2.5 years old 21% BSAB

Involving back, upper buttock rt-arm both loin area, Scald injury hot milk

All vital signs & investigations done with ideal

results

She is doing very well with this large healthy burnd wound

Slow healing

but looks

healthyPt doing

good

SYSTEMIC SKIN ERRUPTION ARE SET TO START

SCALP LESIONSCALP LESION ++CRUSTATIONCRUSTATION

EPIDERMALEXFOLATIONOF EAR SKIN & CHEEKS

Human GVHD occur after allogenic Human GVHD occur after allogenic stem cell transplantationstem cell transplantation,,

Acute GVHD Acute GVHD describes a distinctive describes a distinctive syndrome of Dermatitis,Hepatits,& syndrome of Dermatitis,Hepatits,& Enteritis developing within 100 days Enteritis developing within 100 days of allogenic hematopoietic cell of allogenic hematopoietic cell transplantationtransplantation

Chronic GVHD Chronic GVHD describes a more describes a more diverse syndrome developing after diverse syndrome developing after day 100day 100

Who agree with EXCISION – RE AUTO GRAFTING

Who agree with SYSTIMIC STEROID TREATMENT IF STARTED Auto -SKIN GRAFTING ARE CONTRAINDICATED

Take biopsy from lesion & from unburned skin a maccule 2 cm distant area from the wound.

The allograft are excised ,dressing by sofratule mesh gauze and povidon iodin impregnated gauze bandaging.

DESQUAMATION & BULLAE

Clear face no skin lesion dramatic response

Before Before operationoperation

4 days later After After operationoperation

Separation of epidermis from dermis (bullae like) (x4) biopsy 2 cm distant from wound {at un burned skin}

Irregularity in rete ridges (x4)

Separation of dermis from dermis with upper dermal inflammation (x10)

)

Upper dermal lymphocytic infiltration (x40) path gnomonic Upper dermal lymphocytic infiltration (x40) path gnomonic sign of AGVHD in the Skin sign of AGVHD in the Skin

Auto split thickness Skin-Graft done

1111 55 20132013

Thank you Dr.qutaiba abdulah aldori

Azadi Hospital \kerkuk\ Iraq

1818 66 20132013