불산에 의한 수부 화학 화상의 치료

Treatment for Hydrofluoric Acid Chemical Injury on Hands

  • 남승민 (순천향대학교 의과대학 성형외과학교실) ;
  • 최환준 (순천향대학교 의과대학 성형외과학교실) ;
  • 김미선 (순천향대학교 의과대학 성형외과학교실)
  • Nam, Seung Min (Department of Plastic and Reconstructive Surgery, College of Medicine, Soon Chun Hyang University) ;
  • Choi, Hwan Jun (Department of Plastic and Reconstructive Surgery, College of Medicine, Soon Chun Hyang University) ;
  • Kim, Mi Sun (Department of Plastic and Reconstructive Surgery, College of Medicine, Soon Chun Hyang University)
  • 투고 : 2007.01.12
  • 발행 : 2007.07.10

초록

Purpose: Hydrofluoric acid(HF) is one of the most dangerous mineral acids with dissociated fluoride ions. As hydrofluoric acid is present in various household products(such as rust removers), a large population of industrials is at the risk of HF exposure. It is a very strong organic acid, used widely in glass etching, metal washing, and in the semiconductor industry. Even when using adequate safety measures, lack of care on the user's part results in chemical burn by HF. Symptoms caused by HF-induced chemical burns shows delayed manifestations resulting in a loss of proper treatment opportunities. We therefore reviewed 20 cases of HF-induced chemical burns and treatment principle. Methods: The objects of this study were 19 male patients and 1 female treated from March 2004 to March 2006. There were 19 cases of injury on digits and 1 on the wrist area. There were 15 cases of immediate treatment after sustaining HF-induced burns, and 5 cases of delayed treatment. As a principle, in the emergency treatment, partial or complete removal of the nail along with copious washing with normal saline was done, depending on the degree of HF invasion of the distal digital extremities. Results: The 15 cases who came to the hospital immediately after the injury were healed completely without sequelae, and those who delayed their treatment needed secondary surgical measures, due to the severity of inflammation and necrosis of the digital tissues. Conclusion: As the industrial sector develops, the use of HF is increasing more and more, leading to increase in incidences of HF-induced chemical burns. When treating chemical burns caused by HF, washing by copious amounts of normal saline, along with early removal of the nails, rather than calcium gluconate, seems to be a available method for preserving the shape and function of the digits and the nail. The education of patients regarding this subject should be empathized accordingly.

키워드

참고문헌

  1. Wedler V, Guggenheim M, Moron M, Kunzj W, Meyer VB: Extensive hydrofluoric acid injuries: a serious problem. J Trauma 58: 852, 2005 https://doi.org/10.1097/01.TA.0000114528.15627.65
  2. Roblin I, Urban M, Flicoteau D, Martin C, Pradeau D: Topical treatment of experimental hydrofluoric acid skin burns by 2.5% calcium gluconate. J Burn Care Res 27: 889, 2006 https://doi.org/10.1097/01.BCR.0000245767.54278.09
  3. Nguyen LT, Mohr WJ 3rd, Ahrenholz DH, Solem LD: Treatment of hydrofluoric acid bum to the face by carotid artery infusion of calcium gluconate. J Burn Care Rehabil 25: 421, 2004 https://doi.org/10.1097/01.BCR.0000138288.15403.BA
  4. Foster KN, Jones L, Caruso DM: Hydrofluoric acid bum resulting from ignition of gas from a compressed air duster. J Burn Care Rehabil 24: 234, 2003 https://doi.org/10.1097/01.BCR.0000076057.14582.6A
  5. Anderson WJ, Anderson JR: Hydrofluoric acid bums of the hand: mechanism of injury and treatment. J Hand Surg 13: 52, 1988 https://doi.org/10.1016/0363-5023(88)90200-6
  6. Shewmake SW, Anderson BG: Hydrofluoric acid bums. A report of a case and review of the literature. Arch Dermatol 115: 593, 1979 https://doi.org/10.1001/archderm.115.5.593
  7. Dibbell DC, Iverson RE, Jones W, Laub DR, Madison MS: Hydrofluoric acid burns of the hand. J Bone Joint Surg Am 52: 931, 1970 https://doi.org/10.2106/00004623-197052050-00008
  8. Chick LR, Borah G: Calcium carbonate gel therapy for hydrofluoric acid bums of the hand. Plast Reconstr Surg 86: 935, 1990 https://doi.org/10.1097/00006534-199011000-00016
  9. Greco RJ, Hartford CE, Haith LR Jr, Patton ML: Hydrofluoric acid-induced hypocalcemia. J Trauma 28: 1593, 1988 https://doi.org/10.1097/00005373-198811000-00015