Purpose Acute burn resuscitation in initial 24 h remains a challenge to plastic surgeons. Though various formulae for fluid infusion are available but consensus is still lacking, resulting in under resuscitation or over resuscitation. Parkland formula is widely used but recently its adequacy is questioned in studies. This study was conducted to see how closely the actual volume of fluid given in our center matches with that of calculated volume by Parkland formula. Methods All patients admitted with more than 20% flame burn injury and within 8 h of incident were included in this study. Crystalloid solution for infusion was calculated as per Parkland formula; however, it was titrated according to the urine output. Data on fluid infusion were collected from patient's inpatient records and analyzed. Results The study included a total of 90 patients, about 86.7% ( n = 78) of the patients received fluid less than the calculated Parkland formula. Rate of fluid administered over 24 h in our study was 3.149 mL/kg/h. Mean hourly urine output was found to be 0.993 mL/kg/h. The mean difference between fluid administered and fluid calculated by Parkland formula was 3431.825 mL which was significant ( p < 0.001). Conclusion The study showed a significant difference in the fluid infused based on urine output and the fluid calculated by Parkland formula. This probably is because fluid infused based on end point of resuscitation was more physiological than fluid calculated based on formulae.

A 45‐year‐old man was referred from a primary health care center to our hospital in November 2005 with features of necrotizing fascitis of the right shoulder and upper back. He had been admitted to the previous hospital following an injury, sustained in an accident, while driving a tractor. He was treated for fracture of the right clavicle followed by wound debridement of the right shoulder at the health center. Examination of the wound in our hospital revealed a large, 15 × 15 cm, raw area over the upper back, extending to the right upper arm and shoulder. The wound was grossly infected with slough and purulent discharge. The margin of the wound was indurated. No other abnormality was detected on general examination, except for the fracture of the clavicle.  Laboratory investigation revealed a hemoglobin level of 7.5 g/dL and a total leukocyte count of 19,600/mm3, with a differential count of 82% polymorphs, 16% lymphocytes, and 2% eosinophils. The blood glucose was 80 mg%, blood urea 36 mg/dL, and serum creatinine 0.9 mg/dL.  Culture of a sample of tissue from the wound yielded a mixture of Escherichia coli, which was sensitive to imipenem, cefoperazone/sulbactam, and amikacin, and resistant to ampicillin, gentamicin, cefazolin, cefotaxime, ticarcillin, ofloxacin, amoxyclavulanic acid, and ciprofloxacin, together with a multidrug‐resistant Pseudomonas aeruginosa, which was sensitive to imipenem only. As the patient had features of impending septicemia, he was managed with daily cleaning of the wound, with intravenous imipenem 500 mg eight hourly. Seven days later, the wound showed pockets of white cheesy material extruding out as strands. Microscopic examination of scrapings from this cheesy material showed broad aseptate hyphae suggestive of a zygomycete (Fig. 1). A culture of the tissue on Sabouraud's dextrose agar (SDA) yielded a white fluffy growth after 48 h of incubation at both 25 °C and 37 °C (Fig. 2a). The microscopic morphology of the fungus stained with lactophenol cotton blue revealed broad, ribbon‐like, aseptate hyphae. Sporulation was very poor on the routine SDA medium. Stimulation of sporulation was attempted on 1% water agar.1 After 1 week of incubation, sporulation occurred, and microscopy revealed a sporangiophore measuring around 200–300 µm in length, arising at right angles with a septate basal segment, or foot cell, as it is called. The sporangia were multispored, small (20–50 µm in diameter), typically pyriform in shape, and with hemispherical columellae. The apophysis was funnel shaped (Fig. 2b). The fungus was identified as A. elegans on the basis of these characteristic features. 1 Photomicrograph of 10% KOH mount showing broad aseptate hyphae together with tissue debris (magnification, ×400) 2 (a) Sabouraud's dextrose agar plate showing gray–white cottony growth completely filling the Petri dish. (b) Photomicrograph of lactophenol cotton blue mount showing funnel‐shaped apophyses with broad aseptate hyphae and thickened foot cell (magnification, ×400)  After confirmation of the ...

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Chronic, open, non-healing wounds pose a continual challenge in medicine as the treatment is variable and there are no documented consistent responses. Although wound aetiologies vary and there are a number of factors that affect chronic wound pathogenesis, wound ischaemia and bacterial colonisation of wounds are the chief concerns among them. Conventionally, pulse lavage has been used primarily as a wound debriding device. To address both the critical factors of wound ischaemia and bacterial burden, a couple of technical points were proposed and applied in this study. The objective of our study was to evaluate pulse lavage therapy's ability to improve the healing rate of chronic wounds compared to that of the traditional saline-wet-to-moist dressings. The study period was from 1 August 2010 to 31 January 2012 and was conducted in our institution. Thirty patients with 31 chronic, non-healing wounds were enrolled in the study after obtaining proper consent. Subjects were randomised (15 patients each) to the pulse lavage group and the control group. Patients in the test group were subjected to irrigation of their wounds with pulsed lavage at 10 to 15 psi pressure. In the control group, wound was closed by applying moist betadine saline gauze dressings after cleaning with saline. Wounds treated with pulse lavage system significantly reduced in size, had better control of bacterial contamination and had overall faster healing rates. Efficacy of pulse lavage can be increased by correct method of administration of the irrigant.