Annals of Burns and Fire Disasters - vol. XI - n. 1 - March 1998

ASH BURNS - A NEW ADDITION TO THE AETIOLOGY OF BURNS

Bhat F.A., Bhagwat Swaroop Mathur, Hussain M.T, Fawaz Khalil Beidas, Bunyan A.R.

Department of Plastic and Burn Surgery, Riyadh Medical Complex, Saudi Arabia

SUMMARY. We present nineteen patients with ash burns. The patients had sustained burns by walking on charcoal ash that was the result of the ignition of burning charcoal left covered with sand. A description is given of the unusual mode and typical distribution of the burns in relation to the footwear used by the patients.

Materials and methods

In September 1996, nineteen patients presented to the Emergency Department of Riyadh Medical Complex (Saudi Arabia). All except one, who had suffered an extensive burn of 45% 13SA, had burns of the lower limbs. The patients had sustained their burns by walking on ashes that were the result of left-over charcoal fires deliberately abandoned by the authorities in order to exhaust any remains of charcoal. The part of town where the accident happened used to be the wholesale charcoal and wood market, which had been moved to another area, probably to lessen the traffic burden in the busy market area. All the patients had a unique history of accidental walking on charcoal ash that was smouldering under the sand. The remains of the market had been levelled and covered with sand. About a week later, two groups of people, mainly labourers, made a short-cut and drove their vans unwittingly through the area. Half-way across, the tyres of the vans burst and the men jumped out to see what was happening. Next moment, to their surprise, they were shouting and running over the hot ash towards the other side. This walk on charcoal ash ended with a variable distribution of burns in the feet and legs, depending on the kind of footwear used by each individual.
The slow ignition and smouldering of the charcoal was not noticed by the municipal authorities and citizens until an analogous accident happened a week later. The area was then showered by water and the mud was cleared away.
Nineteen patients were admitted to our burns unit in two groups on different dates. Fourteen presented superficial second-degree or deep dermal burns and were treated conservatively with open dressings, while four patients needed tangential excision and skin grafting. One patient with 45% burns died of septicaemia. Another patient who was diabetic also developed osteomyelitis of the proximal phalanx of the right great toe (Figs. 1, 2).
The distribution and depth of the burn varied according as the patients were wearing shoes or slippers or lost their footwear during their escape. A particular kind of sandal (shib) is commonly wom in this country which covers the sole and part of the distal dorsurn of the foot.

Fig. 1 - Scene of accident. Fig. 2 - Smouldering charcoal. Fig. 3 - Burns to soles of the feet. Fig. 4 - Burns to feet. Fig. 5 - Burns to feet. Fig. 6 - Burns to feet and legs.

The patients were grouped as follows, according to the zone of burn:

• sole only (5)
• dorsurn of foot only (7)
• sole and dorsurn (4)
• foot and lower leg (2)
• other areas (1)

A characteristic common to all cases was that both lower limbs were involved in all the cases.

Discussion

The commonest modes of burn injury are flame, scalds, electrical burns, and chemical burns. However, on occasion, we come across unusual ways of suffering burns either due to ignorance or, as in the cases described here, due to walking on ash used to smother smouldering charcoal. The distribution and depth of burn varied in our patients in relation to the type of shoe worn, and the patients were grouped accordingly.
The persons wearing shoes sustained burns of the dorsum and ankle region, as well as the side of the foot where hot ash filled the shoe. The sole either was not burned or suffered superficial burns.
In persons wearing sandals the sole and dorsum were equally and deeply involved, and the lower legs were not spared. The patients who lost a foot sustained deep burns of the sole that required surgery.
One patient fell while running away. His clothes ignited and he sustained severe 45% TBSA burns and subsequently died of septicaemia in our burn intensive care centre.
As the skin of the sole is thick, with protective layers of keratin, most of the wounds healed with conservative treatment. Four patients needed excision and skin grafting.

RESUME. Les Auteurs présentent dix-neuf cas de brûlures causées par des cendres chaudes. Les patients ont marché sur des char bons couverts par du sable. La modalité inusuelle et la distribution caractéristique des brûlures par rapport au type de chaussure sont présentées.

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