft melting occurred fastest with a combination of oral antibiotics and topical steroids. Isolated topical steroid use, oral antibiotics and antibacterial dressings were the next most effective treatments respectively. Delayed diagnosis and treatment was shown to be associated with worse outcomes in this series [3]. Our practice is to treat melted skin grafts with antistaphylococcal dressings rather than systemic antibiotics or topical steroids. Anti-bacterial dressings such as furosin or mupirocin may offer an advantage over systemic antibiotics in that they provide extended cover against MRSA. Most 1st line systemic antibiotics do not provide such cover making their use in melted grafts secondary to MRSA ineffectual. However, MRSA sensitive anti-bacterial dressings and antibiotics should not be used injudiciously and their utilisation should be judged on a case-by-case basis in conjunction with a microbiology specialist. Currently, a prospective, randomised series on the treatment of melting graft syndrome is lacking from the literature. Such a study would potentially allow burn care specialists to reach a consensus on best management practices. With this letter we would encourage burn care specialists to publish their experience in the treatment of melting graft syndrome.
Conflict of interest None.
Funding None.
references
[1] Matsumura H, Meyer NA, Mann R, Heimbach DM. Melting graft-wound syndrome. J Burn Care Rehabil 1998;19:292–5. [2] Peet EW, Patterson TJS. The essentials of plastic surgery. Oxford: Blackwell Scientific Publications; 1963. [3] Aikins K, Prasad N, Menon S, Harvey JG, Holland AJ. Pediatric burn wound impetigo after grafting. J Burn Care Res 2015;36:e41–6.
N. Hodgins* S.A. Pape Northern Regional Burns Unit, Royal Victoria Infirmary, Queen Victoria Road, Newcastle Upon Tyne, England NE1 4LP, United Kingdom
*Corresponding author at: Ward 37, Northern Regional Burns Unit, Royal Victoria Infirmary, Queen Victoria Road, Newcastle Upon Tyne, England NE1 4LP, United Kingdom. Tel.: +44 774 94 58417 E-mail address: [email protected] (N. Hodgins) http://dx.doi.org/10.1016/j.burns.2015.05.014 0305-4179/# 2015 Elsevier Ltd and ISBI. All rights reserved.
Letter to the Editor Acid violence in India – A modern day somber reality? Acid violence is associated with extensive burns, maiming, blindness, and even death. Acid attacks through the ages, have not uncommonly been reported in literature. From a global standpoint although the South East Asian Region (SEAR) has dominated with regard to volume of said attacks, the distribution still remains wide as do the reasons behind such a form of attack [1,2]. Studies show that a remarkable 50–70% of the documented cases of acid violence in the region were females. This figure on violence against women is alarming and needs urgent attention and necessary interventions. The other side of the sad story is that 30–50% of the victims of acid violence were males, a rather significant number for attacking an individual by means of throwing acid on them. Studies have shown that males were nearly as commonly found to be victims of acid violence as females [1–3]. While our discussion on the male victims of acid attacks may seem chauvinistic in its approach, its sole intent is to convey that males are subjugated to such atrocities too. The fact necessitates a change in the mindset of individuals with regard to acid attacks being directed only against women in the region especially in the Asian sub-continent where it is widely considered a ‘gender crime’. Recognition of this fact assumes more importance given that this region constitutes the largest number of attacks each year world over. Acid violence is a global phenomenon, not restricted to a specific gender. Present day official figures on acid violence in India are found to be lacking. This could be due to the fact that till lately acid violence was not recognized as a distinct crime in India. Besides, there is a possibility of a large number of such cases remaining unreported. Acid attacks are a serious form of violence that has a long lasting physical and psychological effect on the victim. Thankfully, the seriousness of the matter has caught the attention of the country’s lawmakers which has resulted in the implementation of amended laws involving stricter punishments to acid offenders along with provisions for imposing fine toward the treatment of the victim [4]. Now while this can definitely be considered as a footstep in the right direction, effective source control of such acid needs to be impressed upon. For easy and cheap availability of acids makes acid a weapon of choice for the perpetrators. Given the history of abuse of power in the nation and the time factor before which legal proceedings fructify
burns 41 (2015) 1368–1373
into righteous outcomes, many of the victims may never live to see the justice they deserve. Thus, besides implementation of stricter laws, faster disposal of cases through setting up of special courts is advocated for getting justice to the victims of acid violence. Measures must be taken to build confidence in the system we live in. Increase awareness amongst people to stand up for their fundamental right of freedom and report cases of acid violence without fear and prejudice may be an important step in this direction. One such step which serves as a welcome respite to the problem is that through a combination of various factors most importantly personal grit and determination, acid survivors have, in acts of pure nobility created various foundations, which strives to raise awareness amongst the general public with regard to the atrocities caused by acid attacks, provide simple first aid techniques that greatly benefit a victim and support such victims through the host of mental and physical trauma that they undergo. If things are to change and in the hope that they will, it would seem most appropriate to end this letter with the lines of our nations’ founding father Mahatma Gandhi, ‘Be the change you want to see’ and if each one of us follows this motto change is inevitable. The correspondence is for the paper recently published in ‘Burns’ detailed as ‘Waldron NR, Kennifer D, Bourgois E, Vanna K, Noor S, Gollogly J. Acid violence in Cambodia: the human, medical and surgical implications. Burns. 2014;40(8):1799-804.’ The Corresponding author of the paper is NR Waldron.
Funding No source of support in the form of grants.
Conflict of interest No conflict of interest to declare.
1373
references
[1] Waldron NR, Kennifer D, Bourgois E, Vanna K, Noor S, Gollogly J. Acid violence in Cambodia: the human, medical and surgical implications. Burns 2014;40:1799–804. [2] Mannan A, Ghan i S, Sen SL, Clarke A, Butler P. The problem of acid violence in Bangladesh. J Surg 2004;2:39–43. [3] Mannan A, Ghani S, Clarke A, Butler PE. Cases of chemical assault worldwide: a literature review. Burns 2007;33:149–54. [4] The Criminal Law (Amendment) Act, 2013. Available at http://indiacode.nic.in/acts-in-pdf/132013.pdf [accessed 24.04.15].
Tanuj Kanchan* Kasturba Medical College (A Constituent Institute of Manipal University), Mangalore, India Pradhum Ram Albert Einstein Medical Center, Philadelphia, PA, USA Abhishek Tandon Kasturba Medical College (A Constituent Institute of Manipal University), Mangalore, India Kewal Krishan Panjab University, Sector-14, Chandigarh, India *Corresponding author. Department of Forensic Medicine & Toxicology, Kasturba Medical College (A Constituent Institute of Manipal University), Mangalore, India. Tel.: +91 824 2444590x5565/9448252394; fax: +91 824 2428183 E-mail addresses: [email protected] [email protected] (T. Kanchan) http://dx.doi.org/10.1016/j.burns.2015.06.014 0305-4179/# 2015 Elsevier Ltd and ISBI. All rights reserved.
burns 41 (2015) 1368–1373
grafts in the presence of Staphylococcal infection can be traced back to earlier publications in 1963 [2]. Treatment of melted skin grafts with antibacterial dressings, oral antibiotics, topical steroids and combinations of these are all recognised in practice. However, there is limited evidence published in the literature and no established guidelines on the optimal management of the condition. Matsumura et al. described successfully salvaging 27 out of 29 melted skin grafts over a 4-year period with systemic antibiotic therapy and local wound care [1]. In a series of 28 paediatric patients, Aikins et al. identified that resolution of skin graft melting occurred fastest with a combination of oral antibiotics and topical steroids. Isolated topical steroid use, oral antibiotics and antibacterial dressings were the next most effective treatments respectively. Delayed diagnosis and treatment was shown to be associated with worse outcomes in this series [3]. Our practice is to treat melted skin grafts with antistaphylococcal dressings rather than systemic antibiotics or topical steroids. Anti-bacterial dressings such as furosin or mupirocin may offer an advantage over systemic antibiotics in that they provide extended cover against MRSA. Most 1st line systemic antibiotics do not provide such cover making their use in melted grafts secondary to MRSA ineffectual. However, MRSA sensitive anti-bacterial dressings and antibiotics should not be used injudiciously and their utilisation should be judged on a case-by-case basis in conjunction with a microbiology specialist. Currently, a prospective, randomised series on the treatment of melting graft syndrome is lacking from the literature. Such a study would potentially allow burn care specialists to reach a consensus on best management practices. With this letter we would encourage burn care specialists to publish their experience in the treatment of melting graft syndrome.
Conflict of interest None.
Funding None.
references
[1] Matsumura H, Meyer NA, Mann R, Heimbach DM. Melting graft-wound syndrome. J Burn Care Rehabil 1998;19:292–5. [2] Peet EW, Patterson TJS. The essentials of plastic surgery. Oxford: Blackwell Scientific Publications; 1963. [3] Aikins K, Prasad N, Menon S, Harvey JG, Holland AJ. Pediatric burn wound impetigo after grafting. J Burn Care Res 2015;36:e41–6.
N. Hodgins* S.A. Pape Northern Regional Burns Unit, Royal Victoria Infirmary, Queen Victoria Road, Newcastle Upon Tyne, England NE1 4LP, United Kingdom
*Corresponding author at: Ward 37, Northern Regional Burns Unit, Royal Victoria Infirmary, Queen Victoria Road, Newcastle Upon Tyne, England NE1 4LP, United Kingdom. Tel.: +44 774 94 58417 E-mail address: [email protected] (N. Hodgins) http://dx.doi.org/10.1016/j.burns.2015.05.014 0305-4179/# 2015 Elsevier Ltd and ISBI. All rights reserved.
Letter to the Editor Acid violence in India – A modern day somber reality? Acid violence is associated with extensive burns, maiming, blindness, and even death. Acid attacks through the ages, have not uncommonly been reported in literature. From a global standpoint although the South East Asian Region (SEAR) has dominated with regard to volume of said attacks, the distribution still remains wide as do the reasons behind such a form of attack [1,2]. Studies show that a remarkable 50–70% of the documented cases of acid violence in the region were females. This figure on violence against women is alarming and needs urgent attention and necessary interventions. The other side of the sad story is that 30–50% of the victims of acid violence were males, a rather significant number for attacking an individual by means of throwing acid on them. Studies have shown that males were nearly as commonly found to be victims of acid violence as females [1–3]. While our discussion on the male victims of acid attacks may seem chauvinistic in its approach, its sole intent is to convey that males are subjugated to such atrocities too. The fact necessitates a change in the mindset of individuals with regard to acid attacks being directed only against women in the region especially in the Asian sub-continent where it is widely considered a ‘gender crime’. Recognition of this fact assumes more importance given that this region constitutes the largest number of attacks each year world over. Acid violence is a global phenomenon, not restricted to a specific gender. Present day official figures on acid violence in India are found to be lacking. This could be due to the fact that till lately acid violence was not recognized as a distinct crime in India. Besides, there is a possibility of a large number of such cases remaining unreported. Acid attacks are a serious form of violence that has a long lasting physical and psychological effect on the victim. Thankfully, the seriousness of the matter has caught the attention of the country’s lawmakers which has resulted in the implementation of amended laws involving stricter punishments to acid offenders along with provisions for imposing fine toward the treatment of the victim [4]. Now while this can definitely be considered as a footstep in the right direction, effective source control of such acid needs to be impressed upon. For easy and cheap availability of acids makes acid a weapon of choice for the perpetrators. Given the history of abuse of power in the nation and the time factor before which legal proceedings fructify
burns 41 (2015) 1368–1373
into righteous outcomes, many of the victims may never live to see the justice they deserve. Thus, besides implementation of stricter laws, faster disposal of cases through setting up of special courts is advocated for getting justice to the victims of acid violence. Measures must be taken to build confidence in the system we live in. Increase awareness amongst people to stand up for their fundamental right of freedom and report cases of acid violence without fear and prejudice may be an important step in this direction. One such step which serves as a welcome respite to the problem is that through a combination of various factors most importantly personal grit and determination, acid survivors have, in acts of pure nobility created various foundations, which strives to raise awareness amongst the general public with regard to the atrocities caused by acid attacks, provide simple first aid techniques that greatly benefit a victim and support such victims through the host of mental and physical trauma that they undergo. If things are to change and in the hope that they will, it would seem most appropriate to end this letter with the lines of our nations’ founding father Mahatma Gandhi, ‘Be the change you want to see’ and if each one of us follows this motto change is inevitable. The correspondence is for the paper recently published in ‘Burns’ detailed as ‘Waldron NR, Kennifer D, Bourgois E, Vanna K, Noor S, Gollogly J. Acid violence in Cambodia: the human, medical and surgical implications. Burns. 2014;40(8):1799-804.’ The Corresponding author of the paper is NR Waldron.
Funding No source of support in the form of grants.
Conflict of interest No conflict of interest to declare.
1373
references
[1] Waldron NR, Kennifer D, Bourgois E, Vanna K, Noor S, Gollogly J. Acid violence in Cambodia: the human, medical and surgical implications. Burns 2014;40:1799–804. [2] Mannan A, Ghan i S, Sen SL, Clarke A, Butler P. The problem of acid violence in Bangladesh. J Surg 2004;2:39–43. [3] Mannan A, Ghani S, Clarke A, Butler PE. Cases of chemical assault worldwide: a literature review. Burns 2007;33:149–54. [4] The Criminal Law (Amendment) Act, 2013. Available at http://indiacode.nic.in/acts-in-pdf/132013.pdf [accessed 24.04.15].
Tanuj Kanchan* Kasturba Medical College (A Constituent Institute of Manipal University), Mangalore, India Pradhum Ram Albert Einstein Medical Center, Philadelphia, PA, USA Abhishek Tandon Kasturba Medical College (A Constituent Institute of Manipal University), Mangalore, India Kewal Krishan Panjab University, Sector-14, Chandigarh, India *Corresponding author. Department of Forensic Medicine & Toxicology, Kasturba Medical College (A Constituent Institute of Manipal University), Mangalore, India. Tel.: +91 824 2444590x5565/9448252394; fax: +91 824 2428183 E-mail addresses: [email protected] [email protected] (T. Kanchan) http://dx.doi.org/10.1016/j.burns.2015.06.014 0305-4179/# 2015 Elsevier Ltd and ISBI. All rights reserved.
