Long healing process

25/04/2010
Source: The Star

ACID is a corrosive agent and concentrated acid will burn the skin very quickly. If you get it on your skin, immediately flush the affected area with copious amounts of water. Take care to avoid the acid spreading to unaffected areas, particularly the eyes, as it may cause blindness.

Contaminated clothing should be removed.

Consultant plastic and reconstructive surgeon Dr Somasundaram Sathappan explains: “Acid burns the skin, forming a thick crust of dead tissue. It can quickly penetrate into the fat and muscle layer and burn through to the bone. It will keep burning until it is neutralised. That’s why it’s important to immediately wash it off with lots of water to dilute the acid and stop it from doing more damage.”

Keo Srey Vy, 36, receiving treatment at the Cambodia Acid Survivors Charity in Kandal province, west of Phnom Penh, in February. The Cambodian government is drafting a law to specifically target crimes involving acid attacks. – Reuters

Dr Soma (as he is known) stresses that the afflicted person should not delay with this emergency procedure. That means getting to a clean source of running water, if possible, and washing the wound, even before medical assistance arrives.

“Flushing the affected area with water is the first thing to do when acid comes into contact with skin. It will take time to seek medical care, during which the acid would have eroded the dermis (deeper layers of the skin) if it is not flushed with water”.

When seeking medical help, provide as many details as possible to the medical personnel. It is important to inform them that it is an acid burn, as that might not necessarily be obvious.

In an acid attack, flush the affected area immediately because acid eats into the deep layers of the skin.

“An acid burn could look similar to a scald injury, where hot water is thrown on the person. For a scald injury, they (the medics) would wash the wound and put it under cold packs, but they won’t use running water. If it’s an acid injury, they would know exactly what to do – use copious amounts of water and protect the eyes.”

Other relevant details include how the accident happened, the concentration (strength), quantity and type of acid, and how long it was in contact with your skin before it was removed. These are among the factors that determine the extent of tissue damage caused by the acid.

When a patient is admitted to the hospital, IV fluids will be administered to normalise blood volume and heart rate. Antibiotics might also be given to prevent infections. The extent of the acid injury will determine whether reconstructive surgery is necessary.

“A burn that takes more than three weeks to heal is generally a full thickness burn, which will most probably need skin grafting,” Dr Soma says.

“We don’t operate until both the injury and the patient’s general condition have stabilised. That usually means we wait at least two to three days. It can take even up to five days.”

A patient might need multiple surgeries depending on the severity of the injury. Dr Soma points out that a skin graft won’t be exactly like her original skin.

“A skin graft is basically just a mechanism to cover wounds to get them to heal. Without it, healing will be slow and there will be scarring.”

Reconstructive surgery – which aims to improve both appearance and normal function after the acid injury – and the rehabilitation that follows, is a long and tedious process that can stretch over many years.

“One of the concerns in reconstructive surgery is the prevention of contractures,” he says, referring to the inability to move a joint or muscle due to a permanent rigidity. A patient will then need to undergo physiotherapy to restore activity, strength and motion to the affected muscle or limb.

Pressure garmentscan be used to help reduce scarring and deformities.It is not known how exactly that works, but a reduction in blood supply is thought to be an important factor.

“Pressure garments exert pressure (on the affected area) to minimise scarring. The patient might also need silicone therapy – in the form of silicone sheets or silicone ointment applied to the skin - as it has a fantastic effect on scars,” says Dr Soma, adding that all these are done until the scars mature, which will take at least one to two years.