256
Bums (1992) 18, (3), 256
Printed in Great Britain
High pressure industrial steam washer injury reklting in digital amputation S. A. Ray and R. M. Rainsbury Surgical Unit, Royal Hampshire
County
Hospital, Winchester,
Hampshire,
UK
High pressure washers are increasingly used to clean industrial machinery. We report a case of severe fullskinthickness bum resulting from momentary exposure to the jet of steam.
Case report A 62-year-old male was admitted to the surgical department with
an infected bum of the right foot. Four days previously he had been using a steam hose (Sirio SRL, Italy) to clean his lorry when the jet accidentally swept across his right shoe which already had a small hole on the dorsum. The pain of the resulting scald brought him to the Accident and Emergency Department where he was noted to have a 3 cm x 3 cm blister with surrounding erythema on the dorsum. This was treated as a partial skin thickness bum on an outnatient _ -..~-..--... basis _.._._ until cellulitis __.._.__.._ureciuitated ~~--.~~..~.--~ admission. The cellulitis responded well to intravenous antibiotics but escharectomy on day 15 postinjury revealed a 5 cm x 5 cm full skin thickness bum extending down to tendon and involving interosseous muscle (FigtrreI). Two further debridements and amputation of the fifth toe were required before split skin grafting achieved a successful result. The patient was eventually discharged 50 days after the injury and returned to work a further 2 months later.
use should be treated with caution and full skin thickness damage ruled out before the patient is discharged.
Discussion
References
Scalding usually results in partial skin thickness bums which may be treated conservatively. High pressure industrial washers can deliver water/steam at 150 atmospheres pressure and 140°C at a rate of 15 litres/min (Sirio Information Leaflet) -they may therefore conduct up to 25 000 calories per second (100 000 joules per second) of heat energy to an r 1. 1 ~~~~_ #I-_, _ L-1,_L:_ Ll_:_,_____ l_.._ area or sKin. It is already Known mar a ruu SKIIIPICNICS:, uulll will result from exposure of skin to water at 60°C for 1 min (Artz and Yarbrdugh, 1977) or 85°C for 10s (Yarbrough, 1981). The exposure in this case was for only 1-2 s. Scalds from steam hoses are not uncommon industrial injuries (Hansen, 1991), but we are not aware of any reports of extensive tissue loss requiring amputation. We would advocate the wearing of protective clothing/goggles when working with these devices. Any bums resulting from their fi rnn, a..cc,_.._,cl. u,:,,,,,, c,.l &,I 177Y “ uLLc:Iw”L,IL-1 Ic1‘IcIILalLIIT LLU
Artz C. P. and Yarbrough D. R. (1977) Bums. In: Sabiston D. C. (ed.), Davis - Chrisfopher Textbook of Surgery, 11 th edn. Philadelphia: Saunders, p. 298. Hansen T. B. (1991) Occupational injuries caused by breakages of hoses. Ugeskr. Laeger 153, 715. Yarbrough D. R. (1981) Pathophysiology of the bum wound. In:
0305-4179/92/030256-01
Figure I. Photograph
of the injury.
Acknowledgements We would like to thank Miss Katy Shaw for her help with the preparation of this manuscript.
TAT_-__.. \ L-MIC /-“..” “ “,f &Ix. &, “ *,,_o J_,M,,,vD J micnt. Bosfnn: Y”d~‘lCL7%” I”,. h” I”,. ,,A (CU.,, .slI,C” .L’L,“WWI PSG, p. 21.
Paper accepted 22 December
1991.
Correspondence should be addressed to: Mr S. A. Ray, Surgical Unit, Royal Hampshire County Hospital, Romsey Road, Winchester, Hampshire SO22 SDG, UK.
Bums (1992) 18, (3), 256
Printed in Great Britain
High pressure industrial steam washer injury reklting in digital amputation S. A. Ray and R. M. Rainsbury Surgical Unit, Royal Hampshire
County
Hospital, Winchester,
Hampshire,
UK
High pressure washers are increasingly used to clean industrial machinery. We report a case of severe fullskinthickness bum resulting from momentary exposure to the jet of steam.
Case report A 62-year-old male was admitted to the surgical department with
an infected bum of the right foot. Four days previously he had been using a steam hose (Sirio SRL, Italy) to clean his lorry when the jet accidentally swept across his right shoe which already had a small hole on the dorsum. The pain of the resulting scald brought him to the Accident and Emergency Department where he was noted to have a 3 cm x 3 cm blister with surrounding erythema on the dorsum. This was treated as a partial skin thickness bum on an outnatient _ -..~-..--... basis _.._._ until cellulitis __.._.__.._ureciuitated ~~--.~~..~.--~ admission. The cellulitis responded well to intravenous antibiotics but escharectomy on day 15 postinjury revealed a 5 cm x 5 cm full skin thickness bum extending down to tendon and involving interosseous muscle (FigtrreI). Two further debridements and amputation of the fifth toe were required before split skin grafting achieved a successful result. The patient was eventually discharged 50 days after the injury and returned to work a further 2 months later.
use should be treated with caution and full skin thickness damage ruled out before the patient is discharged.
Discussion
References
Scalding usually results in partial skin thickness bums which may be treated conservatively. High pressure industrial washers can deliver water/steam at 150 atmospheres pressure and 140°C at a rate of 15 litres/min (Sirio Information Leaflet) -they may therefore conduct up to 25 000 calories per second (100 000 joules per second) of heat energy to an r 1. 1 ~~~~_ #I-_, _ L-1,_L:_ Ll_:_,_____ l_.._ area or sKin. It is already Known mar a ruu SKIIIPICNICS:, uulll will result from exposure of skin to water at 60°C for 1 min (Artz and Yarbrdugh, 1977) or 85°C for 10s (Yarbrough, 1981). The exposure in this case was for only 1-2 s. Scalds from steam hoses are not uncommon industrial injuries (Hansen, 1991), but we are not aware of any reports of extensive tissue loss requiring amputation. We would advocate the wearing of protective clothing/goggles when working with these devices. Any bums resulting from their fi rnn, a..cc,_.._,cl. u,:,,,,,, c,.l &,I 177Y “ uLLc:Iw”L,IL-1 Ic1‘IcIILalLIIT LLU
Artz C. P. and Yarbrough D. R. (1977) Bums. In: Sabiston D. C. (ed.), Davis - Chrisfopher Textbook of Surgery, 11 th edn. Philadelphia: Saunders, p. 298. Hansen T. B. (1991) Occupational injuries caused by breakages of hoses. Ugeskr. Laeger 153, 715. Yarbrough D. R. (1981) Pathophysiology of the bum wound. In:
0305-4179/92/030256-01
Figure I. Photograph
of the injury.
Acknowledgements We would like to thank Miss Katy Shaw for her help with the preparation of this manuscript.
TAT_-__.. \ L-MIC /-“..” “ “,f &Ix. &, “ *,,_o J_,M,,,vD J micnt. Bosfnn: Y”d~‘lCL7%” I”,. h” I”,. ,,A (CU.,, .slI,C” .L’L,“WWI PSG, p. 21.
Paper accepted 22 December
1991.
Correspondence should be addressed to: Mr S. A. Ray, Surgical Unit, Royal Hampshire County Hospital, Romsey Road, Winchester, Hampshire SO22 SDG, UK.
