Dr Julian Smyth1, Dr Andrea Issler-Fischer1,2,3, Dr Tim Wang, A/Prof Peter Haertsch1,3, Prof Peter Maitz1,2,3
1Burns Unit, Concord Repatriation General Hospital, Concord, Australia, 2ANZAC Research Institute, Concord Repatriation General Hospital, Concord, Australia, 3University of Sydney, Camperdown, Australia
Rhabdomyolysis, due to direct thermal injury to muscle, is rare. We describe the initial management of a forty-seven year old gentleman with rhabdomyolysis and compartment syndrome resulting from severe thermal scald/contact injury.
A forty-seven year old male presented to our Unit via primary rotary-wing retrieval following a 32%TBSA thermal injury to his bilateral lower limbs, buttocks and periumbilical region. He had been partially submerged in molten asphalt (approximately 180 degrees Celsius) for an estimated 120 – 300 seconds before he could extricate. Adequate first aid was administered by first responders. He was intubated and sedated due to significant analgesia requirements and arrived at our centre approximately ninety minutes following injury.
On arrival the patient was tachycardic and normotensive. On assessment, he presented with full-thickness circumferential bilateral lower limbs burns up to his superior thighs, his calves were tense bilaterally, and his feet cold and pulseless. An indwelling catheter was placed revealing frank myoglobinuria. Immediate recognition for need for bilateral leg fasciotomies was made. Escharotomies were performed in the interim. Operative findings revealed direct thermal injury to the superficial portions of all leg musculature, particularly the peroneal compartment. Perfusion was restored to the bilateral lower limbs following release of all compartments and the patient recovered in ICU post-operatively. The patient has made an excellent functional recovery and is now independently ambulating.
Rhabdomyolysis and compartment syndrome may be life or limb threatening. This unusual mechanism of injury highlights the need for clinicians to maintain high levels of clinical suspicion and treat these developing syndromes aggressively.
Julian was the serving burn surgery registrar during when the patient for discussion was admitted.