The acute management of acid assault burns: A pragmatic approach

This case series comprises 31 patients who were victims of acid assault burns. They were admitted for acute or reconstructive care to a regional burns unit. Ten patients were admitted late with suboptimal acute care and needed a total of 50 reconstructive procedures. Of 13 patients admitted acutely, 7 had surgery performed after 48 hours of constant lavage while seven had urgent surgical debridement within 48 hours, followed by lavage. Although the number of reconstructive procedures performed in these two groups was similar, i.e., 20 and 19, respectively, the magnitude of the deformity in the urgent surgery group was significantly less than in the conventional surgery group. As in many cases of acute burns care, determining the evidence for best practice using a prospective, randomised, controlled comparison of conventional versus urgent surgery is difficult in view of the small number of cases involved. However, basing surgical practice on ethical principles, and in particular 'primum non nocere,' we propose that the urgent reduction of the chemical load on the skin by surgical debridement is appropriate in selected cases and should be considered in the acute management of these devastating injuries.