Severe Case of Low Temperature Contact Burn with Rhabdomyolysis

Although low temperature contact burn doesn't have clear definition, it is used to describe the burn occurred by long time exposure under 50℃ temperature. 4(th) degree burn can be occurred by low temperature contact burn because of low pain, especially in patients who are insensitive to stimulation by various reasons. The under-floor heating system such as Ondol or electronic heating pad is popular in Korea because of the cultural influence. Although the upper limit surface temperature of electronic heating pad is 50℃, severe burn injury can happen by long time exposure. So we report a low temperature contact burn case of 4(th) degree involving gluteus maximus muscle of the buttock caused by electric heating pad, which led to Rhabdomyolysis.

Contacts Burns Caused by Electric Pad

PURPOSE: The use of the Ondol, which is a traditional Korean floor heating system, has made the electric heating pad popular in Korea. Although the surface temperature of electric pads is around 45 degrees, rarely they can cause severe contact burns. Because an electric pad is usually used while sleeping, the skin could be exposed to heat and pressure for a prolonged period. The purpose of this study was to investigate the epidemiology and clinical features of these types of burns and to advise caution in the use of electric heating pads. METHODS: We performed a retrospective analysis of 58 cases identified from March 2007 to March 2012 at the Hangang Sacred Heart Hospital plastic surgery department. Collected data included sex, age, seasonal variation, distribution and extent of the burn, underlying disease, related factors, and treatment. RESULTS: Patients (23 females and 10 males) were predominantly in their twenties, with an average age of 40.7 years (range, 14~83). The majority of the burns occurred during winter (51.5%). According to the patients' histories, sleeping in a drunken state was the most common associated factor, with taking hypnotics and lying under spinal anesthesia being the second and third factors, respectively. Eight patients had diabetes mellitus and four patients had hypoesthesia after spinal cord injury and cerebral stroke. The lower extremity was the most commonly involved site (42.4%), followed by the buttocks (33%). The extent burn areas accounted for less than 2% of the total body surface area. But deep second degree and third degree burns were sustained that required surgical intervention. CONCLUSION: Unconsciousness and hypoesthesia were the primary factors that provoked contact burns related to the use of electrical pads. Although the percentage of body surface area burns is often small, the burns caused by electric pads can cause deep thermal injuries, necessitating the use of skin grafts and local flaps. These injuries could be prevented by taking precautions when using electric pads and by educating the public.

The Change of Burn Depth within 24 Hours after Burn in the Standardized Burn Mode

PURPOSE: In full thickness burn, the depth of burn is known to increase until around 1-3 days after the burn. However, no study on how the depth increase during the first 24 hours has been conducted. Therefore, the authors investigated how the depth of burn changes within the first 24 hours after the burn by using the standardized burn model. METHODS: A total of four experiments on pigs were carried out for this study. Experiment 1 was performed to examine how temperature affects the depth of burn. The digitally controlled aluminum thermal block was set at different temperatures-80, 90 and 100 degrees in Celsius, respectively. Then the pig was exposed to the block for 15 seconds each time. The time exposed to heat was set as a variable for the Experiment 2. The temperature was maintained at 80 degrees Celsius, and the pig was contacted with the thermal block for 5, 10 and 20 seconds, respectively. The biopsy of the tissues were performed in one hour, 6 hours, 24 hours, and 7 days after the burn. After hematoxylin and eosin staining a percentage of the depth from a basement membrane of epidermis to the deepest tissue damaged by the burn against total dermal thickness was measured. RESULTS: In Experiment 1, the depth of burn increased considerably as time passed by. At all three temperatures, differences in depths measured in 6 and 24 hours, and in 1 hour and 7 days were both significant. In addition, the depth deepened as the temperature went higher. In the case of Experiment 2, the depth of burn also increased significantly as time passed by. At all three times, differences in depth measured in 6 and 24 hours, and in 1 hour and 7 days were also significant. Moreover, the depth extended with longer contact time when it was compared according to the time. CONCLUSION: Full thickness burn progressed rapidly from 6 to 24 hours after the burn and the depth of burn was almost decided within the first 24 hours after the burn. On the other hand, partial thickness burn also advanced from 6 to 24 hours after the burn but the depth deepened at slower level.