Annals of the MBC - vol. 3 - n' 3 - September 1990CHEMICAL BURNS - OUR EXPERIENCE OVER ELEVEN YEARS
Sinha S., Sinha J.K., Tripathi F.M., Bhattacharya V.
Burns Unit, Division of Plastic Surgery, Department of Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005 India
SUMMARY. An eleven-year review is made of chemical burns consisting of 59 cases presenting at the University Hospital, Varanasi. Chemical burns are an uncommon entity which require special considerations in management. In the period studied, they constituted 4.7% of all burn admissions. Most cases were intentionally inflicted with acids, following property disputes. The patients were usually in their second, third or fourth decades. Depth of burn at the initial assessment was often found to be fallacious. Ocular involvement was common (30.5%). Slough separation was delayed compared to thermal bums. Hydrotherapy was the mainstay of first-aid and casualty department care. Early debridement and skin grafting yielded good results especially in chemical burns of the ear and hand.
Chemical bums are relatively infrequent and consequently the experience of doctors in any centre is limited. Social development and industrialization influence the type of corrosive involved. Industrial accidents, which constitute a major proportion of cases in the west, are but a small case group in India. We present our experience with chemical burns over the past eleven years at the Burns Unit, Division of Plastic Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi.
Materials and methods
Over the period January 1979 to December
1989 a total of 1248 patients with burns were admitted to the Burns Unit at Varanasi, of
whom 59 had chemical burns (4.7%). Fifty of these patients were in the second to fourth
decades of life (84.8%) while only one patient was less than ten years of age (Table 1).
67.8% of patients were males. Acid burns by far exceeded all other types of burns and
sulphuric acid was the commonest agent (Table 2). Most of the cases were intentionally
inflicted (71.2%) while only 18.6% were accidental. In 10.2% of cases the aetiology was
unknown. In most cases the burns surface constituted less than 15% of total body surface
area (Table 3), with the head being the commonest region affected (74.6%) (Table 4). The
neck and trunk were other areas to be commonly affected. Estimation of depth of burn was
often incorrect initially and frequent reassessment was required subsequently. Most of the
burns were third degree (60%) while about 25% of the burns were second degree, the
remaining being first degree. 18 patients (30.5%) had associated ocular burns while
fractures were present in 4 patients. 5 patients (8.5%) had systemic toxicity owing to
absorption of the chemical.
Separation of slough required a longer
time than in thermal burns and generally occurred between 3 and 5 weeks post-burn. Wounds
were sterile in the first two weeks (80% of patients). Most cases showed bacterial growth
after 30 days (86%). The common organisms involved were Staphylococcus aureus,
Pseudomonas aeruginosa, Proteus and E. Coli in order of frequency. The hospital stay
of these patients was prolonged - generally between 3 and 8 weeks, with one patient
staying 66 days before discharge. Only two patients died and in both cases the cause was
overwhelming septicaemia following burn wound sepsis.
The outstanding feature of chemical
burns is the prolonged period for which the burning effect continues. Most patients in our
region present late (after 24 hours). In patients presenting early, dilution and removal
of the chemical by hydrotherapy is now well established, both as a first-aid measure and
in the casualty department (1, 2, 3). In alkali burns there is a place for hydrotherapy
even in those patients who present late, as there may be a prolonged burning effect at the
subeschar level (4). It is important to minimize the time interval between contact with
the chemical and hydrotherapy (5) and time spent in searching for neutralizing agents
leads to more extensive burns (3).
RESUMÉ. Les Auteurs analysent 59 cas de brûlures chimiques qu'ils ont traitées pendant une période de 11 ans à l'Hôpital Universitaire de Varanasi. Les brûlures chimiques représentent une maladie pas commune qui a besoin d'une gestion toute particulière. Ces patients constituaient 4,7% de tous les brûlés hospitalisés pendant la période. Dans la plupart des cas il s'agissait de brûlures intentionnelles infligées avec des acides, à la suite de contestations pour des questions de propriété. L'âge des patients variait normalement entre 10 et 40 ans. L'évaluation initielle de la profondité de la brûlure au moment de l'hospitalisation se révélait souvent fallacieuse. Les yeux étaient fréquemment affectés (30,5% des cas). La séparation de l'escarre avait lieu en retard par rapport aux brûlures thermales. L'hydrothérapie était à la base du secourisme et des soins pratiqués dans le Service des Urgences. Le débridement précoce et la greffe cutanée ont donné de bons résultats, particulièrement dans les brûlures chimiques de l'oreille et de la main.