The Nitric acid burn trauma of the skin

• Published in: Journal of plastic, reconstructive & aesthetic surgery reconstructive & aesthetic surgery, 2010-04, Vol.63 (4), p.e358-e363
• Main Authors: Kolios, L, Striepling, E, Kolios, G, Rudolf, K.-D, Dresing, K, Dörges, J, Stürmer, K.M, Stürmer, E.K
• Format: Article
• Language: English
• Subjects: Administration, Topical; Adolescent; Anti-Infective Agents, Local - administration & dosage; Bandages; Burns, Chemical - diagnosis; Burns, Chemical - therapy; Chemical burn; Explosive Agents - adverse effects; Follow-Up Studies; Humans; Middle Aged; Nitric acid; Nitric Acid - adverse effects; Ointments; Pantothenic Acid - administration & dosage; Pantothenic Acid - analogs & derivatives; Plastic Surgery; Silver Sulfadiazine - administration & dosage; Skin; Skin - drug effects; Skin - injuries; Skin - pathology; Therapeutic Irrigation; Trauma Severity Indices; Treatment; Treatment Outcome; Wound appearance; Wound Healing - drug effects; Young
• ISSN: 1748-6815; 1878-0539
• DOI: 10.1016/j.bjps.2009.09.001

Summary Nitric acid burn traumata often occur in the chemical industry. A few publications addressing this topic can be found in the medical database, and there are no reports about these traumata in children. A total of 24 patients, average 16.6 years of age, suffering from nitric acid traumata were treated. Wound with I° burns received open therapy with panthenol-containing creams. Wound of II° and higher were initially treated by irrigation with sterile isotonic saline solution and then by covering with silver-sulphadiazine dressing. Treatment was changed on the second day to fluid-absorbent foam bandages for superficial wounds (up to IIa° depth) and occlusive, antiseptic moist bandages in combination with enzymatic substances for IIb°–III° burns. After the delayed demarcation, necrectomy and mesh-graft transplantation were performed. All wounds healed adequately. Chemical burn traumata with nitric acid lead to specific yellow- to brown-stained wounds with slower accumulation of eschar and slower demarcation compared with thermal burns. Remaining wound eschar induced no systemic inflammation reaction. After demarcation, skin transplantation can be performed on the wounds, as is commonly done. The distinguishing feature of nitric-acid-induced chemical burns is the difficulty in differentiation and classification of burn depth. An immediate lavage should be followed by silver sulphadiazine treatment. Thereafter, fluid-absorbent foam bandages or occlusive, antiseptic moist bandages should be used according to the burn depth. Slow demarcation caused a delay in performing surgical treatments.