The use of diverting colostomies in paediatric peri-anal burns: experience in 45 patients.
BACKGROUND
Peri-anal burns are common in children. Continual exposure to enteric organisms may lead to a contaminated burn wound, invasive sepsis, graft loss, scar contracture, anal and urinary malfunction, and delayed discharge from hospital. Use of a temporary diverting colostomy has been advocated to reduce complications.


OBJECTIVE
To review the incidence, indications, methods, bacteriology, therapeutic effects and outcomes of colostomy for perianal burns.


METHODS
A prospective study of children with peri-anal burns and stomas over a 17-year period. Prophylactic or therapeutic faecal diversion was achieved by temporary, divided sigmoid end-colostomy with Hartmann's closure of the distal end.


RESULTS
Between 1995 and 2012, 45 children with peri-anal burns received a colostomy. The mean total body surface area burned was 35% (range 3 - 80%). There were 28 flame burns, 16 fluid burns and 1 contact burn. Prophylactic colostomies were performed in 29 children, on average on day 6 after admission, and therapeutic colostomies to counteract deep wound infection and septicaemia in 16 patients, on average on day 24. In all but 2 cases there was a marked improvement in clinical appearance, graft take and healing. The bacterial profile changed from gut-derived organisms to Pseudomonas aeruginosa or no pathogens. Complications occurred in 5 patients (11.1%). Three stomas required manual reduction. Two children died of established septic shock, compounded by stomal dehiscence in 1 case. Reversal of the colostomy was performed on average at 4 months.


CONCLUSIONS
Diverting colostomy has therapeutic advantages in a select group of paediatric burns patients in whom continual faecal soiling poses a threat to both graft and life.
Department of Plastic and Reconstructive Surgery, University of Cape Town, Cape Town, South Africa. cprice2006@gmail.com
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D000293:Adolescent; D001003:Anal Canal / Q000293:injuries* / Q000382:microbiology; D002056:Burns / Q000601:surgery*; D002081:Buttocks / Q000293:injuries / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D003125:Colostomy / Q000009:adverse effects; D006085:Graft Survival; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010502:Perineum / Q000293:injuries / Q000382:microbiology; D017192:Skin Diseases, Bacterial / Q000517:prevention & control; D016038:Skin Transplantation; D013848:Thigh / Q000293:injuries / Q000382:microbiology; D014945:Wound Healing