1. years old 2.5
BSAB 21%
Involving back, upper
buttock rt-arm both loin
, area
Scald injury hot milk

5. & All vital signs
investigations done with ideal
results

6. She is doing very well with this large
healthy burnd wound

10. Slow
healing
but
looks
healthy
Pt doing
good

12. SYSTEMIC SKIN ERRUPTION
ARE SET TO START

13. EPIDERMALEXFOLATION
OF EAR SKIN & CHEEKS
SCALP LESION
CRUSTATION+

14. Human GVHD occur after allogenic 
,stem cell transplantation
Acute GVHD describes a distinctive 
syndrome of Dermatitis,Hepatits,&
Enteritis developing within 100 days
of allogenic hematopoietic cell
transplantation
Chronic GVHD describes a more 
diverse syndrome developing after
day 100

15. EXCISION – RE
AUTO GRAFTING
Who agree with

Who agree with SYSTIMIC STEROID
TREATMENT IF STARTED Auto -SKIN
GRAFTING ARE CONTRAINDICATED


16. 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


18. DESQUAMATION & BULLAE

25. Clear face no skin lesion
dramatic response

28. Before
operation
days later 4
After
operation

29. 
Separation of epidermis from dermis (bullae like) (x4)
biopsy 2 cm distant from wound {at un burned skin}

30. 
Irregularity in rete ridges
(x4)

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

32. 
Upper dermal lymphocytic infiltration (x40) path gnomonic
sign of AGVHD in the Skin

34. Auto split thickness
Skin-Graft done

35. 2013 5 11
2013 6 18
Thank you
Dr.qutaiba abdulah aldori
Azadi Hospital kerkuk Iraq