Effects of washing acid injuries to the skin with water: an experimental study using rats

The Epidemiology of Chemical Burns Among the Patients Referred to Burn Centers in Shiraz, Southern Iran, 2008-2018

Objective:

To investigate the prevalence of chemical burns among the patients admitted to Shiraz burn treatment centers.

Methods:

It is a descriptive study that was conducted on 62 patients with chemical burns who were admitted between 2008 and 2018. The patients’ records were used in the research using the census sampling process. A questionnaire with questions about age, sex, the extent of the burn, the cause of the burn, duration of hospital stay, level of education, incident location, and clinical outcome was used to collect data (survival-death). The data was analyzed by using descriptive statistical methods.

Results:

The prevalence of chemical burns was 1% during 2008-2018. Acid and alkali burns were accounted for 93.5% and 6.5% of burns, respectively. 77.4% of patients were male, and 22.6% were female. The mean age of patients was 27 years. The average burn percentage was 16%. 70.6% of patients were illiterate or had primary education. Burns occurred at the workplace and home in 12.9% and 66.1% of cases, respectively. Moreover, Burns occurred due to accident (61%), acid attack (29%), and self-immolation (10%). The average length of hospital stay was 20 days. One patient (1.6%) died from burns.

Conclusion:

The study’s findings revealed that chemical burns were more common in men than women, and the majority of chemical burns occurred at home. To minimize the occurrence of chemical burns and acid attacks, teaching methods of preventing burns is important at home and work, as well as restricting non-specialists’ access to chemicals.

Electrochemical degradation and saponification of porcine adipose tissue

Body contouring achieved via subcutaneous adipose tissue reduction has notably advanced over the past century, from suction assisted lipectomy to techniques with reduced degrees of invasiveness including laser, radiofrequency, high frequency focused ultrasound, cryolipolysis, and drug-based injection approaches. These costly techniques have focused on damaging adipocyte cell membranes, hydrolyzing triglycerides (TGs), or inducing apoptosis. Here, we present a simple, low-cost technique, termed electrochemical lipolysis (ECLL). During ECLL, saline is injected into the subcutaneous adipose tissue, followed by insertion of needle electrodes and application of an electrical potential. Electrolysis of saline creates localized pH gradients that drive adipocyte death and saponification of TGs. Using pH mapping, various optical imaging techniques, and biochemical assays, we demonstrate the ability of ECLL to induce acid and base injury, cell death, and the saponification of triglycerides in ex vivo porcine adipose tissue. We define ECLL's potential role as a minimally-invasive, ultra-low-cost technology for reducing and contouring adipose tissue, and present ECLL as a potential new application of an emerging electrochemical redox based treatment modality.

An esthetic modification of a nasal conformer

Facial contractures caused by burns can collapse the nasal aperture and lead to airway obstruction. Management in such situations requires surgical and prosthetic intervention. Prosthetically, although a nasal conformer is the treatment of choice, even a well-fabricated nasal conformer may be esthetically unappealing and require an aid for enhanced retention. Expensive implant-aided conformers are not always a viable option. This article introduces a technique for fabricating a nasal conformer that is both esthetically appealing and cost-effective. The technique is illustrated by the treatment of a 12-year-old girl who presented with a history of burn injuries leading to nasal contracture that was effectively managed with this concept.

Guidelines for Bystander First Aid 2016

Cardiac life support is a form of first aid for cardiac emergencies. However, research and evidence in this field is lacking compared with other forms of first aid. Having identified the common emergencies that are encountered in the hospital, based on the available evidence, we have put together what could be an evidence-based approach to the first aid management of some of these common emergencies, viz. breathlessness, chest pain, allergies, stroke, heat injury, poisoning, unconsciousness, seizures, and trauma situations such as bleeding, wounds, contusions, head injury, burns and fractures. Educating the public is the key to developing a first responder bystander. These guidelines could become the basis for training of the public.

A case of chemical assault in Hong Kong (case report)

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A case report highlighting a unique protocol for the acute management of chemical burns in Hong Kong.

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Urgent (<48 h) shaving of chemical burns removes residual chemical load and prevents progressive continuing acid corrosion.

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Shaving tangentially to lacuna-like or punctate bleeding, optimally preserves healthy and viable tissues.

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Delay in surgical interventions had been associated with higher incidences of hypertrophic scarring and need for further reconstructive surgery.

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Trying to prove benefit in terms of an RCT is however ethically challenging.

Introduction

This case report aims to raise awareness of the unique protocol developed in the Prince of Wales Hospital (PWH) in Hong Kong, for the acute management of acid assault burns. Chemical assaults are rare in the UK, although, previously there have been several high-profile cases in the past three decades. In Hong Kong, acid assaults are more common, and a unique strategy has been developed to deal with the immediate injury.

Presentation of case

This case report describes a 16-year-old girl assaulted with an acid solution by her 17-year-old ex-boyfriend. She sustained an 8% TBSA burn involving her face, upper-limbs and back. Immediate lavage was commenced at the local hospital prior to transfer to the PWH burn centre. She underwent urgent (<48 h) EUA in theatres and her burns were tangentially shaved to active bleeding. She then received 48 h of saline soaks changed two-hourly prior to definitive treatment.

Discussion

The conventional strategy for acid burns had been continuous lavage for two to three days, followed by delayed shaving and grafting. Outcomes were often poor with disproportionate needs for reconstructive procedures compared to thermal burns. Since introducing the new protocol three-years ago, outcomes have improved and can be quantitatively assessed in terms of decreased reconstructive needs.

Conclusion

The benefits of urgent reduction in chemical load is intuitively obvious, and by shaving tangentially to bleeding, vital tissue is preserved. Trying to prove benefit in terms of an RCT is however ethically challenging.

Acid violence in Cambodia: the human, medical and surgical implications

INTRODUCTION

Acid violence is the deliberate use of acid to attack another human being. Such attacks leave a terrible human, medical and surgical legacy. This study, from one of the largest cohorts of acid attack victims to date, provides insights into Cambodia's unique demographics of such attacks, as well as the human cost and necessary surgical interventions.

METHODS

A retrospective cohort consisting of all patients presenting to the Children's Surgical Centre, Phnom Penh with acid burns from 1 January 2000 to 1 January 2013 was identified and information retrieved from their hospital records.

RESULTS

254 patients were identified. Males and females were almost equally likely to be victims of an acid attack (48.4% and 51.6% respectively). There was no significant association between victim and assailant gender (p=0.475). The face (78.0%), neck (51.5%) and chest (49.0%) were the most frequently affected body areas. The median total surface body area affected by acid burns was 7.0%. The mortality rate from acid assault was 2.0%. Patients required an average of 2.0 operations, ranging from 0 to 18.

CONCLUSIONS

Acid violence in Cambodia has a complex demographic which is different to many other developing countries and requires more investigation. Tougher legislation is required to reduce the incidence of these horrific crimes.

Occupational chemical burns: a 2-year experience in the emergency department

Chemical burn injuries are a result of exposure to acid, alkali, or organic compounds. In this retrospective study, a total of 21 patients suffering occupational chemical burns, came to the emergency room at the University General Hospital of Alexandroupolis, from 2008 to 2010; 76.2% were workers, 19% were farmers, and 4.8% were desk officers. The majority of burns were due to exposure to acid (61.9%). Upper extremities were the most frequently injured area followed by the lower extremities and thorax. None of the patients needed further hospital care, but in the follow-up, four of the patients suffered keloid. Proper surgical treatment at the emergency room decreases the length of hospital stay for patients who suffer chemically induced burns.

Chemical burns: pathophysiology and treatment

Chemical burns continue to pose a variety of dilemmas to the clinician managing such cases. Assessment of burn depth is often difficult and the decision whether to excise the wound early is not always clear-cut. In this updated review, common agents are classified and the basic principles of management and specific recommendations are examined. The complications arising from exposure to these chemicals and the supportive measures needed during treatment are also described.

Sulfuric Acid Burns (Corrosion and Acute Irritation): Evidence-Based Overview to Management

Concentrated sulfuric acid causes severe skin injury. To prevent skin destruction, efficient early treatment is of utmost importance. However, regimens suggested in the literature are not always supported by experimental data. Further studies are needed. To improve early management of sulfuric acid burns, future experiments need careful extrapolation between animal skin and human skin. The benefit of water, neutralizer, or alternative agents has to be established by precisely defining acid concentration and time of exposure.

Chemical assaults in Hong Kong: a 10-year review

The aim of this study was to assess the patients admitted to Prince of Wales Hospital Burns Unit, Hong Kong between September 1991 and August 2001 following chemical assault. A total of 2319 burns were admitted during the study period of which 19 had been subjected to chemical assault. All victims sustained a burn injury to the head and neck area and 47% of victims' eyes were burnt. A total of 84% required surgical intervention. Where a reason for the attack was admitted most were due to relationship difficulties. This study has defined the victims of chemical assault in Hong Kong. At a time when the overall number of assaults in Hong Kong is at its lowest level for 5 years it is of concern that there appears to have been a recent increase in the number of chemical assaults in Hong Kong.

Epidemiology of domestic chemical burns in Saudi Arabia

The authors reviewed the domestic chemical injury experience in two major government hospitals in Saudi Arabia to determine the most common causative agents and the circumstances of the injury in order to give recommendations for their prevention and reduction of their morbidity. A total of 59 cases were included. The mean age was 25 years and the male to female ratio was 3:1. Alkali drain cleaners were the major cause of chemical burns in the series and this was seen in 75% of the total study population. The remaining 25% of cases resulted from concentrated sulfuric acid, car battery acid and topical application of medical herbs by non-professionals. Unfortunately, immediate water lavage was not done in the majority of alkali and acid burns and hence skin grafting was required in most patients. It was concluded that efforts for prevention of chemical burns in Saudi Arabia should be directed towards education of the population regarding the proper use of alkali cleaners for clogged drains. These cleaners and battery acid containers should also be kept in a safe place away from the reach of children. Furthermore, a warning to the public regarding the non-professional use of medical herbs should be given. Finally, increased awareness among the Saudi population as to the need for prompt water irrigation of chemical burns should help reduce the morbidity from these injuries.

Chemical burn caused by topical vinegar application in a newborn infant

Although there is increasing interest in "alternative medicine," including nontraditional and homeopathic remedies, all around the world, they are not always safe and beneficial and may have adverse effects. We report a chemical burn caused by vinegar applied topically to lower body temperature in a febrile newborn and discuss briefly chemical skin burns caused by organic acids.

A standard burn model using rats

Experimental burn models are always needed, being essential for burn research. In the present study, we describe a standard Fischer F-344 rat burn model, in which burns are produced with a heated brass bar. The animals were anesthetized with ketamine (90 mg/kg). After the burns, they were resuscitated with saline. Burns ranging from 26% to 30% of total body surface area resulted in a 62.5 % mortality rate after 25 days. This model is an additional option for those interested in burn research.