“An unfortunate case of a barbeque burns leading to multi-finger terminalization- how could we have prevented this?”
Michelle JN Ling Henry Li1, 1Western Health, St Albans, Victoria, Australia
Abstract
Introduction:
Circumferential extremity burns can cause significant morbidity if not recognized and treated promptly. We present a case highlighting the importance of early diagnosis, referral and management.
Case:
A 55-year-old lady sustained circumferential burns to her dominant middle, ring and index fingers from a barbeque. First-aid was applied before presenting to the emergency department where the fingers were noted to be mottled, but the circumferential nature of the burns was not appreciated. The patient was discharged and referred to the plastic surgery outpatient clinic without a discussion with the team.
Unfortunately, the fingers were noted to be necrotic to the level of the middle phalanges on clinic review four days later. The patient subsequently underwent an initial debridement and delayed terminalization at the level of the proximal interphalangeal joints. Despite the devastating injury and sequelae, the patient’s wounds have healed well, she is engaging in hand therapy and is psychologically coping admirably.
Discussion:
Escharotomy should be performed immediately in patients with circumferential burns when perfusion is compromised. With early intervention, irreversible tissue ischemia and necrosis leading to terminalization can be avoided (Butts, Holes & Carter, 2020).
Conclusion:
The prevention of adverse outcomes following burns relies on collegiate interdepartmental relationships and ongoing education. Formal teaching sessions have been held in our institution to minimize future adverse outcomes.
References:
1.Butts, CC, Holmes, JH, & Carter, JE 2020, ‘Surgical Escharotomy and Decompressive Therapies in Burns’, Journal of burn care & research : official publication of the American Burn Association, 41(2), 263–269
Biography
Michelle Ling is a surgical resident in Western Health.
Henry Li is a registrar currently training in Victoria.