Cold burn

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The cold burn is a special form of frostbite in which extreme cold causes local, burn-like damage to the affected parts of the body within seconds . While the term has been firmly established among chemists for a long time, there has been no uniform term in medicine for this form of tissue damage .

Etiopathogenesis

A cold burn occurs when the body comes into sudden, brief contact with extremely cold substances such as dry ice , liquid propane , liquid nitrogen or very strongly cooled objects such as poorly insulated transport containers of the aforementioned. Liquid propane, for example, causes unprotected skin to cool down by 90 Kelvin within ten seconds  . Due to the rapid warming after exiting the transport vessel, the gases liquefied under high pressure expand suddenly and evaporate , pulling parts of the tissue water with them. The resulting damage to the tissue roughly corresponds to the consequences of a severe burn. After just a few seconds, sharply demarcated, pale and dry areas with blistering appear on the skin exactly where the harmful substance came into contact. Within these areas, all layers of the skin are dead and dryly stuck together ( coagulation necrosis ). In very severe cases, deeper layers of tissue can also be affected.

In contrast to a burn caused by the action of heat, a cold burn does not create a transition zone with less severely damaged tissue that could recover; no toxins are formed and the wound does not change significantly over time. A classic frostbite, on the other hand, differs from a cold burn in that it has a much slower, phased cooling process: At −2 ° C, complete crystallization occurs before the temperature of the tissue adjusts to the environment. The mechanism of damage and the therapeutic care also differ significantly.

therapy

Contact with the harmful substance is stopped immediately. Since the skin is completely dead after a few seconds and the wound does not expand further, even if left untreated, heating in a water bath is no longer recommended. The initial treatment is limited to sterile draping of the wound surface, the administration of painkillers and general shock therapy , if necessary. Additional heparin infusions counteract the formation of microthromboses . Subsequent surgical treatment is usually essential: the tissue under the skin swells as a result of the traumatic impact, but can not expand enough due to the lack of elasticity of the dead skin. This leads to a strong increase in pressure in the tissue, which hinders the blood flow because the vessels are squeezed together ( compartment syndrome ). In order to counteract this development, the skin is escharotomized (divided in long longitudinal incisions). When the swelling has subsided, necrotic areas are removed and the skin defects are covered with split-thickness skin grafts. The further healing process is supported by wearing compression clothing and physiotherapeutic measures . If there is severe damage to the limb , amputation may be necessary.

literature

  • T. Muehlberger aa: Injuries from liquid propane: Burns or frostbite? In: The surgeon. 72 (11), 2001, pp. 1373-1375. doi : 10.1007 / s001040170045
  • W. Schmidt, W. Hartig: General surgery. Johann-Ambrosius Barth, Leipzig / Heidelberg 1991, ISBN 3-335-00237-7 , p. 441.

Individual evidence

The individual references each cover the entire text section above.

  1. ↑ a b c d T. Muehlberger et al.: Injuries from liquid propane: burns or frostbite? In: The surgeon. 72 (11), 2001, pp. 1373-1375. PMID 11766664 .
  2. ↑ D. Camp, A. Ateaque, W. Dickson: Cryogenic burns from aerosol sprays: a report of two cases and review of the literature. In: British Journal of Plastic Surgery. 56 (8), 2003, pp. 815-817. PMID 14615259 .
  3. ↑ Principles for the testing and certification of blasting devices. ( Memento of January 13, 2017 in the Internet Archive ), publisher: Main association of commercial trade associations .
  4. ↑ Guideline on handling cryogenic liquefied gases (“cryogenic gases”) and dry ice ( memo of January 13, 2017 in the Internet Archive ), publisher: ETH Zurich .
  5. ^ P. Roblin, A. Richards, R. Cole: Liquid nitrogen injury: a case report. In: Burns. 23 (7-8), 1997, pp. 638-640. PMID 9568341 .
  6. ^ W. Schmidt, W. Hartig: General surgery. Johann-Ambrosius Barth, Leipzig / Heidelberg 1991, ISBN 3-335-00237-7 , p. 441.
  7. ↑ C. Corn et al: The protection against and treatment of a liquid propane freeze injury: an experimental model. In: Journal of Burn Care Rehabilitation. 12 (6), 1991, pp. 516-520. PMID 1779004 .
  8. ↑ G. Sotiropoulos et al: Cold injury from pressurized liquid ammonia: a report of two cases. In: Journal of Emergency Medicine. 16 (3), 1998, pp. 409-412. PMID 9610968 .
  9. ↑ P. Kumar, P. Chirayil: Helium vapor injury: a case report. In: Burns. 25 (3), 1999, pp. 265-268. PMID 10323613 .