Friction and cement: Case report and literature

Review of full-thickness cement burns

K. L. Gale and P.B. Milsom

Whangarei Base Hospital, Northland, New Zealand

Case Report

A 40 year old policeman was referred to ED at Whangarei Base Hospital with a circumferential full-thickness burn to the distal third of his right leg. He sustained this whilst helping a friend ‘cut concrete’ despite wearing gumboots. Because the experience was largely non-irritating, he did not notice water and concrete filling his gumboot as he worked.

The wound became increasingly red and painful, and his GP prescribed augmentin for a cellulitic burn. Ten days later, a green exudate developed over the area, prompting further consultation which resulted in a referral to the Base hospital for ‘debridement of slough’.

On examination there was an almost circumferential full thickness alkali friction burn wound, 3cm in width around the distal third of his right leg. A 2 cm bridge of normal skin remained posteriorly.

In theatre, the eschar was debrided to healthy bleeding fat and fascia and grafted with a meshed 1 : 2 SSG and a suction dressing placed. Placed on bedrest with wall suction, prophylactic oral augmentin and subcutaneous clexane for 5 days. It was reviewed 5 days later with 100% graft take. Discharged home on day 7 with a graduated compression stocking for mobilisation.

Discussion

Wet cement remains a poorly recognised cause of fullthickness skin burns amongst the general population. The alkalinity of cement causes liquefactive necrosis in tissue, which initially may go unrecognised. Most burns affect the lower limb, and only half of those involved professional users. It is thought that more education and awareness of the potential hazards of cement should be publicised amongst the labouring, and DIY communities of NZ.

Abstract from publication as appears in 2007 Journal of Surgery. The Royal Australian and New Zealand College of Surgeons. Download abstracts here.