An algorithmic approach to the treatment of hydrofluoric acid burns

doi:10.1016/0305-4179(95)00025-7

Burns

Volume 21, Issue 7, November 1995, Pages 495-499

https://doi.org/10.1016/0305-4179(95)00025-7 Get rights and content

Abstract

Hydrofluoric acid (HF) injuries have a potential for both systemic toxicity as well as severe tissue destruction. We present an algorithm for the management of HF burns. This algorithm addresses these issues emphasizing the differences between major and minor cutaneous burns, and includes the approach to inhalation, ingestion and eye injuries. Although algorithms can never be complete, we hope this algorithm will be used as an aid in the clinical management of these patients.

References (22)

JG Miller et al.
An algorithmic approach to the management of cutaneous burns
Burns
(1992)
WJ Anderson et al.
Hydrofluoric acid burns of the hand: mechanism of injury and treatment
J Hand Surg (Am)
(1988)
MV Vance et al.
Digital hydrofluoric acid burns: treatment with intraarterial calcium infusion
Ann Emerg Med
(1986)
EM Caravati
Acute hydrofluoric acid exposure
Am J Emerg Med
(1988)
TG Mayer et al.
Fatal systemic fluorosis due to hydrofluoric acid burns
Ann Emerg Med
(1985)
Armstrong RF, Bullen C, Cohen SL Singer M, Webb AR. Critical Care Algorithm. The management of burn/smoke inhalation....
RJ Greco et al.
Hydrofluoric acid induced hypocalcaemia
J Trauma
(1988)
DG Dibbell et al.
Hydrofluoric acid burns of the hand
J Bone Joint Surg
(1970)
RE Iverson et al.
Hydrofluoric acid burns
Plast Reconstr Surg
(1971)
MA Trevino et al.
Treatment of severe hydrofluoric acid exposures
J Occup Med
(1983)

MA MacKinnon

Hydrofluoric acid burns

Dermatol Clin

(1988)

Cited by (45)

The use of blood purification in the treatment of hydrofluoric acid poisoning
2022, Asian Journal of Surgery
Updates on the Evaluation and Management of Caustic Exposures
2022, Emergency Medicine Clinics of North America
Application of calcium nebulization for mass exposure to an accidental hydrofluoric acid spill
2020, Burns
To determine the long-term prevalence and characteristics of acute hydrofluoric acid (HF) exposure in 2223 patients during the first 30 months after a mass-casualty exposure, and to confirm the antidotal effect of nebulized calcium on inhalation burns caused by HF.
This observational cohort study included patients after an HF spill in the Republic of Korea on September 27, 2012; registered patients were followed until April 2015. We assessed toxic effects, distance from spill, degree of acute poisoning, and the effect of nebulized calcium in HF-exposed individuals.
Overall, 2223 patients received emergency management or antidote therapy for 20 days. Seventy-four of 134 patients with dermal toxicity received calcium–lidocaine gel, and 368 individuals with bronchial irritation signs received calcium gluconate via nebulizer nCG. A total 377 ampoules 786 g of calcium gluconate were used in the nCG formulation. Calcium administration did not cause adverse reactions during the observation period. Long-term cohort observation showed that 120 patients (120/2233, 5.4%) returned to medical facilities for management of HF-related symptoms within 1 month; 18 persons (18/1660, 1.1%) returned 1–3 months later with chronic cough and respiratory symptoms; and 3 patients (3/1660, 0.2%) underwent medical treatment due to upper-airway toxic symptoms more than 2 years after HF exposure.
Respiratory toxicity after mass exposure to an HF spill was successfully treated by calcium nebulizer. Based on our experience, detoxification processes and the amounts of antidote stocked are important when planning for future chemical disasters at the community level.
Response to Letter to the Editor “Rational treatment of hydrofluoric acid burns of the fingers”
2018, Burns
Importance of initial management and surgical treatment after hydrofluoric acid burn of the finger
2017, Burns
Occupational injuries to digits due to hydrofluoric acid (HFA) are frequently encountered. They have distinctive features, including intense pain, progressive tissue necrosis, and possible bone erosion. To minimize tissue damage, it is of great importance to execute prudent preoperative assessment and determine the correct surgical modality to reconstruct and maintain the function of the hand. However, proper protocols for fingers have not been presented in previous studies.
Eight cases with HFA burn to digits were presented to the emergency room. Wounds were immediately irrigated with saline, calcium gluconate was applied topically to block destructive effects of fluoride ions. Blisters that could lead to progressive tissue destruction were debrided. A fish-mouth fasciotomy was performed and prostaglandin was administered intravenously to maintain maximal distal circulation. Wounds were evaluated daily for apparent demarcation for 6 or 7 days. Digits were reconstructed with free sensate second toe pulp-free flap to provide sufficient padding for the fingertip. All patients showed excellent recovery with stable flaps with acceptable external contour, durable soft tissue padding, and full range of motion of affected joints.
In conclusion, when a patient is admitted due to HFA exposure to the finger, early treatment including irrigation, topical neutralizers, and fasciotomy are of great importance to minimize tissue damage. In addition, a physician should wait at least 7 days until the degree of damage to the tissue can be classified so that the physician can decide whether aggressive debridement should be proceeded. In case of deep layer injuries of weight bearing portions such as finger pulp, reconstruction techniques utilizing durable tissues such as partial second toe pulp free flap should be employed.
Hand chemical burns
2015, Journal of Hand Surgery
Citation Excerpt :
Another important advantage of surgical debridement is the removal of residual chemicals. In severe exposures to chemicals with potentially lethal systemic toxicity (like chromic acid, HF, and phosphorus acid), this may be the only way to limit morbidity and mortality.9,14 In a patient in stable condition, timing of debridement, if necessary, is controversial.
There is a vast and ever-expanding variety of potentially harmful chemicals in the military, industrial, and domestic landscape. Chemical burns make up a small proportion of all skin burns, yet they can cause substantial morbidity and mortality. Additionally, the hand and upper extremity are the most frequently involved parts of the body in chemical burns, and therefore these injuries may lead to severe temporary or permanent loss of function. Despite this fact, discussion of the care of these injuries is sparse in the hand surgery literature. Although most chemical burns require only first response and wound care, some require the attention of a specialist for surgical debridement and, occasionally, skin coverage and reconstruction. Exposure to certain chemicals carries the risk of substantial systemic toxicity and even mortality. Understanding the difference between thermal and chemical burns, as well as special considerations for specific compounds, will improve patient treatment outcomes.

View all citing articles on Scopus

View full text

An algorithmic approach to the treatment of hydrofluoric acid burns

Abstract

Burns

J Hand Surg (Am)

Ann Emerg Med

Am J Emerg Med

Ann Emerg Med

Hydrofluoric acid induced hypocalcaemia

J Trauma

Hydrofluoric acid burns of the hand

J Bone Joint Surg

Hydrofluoric acid burns

Plast Reconstr Surg

Treatment of severe hydrofluoric acid exposures

J Occup Med

Hydrofluoric acid burns

Dermatol Clin