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The use of diverting colostomies in paediatric peri-anal burns
C J Quarmby1, A J Millar, H Rode
1Department of Plastic, Reconstructive and Maxillofacial Surgery, University of Cape Town, Medical School, South Africa. quarmbyc@uctgshl.uct.ac.za
Insights
Diverting colostomies in pediatric burn patients with severe perineal burns significantly improved wound healing and graft take. This surgical intervention reduced infection and prevented complications from fecal soiling in critical cases.
Area of Science:
- Pediatric Surgery
- Burn Management
- Gastrointestinal Surgery
Background:
- Perineal burn injuries in children pose significant challenges to wound healing and graft survival.
- Fecal contamination is a major risk factor for infection and graft loss in pediatric burn patients.
- Colostomy is a potential surgical option to manage severe perineal burns and prevent complications.
Purpose of the Study:
- To evaluate the efficacy of diverting colostomies in managing pediatric patients with severe perineal burns.
- To assess the impact of colostomies on wound healing, graft take, and infection rates.
- To determine the safety and complication profile of colostomies in this patient population.
Main Methods:
- A retrospective review of 13 pediatric patients who underwent colostomy for perineal burns over a 3-year period.
- Analysis of burn characteristics, colostomy indications (prophylactic vs. therapeutic), surgical technique (sigmoid end-colostomy with Hartmann's closure), and patient outcomes.
- Evaluation of clinical improvement, graft take, bacterial profiles, and complications.
Main Results:
- Colostomies were performed in 13 out of 1544 pediatric burn admissions (mean TBSA burn 34%).
- Significant improvements in burn wound appearance, graft take, and healing were observed in most patients post-colostomy.
- Bacterial profiles shifted from gut-derived organisms to Pseudomonas aeruginosa or sterile cultures; complications were minimal (2 cases of prolapse).
Conclusions:
- Diverting colostomies are a valuable surgical option for select pediatric burn patients with severe perineal involvement and fecal soiling.
- This procedure can mitigate infection, enhance wound healing, and improve graft survival in high-risk cases.
- Colostomy should be considered in pediatric burn management when graft and life are threatened by continual fecal soiling.
Abstract:
Over a 3 yr period we performed colostomies in 13 paediatric perineal burn patients out of a total of 1544 patients admitted to our Burns Unit during that period. The mean total body surface area (TBSA) burn was 34% (14-65%); ten patients sustained fire burns and the remaining three hot water burns. We performed prophylactic colostomies in seven children, therapeutic colostomies (to counteract deep wound infection and septicaemia with gut-derived organisms) in five patients and one colostomy in a cerebral palsy child with a left hemiparesis. A sigmoid end-colostomy with Hartmann's closure of the distal segment was the preferred method of choice. In all children but one (died from multi-organ failure 13 days after admission) there was a marked improvement in the clinical appearance of the burn wounds and subsequent graft-take and healing. There was a change in the bacterial profile away from predominantly gut-derived Gram negative organisms to either Pseudomonas aeruginosa or no pathological organisms grown. Complications were few--two children suffered prolapse of their colostomy requiring manual reduction. We advocate diverting colostomies in a highly select group of paediatric burn patients in whom continual faecal soiling is threatening to both graft and life.