Wet cement remains a poorly recognised cause of full-thickness skin burns

doi:10.1016/j.injury.2003.09.010

Injury

Volume 35, Issue 10, October 2004, Pages 982-985

https://doi.org/10.1016/j.injury.2003.09.010 Get rights and content

Abstract

In 1993 we published a paper stating that wet construction cement is a poorly recognised cause of full-thickness burns [Injury 24 (1993) 615]. Ten years since publication we re-evaluated cement burns to ascertain if there had been any changes in awareness and incidence.

All cement related burns assessed at this unit were reviewed over a three and a half year period. Postal questionnaires were sent to all those affected.

Cement burns accounted for 2.2% of referrals to the Burns Unit during this studied period as compared to 1% during the original study. Fifty-one percent of patients stated they were unaware of the risk of cement burns and took no precautions. Eighty-six percent of the burns involved the lower limb. Fifty-three percent of burns affected professional users. Fifty percent had full-thickness involvement with 21% requiring operation. Eighty-eight percent of patients did not notice any warnings on the cement bag or delivery docket and 95% felt warnings should be larger and more obvious.

This study has shown that cement burns may have resulted from shortcomings in the information and warnings provided to customers by cement manufacturers.

Introduction

In 1993 we published a paper stating that wet construction cement is a poorly recognised cause of full-thickness burns.¹ Ninety-five percent of patients stated that they were unaware of the potential for cement to cause burns. Only 40% took precautions and none had noticed any warnings on the cement bag or delivery docket. At the time the British Cement Association was asked to comment on this paper. They stated that they were aware of the serious risk of burns and that its members produce bags that carry a warning that advises simple first aid measures in case of contact with skin or eyes. This complies with the classification, Packaging and Labelling of Dangerous Substances Regulations, 1984. We suggested although complying with regulations, these warnings are ineffective in alerting both professionals and the general public to the burn dangers of cement.

Ten years on we decided to re-evaluate cement burns and ascertain if there had been any changes in awareness and incidence of cement burns since the last paper was published.

Section snippets

Method

All patients admitted to the burns unit with cement burns between January 1998 and June 2001 were included in the study. The patient’s notes were reviewed and each contacted by means of a postal survey. A further questionnaire was sent to all those who did not initially reply.

Results

There were 3194 referrals to the burns unit during the studied period (January 1998–June 2001). Cement burns accounted for 71 referrals (2.2%). During the last study period (1987–1991), 24 patients with cement burns contributed to a total of 2795 referrals (1%).

The annual variation of the period January 1998–December 2000 is shown on Fig. 1. Sixty-seven patients were male and four female. The median age was 36 years (range 22 months to 62 years).

Sixty-six patients (93%) had detailed records of

Discussion

Wet cement damages skin in three ways:

1.
Allergic dermatitis as a reaction to its hexavalent chromate ions.
2.
As abrasions caused by the gritty nature of the coarse and fine aggregate in the cement.
3.
Wet cement has a pH of 12.5 causing alkali burns.

The severity of the burn depends on the amount of abrasion created by the cement aggregate and the duration of cement contact.

Unfortunately the ability of cement to cause such injury is not well recognised, even by professional users. Over half of the

Conclusion

The incidence of cement burns has increased the last 10 years and now accounts for 2.2% of admissions to this burns unit. One in five required operation. This study has shown that cement burns may have resulted from shortcomings in the information and warnings provided to customers by cement manufacturers. Eighty-eight percent of patients did not notice any warnings on the cement bag or delivery docket and 95% felt warnings should be larger and more obvious. If this prevents even a small

Comment from the Concrete Trade Association

This paper has been reviewed by the Concrete Trade Association. They stated that they were disappointed that despite efforts to provide clear guidance on the risks of using cement they have had no impact on reducing cement burns including those to so-called ‘professional’ users. They accept a social responsibility to try to improve the situation. This paper has been sent to all their members and will be discussed at their next meeting. Following this review the association will endeavour to

References (0)

Cited by (18)

Deep alkali burns: Evaluation of a two-step surgical strategy
2018, Annales de Chirurgie Plastique Esthetique
Les brûlures chimiques sont rares mais entraînent des lésions cutanées souvent profondes. Les agents basiques possèdent un pouvoir pénétrant fort et prolongé, provoquant des brûlures évolutives sur plusieurs jours. Le traitement local de ces patients est chirurgical associant excision et couverture par greffe de peau mince. Réalisées précocement dans un contexte d’agent chimique, ces greffes sont de prise difficile, retardant la cicatrisation. Nous proposons donc pour ces patients de différer la greffe de peau mince, 10 jours après l’excision de la brûlure. Nous présentons une étude comparative originale et nouvelle pour évaluer notre stratégie chirurgicale en deux temps.
Nous avons réalisé une étude rétrospective des patients victimes de brûlures profondes par agents basiques pris en charge dans le centre des brûlés de Lille. Les caractéristiques épidémiologiques et les modalités de prise en charge chirurgicales ont été étudiées sur dossier. Nous avons comparé la durée de cicatrisation et le taux de lyse de greffes de peau chez les patients ayant bénéficié d’une couverture initiale (témoins) ou secondaire (cas) après excision. Cette comparaison a été possible après appariement sur l’âge et le sexe.
Notre population a inclus 25 témoins et 16 cas. Les hommes étaient majoritairement atteints avec un âge moyen de 41,9 ans. Les brûlures étaient localisées dans 78 % des cas aux membres inférieurs. Le délai entre la brûlure et l’excision était en moyenne de 16,5 jours. Chez les cas, la greffe de peau mince était réalisée en moyenne 11,3 jours après l’excision initiale. Nous n’avons pas mis en évidence de différence significative entre les deux groupes pour la surface corporelle totale atteinte, la topographie des brûlures et l’agent causal. La durée de cicatrisation était significativement plus courte chez les cas par rapport aux témoins (37,5 jours vs 50,3 jours ; p < 0,025). On observait de plus une diminution du nombre de lyse de greffes chez les cas par rapport aux témoins (13,3 % vs 46,7 % ; p = 0,059).
Notre étude montre l’intérêt d’une stratégie chirurgicale en deux temps chez les patients victimes de brûlures par agents basiques. L’excision dite précoce associée à la réalisation d’une greffe de peau mince dans un second temps permet une cicatrisation plus rapide et diminue les risques de lyse de greffe.
Chemical burns are rare but often lead to deep cutaneous lesions. Alkali agents have a deep and long lasting penetrating power, causing burns that evolve over several days. The local treatment for these patients is excision of the wound and split thickness skin graft. Early excision and immediate skin grafting of alkali burns are more likely to be complicated by graft failure and delayed wound healing. We propose a two-step method that delays skin grafting until two-three days after burn wound excision.
Our population included 25 controls and 16 cases. Men were predominant with a mean age of 41.9 years. In 78% of cases, burns were located on the lower limbs. The mean delay between the burn and excision was 16.5 days. In cases, the skin graft was performed at a mean of 11.3 days after the initial excision. We did not unveil any significant difference between both groups for the total skin surface affected, topography of the burns and the causal agent. Wound healing was significantly shorter in cases vs controls (37.5 days vs 50.3 days; P < 0.025). Furthermore, we observed a decreased number of graft failures in cases vs controls (13.3% vs 46.7%; P = 0.059).
Our study shows the relevance of a two-step surgical strategy in patients with alkali chemical burns. Early excision followed by interval skin grafting is associated with quicker wound healing and decreased rate of graft failure.
Is it time for a change in the approach to chemical burns? The role of Diphoterine <sup>®</sup> in the management of cutaneous and ocular chemical injuries
2017, Journal of Plastic, Reconstructive and Aesthetic Surgery
Citation Excerpt :
They cause injury by producing a chemical interaction that can lead to extensive tissue destruction and extreme pain. Injuries may not be immediately obvious, and there can be a delay in presentation.1 These injuries account for only 3% of all burns but lead to approximately 30% of burn deaths,2 usually secondary to ingestion in children.
A multitude of household and occupational compounds have the potential to induce chemical burns to the eye and skin. Without prompt intervention, irreversible visual loss and disfigurement may prevail. Diphoterine^® and Hexafluorine^® are amphoteric and hypertonic chelating solutions used in the management of general chemical and hydrofluoric acid burns, respectively. They rapidly neutralise both acid and alkali agents without heat release and limit diffusion, making them superior to water irrigation alone. However, although Diphoterine^® and Hexafluorine^® uptake is slowly increasing in industrial workplaces, there is a paucity of education and use in both emergency departments and plastic surgery units worldwide. Herein, we present a case report of combined ocular and cutaneous acid burn treated with Diphoterine^®, together with a review of the current supporting literature.
Cement burns: A 10-year retrospective study in our burn unit. About 55 cases
2014, Annales de Chirurgie Plastique Esthetique
Les brûlures par ciment, bien que ne représentant qu’un faible pourcentage des admissions dans les centres de brûlés, sont des brûlures au diagnostic et au traitement particuliers. Notre étude rétrospective concernait tous les patients traités pour une brûlure par ciment dans notre service entre 1999 et 2009. À notre connaissance, il s’agit de la plus importante série de brûlures par ciment décrite à ce jour.
Cinquante-cinq patients âgés de 23 à 63 ans étaient pris en charge dans le centre des brûlés du CHRU de Tours entre 1999 et 2009. Un recueil des données médicales et socioéconomiques était réalisé à partir des dossiers informatisés.
La population concernée était majoritairement masculine, jeune (moyenne d’âge de 34 ans) et active. Les brûlures survenaient principalement dans le cadre d’accidents domestiques (78,2 %). Elles étaient de surface limitée mais profondes et atteignaient majoritairement les membres inférieurs. La durée moyenne des soins étaient de 39 jours. Quarante-quatre patients étaient traités médicalement. La durée moyenne de l’arrêt de travail chez ces patients était de 63 jours et de 21 jours pour ceux traités chirurgicalement. Des séquelles esthétiques et fonctionnelles étaient présentes chez 88 % des patients traités médicalement et pour 18 % des patients traités chirurgicalement.
Cette étude confirme l’intérêt du diagnostic et de la prise en charge chirurgicale précoces des brûlures par ciment, qui réduisent le retentissement socioéconomique et le risque de séquelles, pour cette population de patients majoritairement jeune et active. La nécessité de renforcer les mesures préventives auprès des ces usagers qui ne sont pas assez informés des risques encourus lors du mésusage du ciment est également une réalité.
Although cement burns represents only a small percentage of admissions to burn centers, their diagnosis and treatment are specific. Our retrospective study concerns all patients treated for cement burns in our unit between 1999 and 2009. This is the largest series described.
Fifty-five patients, aged from 23 to 63, were treated in our burn unit from 1999 to 2009. A review of medical and socioeconomic data was made from computer data files.
This population is predominantly male, young and active. These burns occurred mainly in a domestic accident situation (78.2%). Burns were limited but deep and concerned especially lower limbs. The average duration of treatment was 39 days. Forty-four patients were treated medically. The mean duration of sick live for these patients was 63 days. It was only of 21 days for those treated surgically. Aesthetic and functional sequelae were present in 88% of medically treated patients and in 18% of patients treated surgically.
This study demonstrates that early surgical diagnosis and the coverage (care) of these burns allows to limit the socioeconomic echo and to reduce the risk of after-effects for this population of patients mainly young and active. The necessity of strengthening the precautionary measures with these users who are informed enough about the risks incurred during the misuse of the cement is also a reality.
Irritant Contact Dermatitis: Clinical Aspects
2014, Applied Dermatotoxicology: Clinical Aspects
Irritant dermatitis, a common inflammatory skin condition, results from of single or repetitive exposure to chemicals with irritant properties. Irritants interact with structural skin components and elicit a spectrum of reactions that may range from mere sensory responses to a widespread severe disease with systemic involvement. This chapter provides an overview of common and rare clinical manifestations of irritant contact dermatitis based on the course of disease and morphology.
Evaluation of the burn wound: Management decisions
2012, Total Burn Care: Fourth Edition
Chemical burns: Pathophysiology and treatment
2010, Burns
Citation Excerpt :
On the other hand, calcium oxide dust may aerosolise and become an irritant to the respiratory tract. Some studies document that most patients who suffer cement burns ignore the potential of wet cement to cause injury [28]. Information and use of adequate protective materials are essential in the prevention of cement burns.
Chemical burns continue to pose a variety of dilemmas to the clinician managing such cases. Assessment of burn depth is often difficult and the decision whether to excise the wound early is not always clear-cut. In this updated review, common agents are classified and the basic principles of management and specific recommendations are examined. The complications arising from exposure to these chemicals and the supportive measures needed during treatment are also described.

View all citing articles on Scopus

View full text