Management of burns of the perineum and buttocks

Twenty patients are reported who suffered acute thermal bums of the perineum and buttocks and were treated at the Shriners Burns Institute, Cincinnati Unit. Seventeen of the 20 patients had burns which resulted from ignition of clothing. The most common source of ignition was refuse fires. Ages ranged from 11 months to 12 years; 17 of the patients were males and 3 were females.Topical agents used to treat the perineal burns consisted of mafenide (Sulfamylon), gentamicin and silver sulphadiazine. All perineal burns were treated by the open technique. The whirlpool was used two times a day for cleansing and débriding the superficial eschar. Initial wound care, in addition to hydrotherapy, consisted of cleaning the perineum twice a day with a mixture of saline, peroxide and ‘Dreft’, after which the topical agent was applied. Once the eschar was removed, the wounds were prepared for grafting by the use of porcine xenografts or cadaver allografts. Meshed skin grafts were used for final coverage.Pseudomonas aeruginosa was the most common organism recovered; Escherichia coli was a close second. Follow-up on these patients revealed that late complications of the buttocks and perineum were minimal. A colostomy was performed in 1 of the 20 patients. This experience indicated that colostomy is not necessary for the handling of perineal burns and that involvement of the perineum in acute burns can be handled by relatively simple means.