[Danger in the pocket: explosive e-cigarette]

Be it as a nicotine replacement or a fashionable seduction for young people or casual smokers with or without nicotine additives - the popularity of e-cigarettes in Europe has increased during the past decade. In addition to the potential of long-term pulmonary damage, which is still largely unknown to date, there is a risk of battery explosion with specific injury patterns. Most users are unaware of the danger in their pockets.

Between February and July 2019, four patients were treated with burns from exploded e-cigarettes in the burn centre at Sana Hospital in Offenbach am Main (Germany). This article describes the cause and extent of the injury and its treatment.

In all patients, the cause of the explosion was what is called "thermal runaway" (very rapid discharge of the battery). The average age of the patients, who were exclusively male, was 37 (25-50) years. The combustion depth ranged from grade I to deep grade IIb. The burnt body surface averaged 3 % (0.5-4.5 %) TBSA and affected the body regions that are typically in direct contact with the e-cigarette: thighs, genitals and hands. Conservative treatment was successful in one case and surgical treatment in two cases (two alloplastic covers, one meshed split-skin transplant). One patient discharged himself from hospital against medical advice after initial treatment. The average time in hospital for the three remaining patients was 15.6 days (6-17).

Burns from an exploding e-cigarette represent a rare new entity. The force of the explosion of the battery body leads to injury patterns that require treatment in specialised centres with the entire spectrum of burn care. Mixed injuries with deep burns occur at the predilection sites due to thermal action, colliquative necrosis due to leaking electrolyte fluid and contamination by foreign bodies (metallic lithium, splinters of the destroyed housing) and require special initial measures. The extinction of fire caused by e-cigarettes also requires special measures. Proper handling of CE-certified devices is essential. Manipulation of the device in the event of defective functions or defective batteries is highly dangerous and should be strictly prohibited. General security requirements must be observed.