The use of diverting colostomies in paediatric peri-anal burns

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 colos tomies (to counteract deep wound infection and septicaemia with gut-derived organisms) in five patients and one colostomy in a cerebral palsy child wi th a left hemiparesis. A sigmoid end-colostomy with Hartmann's closure of t he distal segment was the preferred method of choice. In all children but o ne (died from multi-organ failure 13 days after admission) there was a mark ed improvement in the clinical appearance of the burn wounds and subsequent graft-take and healing. There was a change in the bacterial profile away f rom predominantly gut-derived Gram negative organisms to either Pseudomonas aeruginosa or no pathological organisms grown. Complications were few - tw o children suffered prolapse of their colostomy requiring manual reduction. We advocate diverting colostomies in a highly select group of paediatric b urn patients in whom continual faecal soiling is threatening to both graft and life. (C) 1999 Elsevier Science Ltd and ISBI. All rights reserved.