Local Tissue Flaps: Definitive Treatment for Chronic Blisters After Chemical Burns

Abstract

Chronic blistering in grafted burn wounds is an infrequently described but severely debilitating complication that can appear after alkali burns and seems to coincide with a delay in initial treatment. Histological studies have concluded that the pathogenesis of chronic subepidermal blister formation in previously grafted burn wounds is related to abnormalities in the basement membrane. Although several reports have described this problem, none have reported adequate treatment for the chronic blistering in previously grafted alkali burns. The authors describe the case of a 30-year-old man in whom caustic soda burns treated with excision and split-thickness skin grafting resulted in chronic subepidermal blistering that failed to improve over the next 2 years. The problem was resolved with full-thickness skin excision and reconstruction with bipedicled fasciocutaneous flaps.

Recalcitrant Caustic Burn Wound and Definitive Treatment with Medial Plantar Flap

“…If early excision and skin grafting operation chances are missed, delayed surgical treatment may necessitate deeper excision and flap surgery. [5] Nevertheless, in this reported case, even though an early excision and skin grafting was performed ten days after the burn, the patient still encountered a total graft lysis due to delayed blisters three weeks after the initial operation. Recurrent graft loss even after the third operation, in this case, necessitated a definitive treatment with medial plantar flap.…”

“…[7] Likewise, blistering of the skin graft after caustic burn is also rare. [5,9] To the best of our knowledge, repeated episodes of blistering and necrosis following alcali burn is reported only for one case in a long term follow-up period. Besides, recurrent graft lysis in a few weeks after total skin graft take without any trauma is an unusual complication for most of the burn cases.…”

“…[9] The caustic burn may have a deceptively superficial appearance concealing the chemical reactions that further damage the tissue. [5] Therefore, early surgical interventions with flap options should be kept in mind as the primary treatment option for an alcali burn, instead of applying dressings for the long term. During initial surgery, excision depth of the affected site should be determined by considering the recurrent blistering nature of the skin graft after caustic burn.…”

“…[3,4] Unlike thermal injuries, caustic chemicals cause destruction in the tissue even long after the initial exposure. [5] Sodium hydroxide burn is still an ongoing, underestimated and rarely reported problem for domestic environments.…”