title: The use of diverting colostomies in paediatric peri-anal burns.
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.
authors.affiliation: Department of Plastic, Reconstructive and Maxillofacial Surgery, University of Cape Town, Medical School, South Africa. quarmbyc@uctgshl.uct.ac.za
authors.forename: C J
authors.initials: CJ
authors.lastname: Quarmby
authors.forename: A J
authors.initials: AJ
authors.lastname: Millar
authors.forename: H
authors.initials: H
authors.lastname: Rode
mesh_terms: D000293:Adolescent; D001003:Anal Canal / Q000293:injuries* / Q000601:surgery; D002053:Burn Units; D002056:Burns / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003125:Colostomy / Q000379:methods* / Q000401:mortality; D003625:Data Collection; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015601:Injury Severity Score; D008297:Male; D010502:Perineum / Q000293:injuries* / Q000601:surgery; D013019:South Africa; D015996:Survival Rate; D016896:Treatment Outcome