Experience in the burns unit of Tygerberg Hospital
During the years 1974 to 1979, the Burn Injury Unit at the Tygerberg Hospital managed 7181 patients, of which 2847 were inpatients and 4334 outpatients. Our emphasis has always been on a team effort, including a variety of departments in addition to the medical and nursing staff directly involved in the management of the patients. In this paper we review certain aspects of the epidemiology of burn injuries as experienced in the Cape Peninsula: also in relationship to the severe pulmonary damage sustained in burn injuries where the victims are exposed to complete and incomplete combustion of plastic materials. The high incidence of pulmonary damage with its severe effect in morbidity and mortality is discussed in some detail. Regarding the local treatment of the burnt area, we recount briefly our experience with different application and emphasize the remarkable improvement that we have been able to achieve since beginning to apply a mixture of Betadine and Aserbine. The mechanism involved is that the Aserbine breaks down the necrotic tissue, allowing the Betadine to penetrate into the depths, and in this manner we can control sepsis far more effectively than had been the case with any of the materials previously used. A brief reference is made to the management of graft donor areas. In the management of pain we make extensive use of Ketalar and to maintain accuracy of dosage in severely burnt patients we supply the drug through an infusion pump. The prevension of contractures is a major feature of our burns program and here we are particularly impressed with the advantages of the Lightcast glass fibre splints. Although initially expensive, their long life, convenience, lightness and the ease with which they are cleansed bring advantages which, in the long run, outweigh the cost involved. In attempting to reduce hypertrophic scarring we make use of tight-fitting compression clothing. These garments and gloves are tailor-made for our patients by the Department of Occupational Therapy.