title: The nitric acid burn trauma of the skin.
abstract: 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 degrees burns received open therapy with panthenol-containing creams. Wound of II degrees 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 degrees depth) and occlusive, antiseptic moist bandages in combination with enzymatic substances for IIb degrees -III degrees 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.
authors.affiliation: Department of Trauma, Plastic and Reconstructive Surgery, Georg-August University of Goettingen, Robert-Koch-Str. 40, 37075 Goettingen, Germany. leilakolios@freenet.de
authors.forename: L
authors.initials: L
authors.lastname: Kolios
authors.forename: E
authors.initials: E
authors.lastname: Striepling
authors.forename: G
authors.initials: G
authors.lastname: Kolios
authors.forename: K-D
authors.initials: KD
authors.lastname: Rudolf
authors.forename: K
authors.initials: K
authors.lastname: Dresing
authors.forename: J
authors.initials: J
authors.lastname: Dörges
authors.forename: K M
authors.initials: KM
authors.lastname: Stürmer
authors.forename: E K
authors.initials: EK
authors.lastname: Stürmer
mesh_terms: D000287:Administration, Topical; D000293:Adolescent; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D001458:Bandages; D002057:Burns, Chemical / Q000175:diagnosis* / Q000628:therapy; D053834:Explosive Agents / Q000009:adverse effects*; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D017942:Nitric Acid / Q000009:adverse effects*; D009824:Ointments; D010205:Pantothenic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives*; D012837:Silver Sulfadiazine / Q000008:administration & dosage*; D012867:Skin / Q000187:drug effects / Q000293:injuries* / Q000473:pathology; D007507:Therapeutic Irrigation; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D014945:Wound Healing / Q000187:drug effects
chemical_list: D000891:Anti-Infective Agents, Local; D053834:Explosive Agents; D009824:Ointments; D010205:Pantothenic Acid; C007288:dexpanthenol; D017942:Nitric Acid; D012837:Silver Sulfadiazine