Cement burns and their treatment

CEMENT BURNS

BACKGROUND

Burns are a common condition presenting to the emergency department; the majority are thermal burns. The treatment for thermal burns and chemical burns differs greatly, and prompt recognition of a chemical burn is necessary. An often unrecognized and underestimated type of chemical burn is an alkali burn from wet cement.

CASE REPORT

A 7-year-old boy was transferred from an outside facility for evaluation of burns after exposure to wet cement. The patient underwent partial decontamination at the outside facility with polyethylene glycol and, to prevent ongoing alkali burns, the patient necessitated further decontamination with irrigation. Burn surgery was consulted for additional evaluation. The patient required no further intervention and the patient was discharged to home and made a full recovery. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Serious morbidity and mortality can occur from unrecognized cement burns, and early decontamination and evaluation by a burn surgeon is necessary. It is critical that emergency physicians both recognize and appropriately treat this condition in a timely manner to prevent adverse outcomes.

[Cement burns: a 10-year retrospective study in our burn unit. About 55 cases]

SUBJECT

Although cement burns represents only a small percentage of admissions to burn centers, their diagnosis and treatment are specific. Our retrospective study concerns all patients treated for cement burns in our unit between 1999 and 2009. This is the largest series described.

PATIENTS AND METHOD

Fifty-five patients, aged from 23 to 63, were treated in our burn unit from 1999 to 2009. A review of medical and socioeconomic data was made from computer data files.

RESULTS

This population is predominantly male, young and active. These burns occurred mainly in a domestic accident situation (78.2%). Burns were limited but deep and concerned especially lower limbs. The average duration of treatment was 39days. Forty-four patients were treated medically. The mean duration of sick live for these patients was 63 days. It was only of 21 days for those treated surgically. Aesthetic and functional sequelae were present in 88% of medically treated patients and in 18% of patients treated surgically.

CONCLUSION

This study demonstrates that early surgical diagnosis and the coverage (care) of these burns allows to limit the socioeconomic echo and to reduce the risk of after-effects for this population of patients mainly young and active. The necessity of strengthening the precautionary measures with these users who are informed enough about the risks incurred during the misuse of the cement is also a reality.

Skin burned by contact with flagstones made of cement

Chemical burns account for few admissions to burns units. A well-known but rare cause is wet cement. We present a case where a man had a full-thickness skin burn after contact with flagstones made of cement.

Cement-related injuries: review of a series, the National Burn Repository, and the prevailing literature

The spectrum of cement-related injuries encompasses contact dermatitis, abrasions, ulcerations, chemical burns, and burns from explosions during the manufacturing process. The purpose of this study was to compile cement-related conditions seen in two burn units (1999-2005), literature case reports and series (1950-2006) and the (1989-2001) National Burn Repository (NBR). There were 3597 admissions in two Midwestern burn units, of which 12 cases (0.8%) were cement burns. They occurred in men, aged 15 to 64 years with a burn range of 0.25 to 10% TBSA, exposure time of 1 to 6 hours, treatment delay of 1 day to 2 weeks, hospitalization (2-14 days). Literature review of 109 cases indicated that cement-related injuries were predominantly seen in men, aged 26 to 45 years; with a cement-exposure time of 1.5 to 4 hours, treatment delay (1 day to 5 weeks), hospitalization (10-33 days), and healing time (2-7 weeks). There were 52,219 burn admissions in the NBR, of which 44 (0.08%) were cement-related burns; 95% were men with a mean age of 41 years, 6% TBSA cement burn and an 8-day hospital stay. The demographic characteristics of the burn units and NBR cases were similar to those in the literature. This preventable injury occurred primarily in the working age male patient and was associated with long healing times. Public awareness and enhanced manufacturer package warnings and education may decrease future cement-related injuries.

Cement burns: Retrospective study of 18 cases and review of the literature

SUBJECT

Cement is increasingly used in the construction industry, but the occurrence of cement burns is rarely reported. This retrospective study concerns patients treated for cement burns in our unit between 1997 and 2002.

MATERIALS AND METHODS

Eighteen patients 18-64 years of age, treated previously in our unit for cement burns, were interviewed by telephone for evaluation.

RESULTS

The mean time since treatment was 39 months. Burns were predominantly seen on the lower limbs, and a third occurred during an accident on the job. All deep burns were excised, and 16 patients received grafts. Mean hospital stay was 10 days, and mean sick leave 2 months. Our study indicated that all patients were poorly informed about cement-related risks.

DISCUSSION

Surgical treatment of full-thickness cement burns at diagnosis enables rapid healing with a minimum of sequelae and reduces the high socioeconomic costs resulting from these lesions.

CONCLUSION

This study indicates once again the need to improve preventive measures; which are very often inadequate because of lack of awareness of risks.

Chemical injuries: the Tasmanian Burns Unit experience

BACKGROUND

Chemical burns account for relatively few admissions to a burns unit. These injuries, however, deserve separate consideration because of their ability to cause continuing tissue destruction, their potential to cause systemic toxicity and the value of early treatment with copious lavage. Widespread inexperience in the treatment of chemical burns highlights the potential for greater levels of general awareness and knowledge.

METHODS

A review of 31 patients with chemical injuries admitted to the Tasmanian Burns Unit at the Royal Hobart Hospital (RHH) was carried out for the years 1989-1999.

RESULTS

The majority of patients were men aged 20-49 years (mean age: 32 years). Fifty-one per cent of injuries occurred in a domestic and 38% in an industrial setting. The more common aetiological agents were cement (25%), sulphuric acid (16%) and hydrofluoric acid (16%). The upper and lower extremities were involved in all but four patients and the mean total body surface area affected was 3.4%. The mean length of hospital stay was 9 days with a range of 1-30 days. Management of injuries consisted of either surgical or conservative treatment. The former included debridement and split-thickness skin grafting or primary closure and the latter of topical treatment with 1% silver sulfadiazine cream and appropriate dressings.

CONCLUSION

Widespread inexperience in the treatment of chemical injuries highlights the potential for greater levels of knowledge. This is particularly apparent in the early management of these injuries.

Cement burns: a review 1960-2000

We review the literature on cement burns of the skin published during the last 4 decades. 51 case reports were analyzed with special regard to common modes of injury, localization of cement exposure, preventive measures taken and treatment. Cement burns are injuries concerning professionals at the workplace as well as amateurs during do-it-yourself work. In 49% of the cases, no attempt to protect the skin had been made. The majority of injuries were located on the lower legs and knees. Full-thickness burns were reported in 66% of cases. Surgery had to be performed in 34%. Cement burns can be avoided by adequate skin protection. Although acute cement injuries may seem rare, prospective studies should be carried out for correct estimation of prevalence. The need for information on the harmful properties of cement in the occupational as well as the domestic environment is emphasized.

Kerosene stove as a cause of burns admitted to the Ain Shams burn unit

Kerosene stoves are in widespread use for cooking and warming water in underprivileged areas in Cairo. These stoves are dangerous and lack safety measures; they are often a cause of fire incidents and burn injuries. During the period from May 1995 to December 1996 the number of patients who presented to the burn unit of Ain Shams University, Cairo, Egypt was 759, of whom 304 (40%) sustained the injury as a consequence of kerosene stove fires. Efforts to inform the public about the danger of these stoves are recommended to minimize the incidence, morbidity, mortality and cost of this relatively common and preventable type of injury.

Classification and specificity of cement burns

In this report cement burns are divided into abrasion, heat and explosive type according to the cause or to the environment in which the injury occurred. This classification reflects the obvious differences in the cause, damage factors, specificity of wounds and clinical manifestation of the various types of cement burns.

Specificity and treatment of thermal and inhalation injury following an explosion in a cement manufacturing kiln

Six patients sustained a unique type of burn injury while working during the manufacture of cement in China. These patients suffered a combination of chemical and thermal injuries with extensive deep burns and inhalation injury, when they were involved in an accidental explosive leakage of cement from a manufacturing kiln. This report discusses the aetiology of the burn injury and the principles of treatment. All of these burns were preventable.