Leung B C, Burd A
Plastic Surgery CT1, John Radcliffe Hospital, Oxford, UK.
Consultant Plastic Surgeon, Prince of Wales Hospital, Hong Kong.
Int J Surg Case Rep. 2015;10:223-7. doi: 10.1016/j.ijscr.2015.03.059. Epub 2015 Apr 4.
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.
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 (<48h) EUA in theatres and her burns were tangentially shaved to active bleeding. She then received 48h of saline soaks changed two-hourly prior to definitive treatment.
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.
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.
本病例报告旨在提高对香港威尔士亲王医院（PWH）制定的针对酸性袭击烧伤急性处理的独特方案的认识。化学袭击在英国较为罕见，尽管在过去三十年中有几起备受瞩目的案例。在香港，酸性袭击更为常见，因此已制定了一种独特的策略来处理即时损伤。
本病例报告描述了一名16岁女孩被其17岁前男友用酸性溶液袭击。她全身烧伤面积达8%，涉及面部、上肢和背部。在转至PWH烧伤中心之前，当地医院立即开始进行冲洗。她在手术室接受了紧急（<48小时）的扩创术，烧伤创面进行了削痂直至出血。然后在进行确定性治疗前，她接受了48小时的生理盐水浸泡，每两小时更换一次。
传统的酸性烧伤治疗策略是持续冲洗两到三天，随后延迟削痂和植皮。与热烧伤相比，重建手术需求不成比例，结果往往较差。自三年前引入新方案以来，结果有所改善，并且可以根据重建需求的减少进行定量评估。
紧急减少化学负荷的益处直观上很明显，通过削痂直至出血，重要组织得以保留。然而，从随机对照试验的角度证明其益处存在伦理挑战。
