In 2024, Jayavarman VII Hospital recorded a total of 406 patients with significant burn injuries. Of these, 225 patients had burns that affected less than 10 percent of the body surface area. 128 patients had injuries that accounted for between 10 percent and 20 percent of their body surface area, while the remaining 53 patients had burns of more than 20 percent of their body surface area.
Although an affected area of 10 percent may not seem like much at first glance, this corresponds to the size of an entire arm, for example. An entire leg, on the other hand, accounts for around 20 percent of the body's surface area. These serious injuries usually require extensive treatment and a long stay in hospital. Despite limited resources, the hospital succeeds in providing complete care through innovative approaches and exceptional commitment, enabling patients to fully regain their quality of life and resume active participation in life.
Accidents in the home are among the most common causes of burn injuries. Other reasons for the high incidence are inadequate childcare and the many open fires at floor level, which are often used for heating or cooking. Furthermore, there are rarely smoke alarms, fire alarms and sprinklers in most homes. Another important factor that could easily be remedied is the lack of general awareness of fire prevention.
Infections, traffic accidents or machine accidents also frequently lead to major skin injuries. One example of this is this girl: She lost part of her scalp when her hair got caught in a machine in an unfortunate incident. Now the integrity of her scalp needs to be restored.
Another challenge is that many families live far away from this hospital. As a result, several hours often pass without adequate acute burn treatment being administered. This includes preventing further burns by cooling the wound, hydration, basic wound care to prevent secondary infection and compensating for evaporative heat and fluid loss - all due to a lack of parental education about first aid.
Another problem is that the necessary care cannot be provided in every region and in every hospital. This is due to a lack of specialist knowledge, appropriately trained staff and insufficient equipment and resources. In Switzerland, we are well-equipped with highly qualified plastic surgeons and unlimited resources. In this children's hospital, however, resources are limited, and a plastic surgeon is not available.
But this is not an obstacle, because every surgeon here knows how to treat burns surgically. If there is no plastic surgeon available, all surgeons have to learn the necessary knowledge and skills.
In the case of superficial injuries with a well-perfused wound bed, the burn is usually covered with full-thickness or split-thickness skin grafts. A battery dermatome is required for the removal. There is only one battery dermatome in this hospital, which is why the surgeons here are also practiced in the manual removal of split-thickness skin and skin grafts. The split skin is then processed into a mesh graft using a mesh technique so that the graft surface is enlarged by a factor of 1.5 to 8. For maximum enlargement, small manual incisions are also made using a scalpel.
In Switzerland, we use BTM (biodegradable temporizing matrix) for more severe, deeper injuries where the wound bed is less well supplied with blood. This is a dermis substitute that is transformed into a high-quality neodermis through vascularization and thus provides a better wound bed for subsequent split-thickness skin grafts. Unfortunately, this option is not available here. Nevertheless, adequate surgical treatment is achieved here despite limited resources. The path to the goal is somewhat more difficult and longer, but the results enable the children to participate fully in life again.
After the wound has been covered, comprehensive aftercare and rehabilitation is necessary. This includes regular check-ups and follow-up treatment, which in some cases must be carried out over several years. The injury must be kept mobile through physiotherapy and occupational therapy, as otherwise contractures can develop that restrict the functionality and range of movement of the affected limbs. Scars often cause chronic pain or sensory disturbances. The patient's self-image and the aesthetic aspect must also be taken into account.
Of course, the psychological care of the patient must not be neglected. As you can see, the complete treatment of burn injuries requires a large team from different specialist areas. However, this cannot be fully guaranteed in this hospital. Scars are treated conservatively here with cortisone therapy, as there is no cryotherapy or laser therapy (yet). Physiotherapists are also not available. Parents are therefore taught how to carry out physiotherapy with their child.
The first and (currently) only child psychiatrist in the entire hospital has also recently started working here. For many families who live far away and do not have the financial means, transportation to the many appointments can be very expensive. However, the hospital provides financial support for families in need so that every child receives comprehensive treatment.
This is just one of many examples of how this hospital uses innovative ideas and a great deal of effort to provide every child with comprehensive and fair treatment.
With best regards from Siem Reap
Anett
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