Machado P, Barbosa T, Jarnalo M, Mendes M, Brito I, Horta R, Egipto P
Hospital Universitário São João, Porto, Portugal.
Ann Burns Fire Disasters. 2023 Dec 31;36(4):317-319. eCollection 2023 Dec.
Despite current workplace protection measures, chemical burn accidents are not uncommon. Among these, alkali burn is the most challenging due to its silent behaviour and aggressive mechanism. Characterized by its initial painless onset, allowing a prolonged exposure, it tends to result in deeper and more destructive burns, creating major reconstructive and therapeutic challenges. This case concerns a 53-year-old male who sustained a full thickness burn of his left instep foot after prolonged contact with an alkali substance. The wound was submitted to several surgical debridement procedures, with preservation of the major tendinous and vascular-nervous structures. The skin defect was then repaired with skin graft. Early recognition and prompt management with copious and prolonged wound irrigation is paramount. As in this type of burn it is difficult to initially assess its true depth, even after initial surgical debridement, a more cautious approach is recommended. Chronic pain is associated with chemical burns and it should be treated early in the process with the use of multimodal analgesia in order to prevent future complications. No matter the absence of major complaints in the 4 week-postoperative evaluation, the possible long-term consequences are still unknown. Despite the prolonged exposure time and the initial presentation with a deep burn, after several surgical debridement procedures, preservation of major tendon and neurovascular structures was assured, which allowed a plain approach for reconstruction of the wound with a skin graft. The case illustrates different challenges associated with evaluation and treatment of patients with deep alkali burns. Also, usage auditing and awareness of regular users appear to be essential.
尽管目前有工作场所保护措施，但化学烧伤事故并不罕见。其中，碱烧伤因其隐匿性和侵袭性机制而最具挑战性。其特点是初期无痛，可长时间接触，往往会导致更深、更具破坏性的烧伤，带来重大的重建和治疗挑战。本病例涉及一名53岁男性，他在长时间接触碱性物质后左脚脚背发生全层烧伤。伤口接受了多次外科清创手术，主要肌腱和血管神经结构得以保留。然后用皮肤移植修复皮肤缺损。早期识别并通过大量、长时间的伤口冲洗进行及时处理至关重要。由于在这类烧伤中，即使在初次外科清创后，也很难初步评估其真正深度，因此建议采用更谨慎的方法。慢性疼痛与化学烧伤有关，应在病程早期使用多模式镇痛进行治疗，以预防未来并发症。尽管术后4周评估时没有主要不适主诉，但可能的长期后果仍不明朗。尽管接触时间长且最初表现为深度烧伤，但经过多次外科清创手术后，主要肌腱和神经血管结构得以保留，这使得能用简单的方法用皮肤移植修复伤口。该病例说明了与深度碱烧伤患者评估和治疗相关的不同挑战。此外，对经常使用者的使用情况审核和意识培养似乎至关重要。
