Dr Fadie Aziz1, Dr Andrea Issler-Fisher1,2,3, Dr Francesca Dudas1, Professor Peter Haertsch1
1Burns Unit, Concord Repatriation General Hospital, Sydney, Australia, 2ANZAC Research Institute, Concord Repatriation General Hospital, Sydney, Australia, 3Concord Clinical School, University of Sydney, Sydney, Australia
A report of two simultaneous Bitumen burn injuries managed with early bitumen removal, Versajet debridement and Biobrane xenografting
Background: Bitumen burns can be a confronting presentation and represent a clinical challenge due to the rarity. Hot bitumen (>200 degrees celcius) adheres to skin and dissipates its heat, potentially causing simultaneous severe contact and chemical burns. It has been suggested that early management should focus on cooling rather than removal of the bitumen.
Methods/Results: We present a report on two roadside workers simultaneously injured with bitumen burns involving face, neck and hands/wrists. Following rapid retrieval, adequate first aid and securing of airways, bitumen was carefully removed with hydrophobic solvent in the emergency department. Subsequently, the patients were taken to theatre for Versajet debridement and application of Biobrane xenograft within 4 hours after the injury. One patient required a small skin graft to the wrist, whereas the rest of the injuries were adequately addressed with above measures. Both patients had good outcomes with minimal post-procedural pain.
Conclusion: We believe this case is both interesting and educational due the inherent rarity of bitumen burns. Furthermore, the use of Biobrane xenograft has not previously been reported in the management of bitumen burns. Our own experience with a good outcome of both patients may support an approach of rapid bitumen removal. We feel that the proficiency and swiftness of the first responders in this case likely had the greatest contribution to the observed good outcome.
I am a Surgical SRMO, currently rotating through the Burns Unit at Concord Repatriation General Hospital. My interests include emergency burns care, reconstructive burns surgery and scar management. I find burns to be a dynamic and highly rewarding field and am committed to burns research and education.