[Chemical burns of the hand and upper limb: therapeutic approach]

Clinical burns of the hand and the upper limb induce various lesions, depending on the degree of tissue penetration and their aggressive properties; strong acids, particularly sulfuric acid and strong bases such as lime are the most dangerous. The clinical attitude should be surgical. Early skin excision, as economic as possible, will be indicated, taking into account the difficulties of precisely determining the limit between normal and necrotic tissues; fluorhydric acid, rapidly dissociates into H+ and Fl- which, because of its small size, will rapidly penetrate deeply into the blood circulation. Moreover this molecule has the peculiar power to provoke marked hypocalcemia able to cause death, due to its avidity for Ca++, with a subsequent cellular lysis. There is currently an increase in domestic accidents, as fluorhydric acid is present in several scouring solutions; in every case of chemical burns, the main treatment remains emergency washing with water possibly, followed by a specific neutralization; skin excision must be the rule when the power of neutralization is limited, because of the risk of progressively deepening lesions due to the presence of residual scouring solutions.