Nepal Skin BankSaving lives with donor skin grafts

Global Scenario- BurnsGlobal Scenario- Burns

Eleven million /year Eleven million /year

WHO. Global Burden of Disease, 2004 Summary Tables. Geneva, WHO, 2008WHO. Global Burden of Disease, 2004 Summary Tables. Geneva, WHO, 2008

Global ScenarioGlobal Scenario

* Fire related deaths 320,000 * Fire related deaths 320,000 globally globally

* >50% in South-East * >50% in South-East Asia=Global epicenterAsia=Global epicenter

Murray CJL. The global burden of diseases. Vol I, WHO: 1996Murray CJL. The global burden of diseases. Vol I, WHO: 1996

Women, Burns and Women, Burns and Other DiseaseOther Disease

WHO’s Estimated annual incidence (‘000s) for selected causes: by sex, age and WHO subregion 2002

More children worldwidedie of fires each year than of tuberculosis or malaria.

Girls 5-14 years from Girls 5-14 years from South East AsiaSouth East Asia Death Due to Burn = 9700Death Due to Burn = 9700

Tuberculosis = 6337Tuberculosis = 6337 HIV / AIDS = 2105HIV / AIDS = 2105 Malaria = 352Malaria = 352

WHO. Global Burden of Disease, 2002WHO. Global Burden of Disease, 2002

IndiaIndia

• >1 million suffer moderate to >1 million suffer moderate to severe burns/year severe burns/year (1)(1)

• 1,40,000 die of burn injuries every 1,40,000 die of burn injuries every year in India alone.year in India alone.

1.1. World Health Organization. Burns: WHO Factsheet. Factsheet No. World Health Organization. Burns: WHO Factsheet. Factsheet No. 365 May 2012.365 May 2012.

BangladeshBangladesh

Incidence 375,000/yr Incidence 375,000/yr 0.24% of 150 Million 0.24% of 150 Million (1)(1)

Burn Deaths=3.97/100,000 Burn Deaths=3.97/100,000 (1)(1)

>173,000 children/year >173,000 children/year (2)(2)

1. Mashreky SR et al. Burn Injury in Bangladesh: Electrical injury a 1. Mashreky SR et al. Burn Injury in Bangladesh: Electrical injury a major contributor. Int. J Burns Trauma. 2011; 1(1):62-7. Epub 2011 major contributor. Int. J Burns Trauma. 2011; 1(1):62-7. Epub 2011 Sep 3.Sep 3.

(2) WHO. Burns: WHO Factsheet. Factsheet No. 365 May 2012(2) WHO. Burns: WHO Factsheet. Factsheet No. 365 May 2012..

PakistanPakistan

Incidence 210,977 / 159 million popn. Incidence 210,977 / 159 million popn. (1)(1)

Mortality rate of >40% Burn= 86% Mortality rate of >40% Burn= 86% (2)(2)

Developed Country= < 20%Developed Country= < 20%

Overall Mortality in hospital admitted Overall Mortality in hospital admitted patientspatients= 41.30% = 41.30% (3)(3)

1. www.rightdiagnosis.com/b/burns/stats-country.htm#extrapwarning1. www.rightdiagnosis.com/b/burns/stats-country.htm#extrapwarning2. www. Pims.gov.pk/burnscenter.htm2. www. Pims.gov.pk/burnscenter.htm3. Madina Hashmi. Management of patients in dedicated burn intensive 3. Madina Hashmi. Management of patients in dedicated burn intensive

care unit in a developing country. Burns (2012)care unit in a developing country. Burns (2012)

Disabilities and Disabilities and DeformitiesDeformities

Disability Adjusted Life Years (DALYs) Disability Adjusted Life Years (DALYs) per annumper annum

Fire related burns alone causes 10 Fire related burns alone causes 10 million DALYS/yearmillion DALYS/year

Peden M, McGee K, Sharma G. The injury chart book: a graphical overview of the Peden M, McGee K, Sharma G. The injury chart book: a graphical overview of the global burden of injuries. Geneva, WHO, 2002. p30global burden of injuries. Geneva, WHO, 2002. p30

USAUSA

Total Population =300 Total Population =300 millionsmillions

Total Burn Cases =450,000Total Burn Cases =450,000 Deaths 3500/ per year (0.7%)Deaths 3500/ per year (0.7%)

American Burn Association, National Burn Repository. 2011 ReportAmerican Burn Association, National Burn Repository. 2011 Report

BurnsBurns

Forgotten Global Health Forgotten Global Health CrisisCrisis

Nepalese ScenarioNepalese Scenario

Total cases= 55,902/ yearTotal cases= 55,902/ year (0.22% of Popn)(0.22% of Popn)

153/day, 6/hour, 1/10 mins153/day, 6/hour, 1/10 mins

Annual Report 2008-9. Ministry of Health and Population, Annual Report 2008-9. Ministry of Health and Population, Department of Health Services, Government of Nepal.Department of Health Services, Government of Nepal.

Nepalese ScenrioNepalese Scenrio

2100 deaths due to burn (4%) 2100 deaths due to burn (4%) 11

>40% TBSA= 100% mortality >40% TBSA= 100% mortality 22

1.1. WHO. Global burden of disease, 2002WHO. Global burden of disease, 20022. EH Liu et al. A 3 year prospective audit of Burns patients treated at WRH of Nepal. Burns, 2. EH Liu et al. A 3 year prospective audit of Burns patients treated at WRH of Nepal. Burns,

24(1998), 129-133.24(1998), 129-133.

Cause of Burns: Nepal2004-2008 / Total cases 833*

Open Fire (cooking, field) 87% Open fire (w/gasoline) 1% Boiling liquid (scald) 10% Electrical 2%

*Unpublished Data from Department of Burns, Plastic & Reconstructive Surgery, Kathmandu Model Hospital, Exhibition Road, Nepal, 2012.

Time Lapse Before Time Lapse Before Constructive SurgeryConstructive Surgery

Average time lapse before Average time lapse before reconstructive surgeryreconstructive surgery

18yr18yrss

Burns asBurns as

-Human Right Issue-Human Right Issue

-Economic Issue -Economic Issue ($80.2 ($80.2 B)B)

SkinSkin

-Defensive barrier-Controls temperature-Waterproof, prevents infection, leakage of protein and fluidSkin for Skin

Rule of nines for adults and children older then 10 years

Rule of nines for a child 1 year of age

Major BurnsMajor Burns= 20% TBSA (Adult)= 20% TBSA (Adult)=10% (Children)=10% (Children)

Deep Burn=30% TBSA Deep Burn=30% TBSA (?)(?)

LD 50/ LA 50LD 50/ LA 50

India 1989= 35%India 1989= 35%1995=50%1995=50%

Cadaveric Skin- life Cadaveric Skin- life savingsaving

-Prevents Infection-Prevents Infection

-Decreases Pain-Decreases Pain

-Decreases plasma oozing-Decreases plasma oozing

-Less dressing changes-Less dressing changes

-Promotes wound healing-Promotes wound healing

Skin Skin -The most effective -The most effective dressingdressing- Hospital Stay- Hospital Stay

- Cost of Treatment- Cost of Treatment

-- Survival-- Survival

- Pain- Pain

Allograft skin in burn Allograft skin in burn wound coveragewound coverage

Bettman- 1938Bettman- 1938

Webster- 1944Webster- 1944

Matthews- 1945Matthews- 1945

Skin autografts stored for Skin autografts stored for 3 weeks at 4 to 7 degree C3 weeks at 4 to 7 degree C

SKIN BANKSKIN BANK

America Nepal Medical Foundation

Skin From Dead BodySkin From Dead Body

-Harvested within 6 hours of deathHarvested within 6 hours of death-Donor – without HIV, Hep B, Hep C, Donor – without HIV, Hep B, Hep C, skin conditions, Cancer, Infection, skin conditions, Cancer, Infection, Active JaundiceActive Jaundice

Skin HarvestingSkin Harvesting

-Permission from the family-Permission from the family

-All aseptic precautions-All aseptic precautions

-Home, Hospital, Morgue-Home, Hospital, Morgue

-Thighs, Back of the body-Thighs, Back of the body

-Only thin layer-Only thin layer

-No disfigurement, no -No disfigurement, no bleedingbleeding

-Takes 45 minutes-Takes 45 minutes

-No matching required-No matching required

Processing and Processing and StorageStorage

-Bio safety Cabinet-Bio safety Cabinet

-Refrigeration-Refrigeration

-Chemical (Glycerol 85 %)-Chemical (Glycerol 85 %)

-Stored up to 5 years in -Stored up to 5 years in GlycerolGlycerol

-Cryopreservation-Cryopreservation

““We make a living by We make a living by what we get, but we what we get, but we make a life by what we make a life by what we givegive””

ChurchillChurchill

Giving means living..Giving means living..

Organ donations- Organ donations- Kidney, Heart, Lung, Kidney, Heart, Lung, Pancrease, Bone/Bone Pancrease, Bone/Bone Marrow, Skin, Liver, Marrow, Skin, Liver, Intestine, Eyes/Cornea, Intestine, Eyes/Cornea, Tendons, Ligaments…Tendons, Ligaments…

-Eye Donation in Nepal-Eye Donation in Nepal

-Body Donation after -Body Donation after DeathDeath

Save lives even after Save lives even after your deathyour death

*Donate Blood- save *Donate Blood- save lifelife

*Donate Eye- save *Donate Eye- save somebody from somebody from blindnessblindness

*Donate skin- save *Donate skin- save lives after your deathlives after your death

Mutual Donation Mutual Donation Program with Eye Program with Eye DonationDonation

‘‘You give but little You give but little when you give of your when you give of your possessions. It is only possessions. It is only when you give of when you give of yourself, that you truly yourself, that you truly give.give.’’

Kahlil GibranKahlil Gibran

Thank YouThank You