Mehmet YILMAZ, Kemal Tolga SARAÇOĞLU, Ayten SARAÇOĞLU

Kimyasal Yanıklar

Kimyasal yanıklar sıklıkla koroziv maddelere maruziyet sonrasında gelişmektedirler. Tüm yanık türlerinin %10,7’sini, yanık merkezine hasta kabullerinin de %2-6’sını oluşturmaktadır. Kimyasal komponentlere bağlı hasar 6 farklı mekanizmayla ortaya çıkmaktadır. Bunlar redüksyon, oksidasyon, korozyon, protoplazmik toksinler, yakıcı kimyasallar ve kurutuculardır. Kimyasal yanık hasarının karakteristikleri arasında ciltte renk değişiklikleri ve korozyon, nadiren regüler bir yapı, gastrointestinal kanalda perforasyon, ciddi sistemik toksisite ve mortalite riski yer almaktadır. Termal yanıklarla karşılaştırıldığında yara iyileşme süreci belirgin derecede daha yavaş olup sıklıkla hastanede uzamış yatış süresiyle ilişkilidir. Ayrıca yanık hasarı genellikle kimyasal ajana uzamış maruziyet sonrasında oluşmaktadır. Beyaz fosfor yanıkları bunun iyi bir örneğidir. Progresif nekroz gelişen yanıkların patogenezinde akla getirilmelidir. Acil resusitasyon hasar yönetiminde önceliklidir. Evde oluşan kazalardaysa sıklıkla sebep sıvı amonyak ve nitrik asiddir. Kimyasal yanık hasarı tedavisinde halen altın standart yeterli miktarda su ile yaranın irrigasyonudur. Kimyasal yanık hasarı prevalansını azaltmaya amaçlı olarak koruyucu önlemlerin alınması önemlidir. Genel nüfus ve önleyici stratejilerin farkındalığını artırmak için medyanın tam desteğiyle ülke çapında kampanyalara ihtiyaç duyulmaktadır. Kamu spotları, medya organları, özel kuruluşlar, hekimler ve hastalar bu amaçla birlikte çalışmalıdırlar.

Chemical Burn Injuries

Chemical burns often develop after exposure to corrosivesubstances. They include 10.7% of all burn types and 2-6% ofthe patient admissions to the burn center. Chemical compoundspossess 6 different types of damaging mechanisms; reduction,oxidation, corrosion, protoplasmic toxins, vesicants anddesiccants. The characteristics of chemical burn injuriesinclude skin discoloration and contractures, having rarelyregular shape, perforation in the gastrointestinal tract with therisk of severe systemic toxicity and mortality. Compared to thethermal burns, the wound healing process following chemicalburn injuries is markedly slower and also frequently relatedwith a prolonged stay at the hospital. Moreover, generally theburn injury results following a prolonged exposure to thechemical agent. White phosphorus burns are good examplesfor this process. It should be considered in presence of burnswith progressive necrosis. Emergency resuscitation is crucialfor the management of injury. Most frequently observed agentsin home injuries are liquid ammoniac and nitric acid. Forchemical burn injuries the gold standart of treatment still is theirrigation of the wound with a copious amount of water. It isimportant to take protective measures in order to reduce theprevalence of chemical burn injury. Nation-wide campaignswith full support from the media are needed to raise awarenessof the general population and preventive strategies. Publicservice broadcastings, media organs, trade unions, physiciansand patients should work together for this purpose.

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1. Barillo DJ, Cancio LC, Goodwin CW. Treatment of white phosphorus and other chemical burn injuries at one burn center over a 51- year period. Burns 2004; 30(5):448-52.
2. Ahmadi H, Durrant CAT, Sarraf KM, et al. Chemical burns: A review. Trends Anaesthesia & Critical Care 2008; 19(5-6):282-6.
3. Maghsoudi H, Gabraely N. Epidemiology and outcome of 121 cases of chemical burn in East Azarbaijan province, Iran. Injury 2008; 39(9):1042- 6.
4. Pitkanen J, Al-Qattan MM. Epidemiology of domestic chemical burns in Saudi Arabia. Burns 2001; 27(4):376-8.
5. Doğan Y, Erkan T, Cokuğraş FC, et al. Caustic gastroesophageal lesions in childhood: an analysis of 473 cases. Clin Pediatr (Phila) 2006; 45(5):435- 8.
6. Gün F, Abbasoğlu L, Celik A, et al. Early and late term management in caustic ingestion in children: a 16-year experience. Acta Chir Belg 2007; 107(1):49-52.
7. Coban YK, Erkiliç A, Analay H. Our 18- month experience at a new burn center in Gaziantep, Turkey. Ulus Travma Acil Cerrahi Derg 2010; 16(4):353-6.
8. Kozawa S, Kakizaki E, Muraoka E, et al. An autopsy case of chemical burns by hydrochloric acid. Leg Med (Tokyo). 2009; 11(1):S535-7.
9. Rice P. Sulphur Mustard Injuries of the Skin: Pathophysiology and Management Toxicological Reviews 2003; 22(2):111-8.
10. Saracoglu KT, Acar AH, Kuzucuoglu T, et al. Delayed diagnosis of white phosphorus burn. Burns 2013; 39(4):825-6.
11. Palao R, Monge I, Ruiz M, et al. Chemical burns: pathophysiology and treatment. Burns 2010; 36(3):295-304.
12. Pavelites JJ, Kemp WL, Barnard JJ, et al. Deaths related to chemical burns. Am J Forensic Med Pathol 2011; 32(4):387-92.
13. Xie Y, Tan Y, Tang S. Epidemiology of 377 patients with chemical burns in Guangdong province. Burns 2004; 30(6):569-72.
14. Chou TD, Lee WT, Chen SL, et al. Split calvarial bone graft for chemical burn-associated nasal augmentation. Burns 2004; 30(4):380-5.
15. Ricketts S, Kimble FW. Chemical injuries: the Tasmanian Burns Unit experience. ANZ J Surg 2003; 73(1-2):45-8.
16. Merle H, Donnio A, Ayeboua L, et al. Alkali ocular burns in Martinique (French West Indies) Evaluation of the use of an amphoteric solution as the rinsing product. Burns 2005; 31(2):205-11.
17. Kai-Yang L, Zhao-Fan X, Luo-Man Z, et al. Epidemiology of pediatric burns requiring hospitalization in China: a literature review of retrospective studies. Pediatrics 2008; 122(1):132- 42.
18. Diarra B, Roudie J, Ehua Somian F, et al. Caustic burns of rectum and colon in emergencies. Am J Surg. 2004; 187(6):785-9.
19. Ogunleye AO, Nwaorgu GB, Grandawa H. Corrosive oesophagitis in Nigeria: clinical spectrums and implications. Trop Doct 2002; 32(2):78-80.
20. Milton R, Mathieu L, Hall AH, et al. Chemical assault and skin/eye burns: two representative cases, report from the Acid Survivors Foundation, and literature review. Burns 2010; 36(6):924-32.
21. Ustaoglu M, Solmaz N, Onder F. Ocular surface chemical injury treated by regenerating agent (RGTA, Cacicol20). GMS Ophthalmol Cases 2017;7:Doc28.
22. Dinis-Oliveira RJ, Carvalho F, Moreira R. Clinical and forensic signs related to chemical burns: a mechanistic approach. Burns 2015;41(4):658-79.