Chemical burns: pathophysiology and therapeutic protocols-do cervico-facial injuries pose specific challenges?

Abstract

Chemical burns, though relatively rare, present significant diagnostic and therapeutic challenges due to their complex pathophysiology and the need for specialized care. A retrospective study was conducted, examining the characteristics, treatment, and outcomes of 33 patients with chemical burns admitted to our burn center for 8 years, representing 4.39% of all burn cases. Among them, 15 patients (45.45%) had chemical burns on the face and neck. The majority of these patients were men, with a relatively younger average age, and a significant proportion had work-related accidents. The burned surface area was variable, with many patients sustaining small total body surface area (TBSA), although some presented with extensive involvement. The prevalence of superficial partial-thickness burns was higher, but deep partial-thickness and full-thickness burns were also common. A large proportion of patients had favorable Abbreviated Burn Severity Index (ABSI) scores, indicating a high probability of survival. However, ocular involvement was a major complication. The study emphasizes the importance of timely intervention, including appropriate wound management strategies, specialized dressings, and skin substitutes. The findings also stress the need for a multidisciplinary approach, close monitoring, and adherence to safety protocols to optimize outcomes and minimize long-term complications in patients with chemical burns, particularly those of the face and neck region.

Keywords: burns; chemical agents; dressings; surgical treatment; therapeutic algorithm.

Figure 1

Etiological agents of chemical burns

Figure 2

Etiologic agents of face and neck chemical burns

Figure 3

Advanced wound dressings in burn management. A, Aquacel Ag Burn Hydrofiber, a non-woven hydroentangled dressing comprised of hydrofiber (sodium carboxymethylcellulose) with nylon thread; B, Integra following a deep burn excision, the dermal matrix with the overlying silicone epidermal layer was applied; C, Epicite Hydro, a hydro-active dressing that creates a moist and supportive environment for wound healing used in a patient with chemical burns on the face.

Figure 4

Sodium hydroxide (caustic soda) chemical burns and reconstruction. A, Acute full-thickness facial burns, including periocular involvement; B, upper limb; C, lower limb; D, Skin grafts in the upper limb; E, Skin grafts in the lower limb.

Figure 5

Reconstruction of facial chemical burns with split-thickness skin grafts. A, B Full-sheet split-thickness skin grafts used for definitive coverage after the excision of chemical burns on the face; C, Postoperative aspect on day 30 after skin grafting.

Figure 6

Therapeutic algorithm of chemical burns: particularities of cervico-facial burns