A case of chemical assault in Hong Kong (case report)

INTRODUCTION: This case report aims to raise awareness of the unique protocol developed in the Prince of Wales Hospital (PWH) in Hong Kong, for the acute management of acid assault burns. Chemical assaults are rare in the UK, although, previously there have been several high-profile cases in the past three decades. In Hong Kong, acid assaults are more common, and a unique strategy has been developed to deal with the immediate injury. PRESENTATION OF CASE: This case report describes a 16-year-old girl assaulted with an acid solution by her 17-year-old ex-boyfriend. She sustained an 8% TBSA burn involving her face, upper-limbs and back. Immediate lavage was commenced at the local hospital prior to transfer to the PWH burn centre. She underwent urgent (<48 h) EUA in theatres and her burns were tangentially shaved to active bleeding. She then received 48 h of saline soaks changed two-hourly prior to definitive treatment. DISCUSSION: The conventional strategy for acid burns had been continuous lavage for two to three days, followed by delayed shaving and grafting. Outcomes were often poor with disproportionate needs for reconstructive procedures compared to thermal burns. Since introducing the new protocol three-years ago, outcomes have improved and can be quantitatively assessed in terms of decreased reconstructive needs. CONCLUSION: The benefits of urgent reduction in chemical load is intuitively obvious, and by shaving tangentially to bleeding, vital tissue is preserved. Trying to prove benefit in terms of an RCT is however ethically challenging.