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burns 41 (2015) 638–647

Letter to the Editor

Letter to the Editor

Long shot suggestion for the treatment of extensive burns

Burns due to air freshener aerosol can explosion: A preventable accident

Dear Sir,

Dear Sir,

When I worked as an obstetrician & gynecologist in subSaharan Africa before HIV therapy was available, I regularly saw HIV infected women, especially if they were also pregnant, with fist-sized vulvar conglomerations of condylomata acuminata [1]. These had a very serious psychological effect, smelled (anaerobic odor), interfered with walking and some colleagues saw them, on mechanical grounds, as an indication for an elective caesarean section. To remove them during pregnancy was more or less contra-indicated because of the increased blood flow. But 4–6 weeks postpartum these growths could be removed by electrocautery sometimes resulting in third degree burns as large as 50 cm2 which tended to heal (epithelialize) within 10 days. Surgeons observed this also after removing penile/anal/ perineal warts. I wondered then if human papilloma virus (HPV) promotes epithelialization – not so strange because there are many gyri and sulci to cover. That trait could perhaps be exploited for covering extensive burns temporary. In theory one could imagine that squamous cells of a patient are cultured, infected with HPVs 6 or 11 and that the cells are subsequently transplanted to denuded areas. After epithelialization a virucide – there is in the meantime a candidate called AV2 – is sprayed on the new epithelium to destroy the virus [2]. This would create time for a more permanent solution. Perhaps readers with access to cell cultures could try out the first steps of this experimental approach, not much odder than a stool transplant or maggot therapy.

We read with great interest the manuscript ‘‘Burns due to aerosol can explosions’’ by Yarbrough 3rd [1]. We would like to add to some social issues that were not addressed by the author. The increasing use of aerosol cans as a carrier for different materials has led to the emergence of a new form of burns. There are a small number of reports on burns due to aerosol can explosion in the literature [1,2]. Closer distance than necessary and long-term and improper usage of aerosol sprays can cause cryogenic burns [3]. A 38-year-old man and a 36-year-old woman with burns on the face and both hands due to explosion were admitted to our burn center. The explosion had occurred when changing the air-freshener can in the device while cooking in the kitchen. The batteries in the automatic plastic air-freshener device had also exploded. Second-degree burns were observed on the male patient’s face and both hands (Figs. 1 and 2). First- and second-degree burns were identified on the female patient’s face and the hands (Fig. 3). The patients were hospitalized under the suspicion of sustaining inhalation burns. Treatment was continued in the burn center to track alveolar damage. Both patients recovered after regular burn care in 2 weeks. The contents of the air-freshener can were isobutane, propane, ethylene alcohol, and perfume. Exposure to flame or heat of aerosol cans leading to explosions can cause serious injuries or death. Although the hazards of using pressurized spray cans are considered by the manufacturers, disclosures made by the company are printed on the back of the box in small font. It is important to pronounce these disclosures significantly more in terms of public health. Patients can be exposed to explosions even when far from the flames as seen in our case, where selfinjection of the automatic plastic air-freshener device caused an explosion. This situation is different from other explosions described in the literature.

references

[1] Verkuyl DAA. Practising obstetrics and gynaecology in areas with a high prevalence of HIV infection. Lancet 1995;346:293–6. [2] AV2 antiviral spray versus placebo in human papillomavirus cervix infections. U.S. National Institutes of Health Clinical Trials; 2012, http://clinicaltrials.gov/ct2/show/NCT01654822 [accessed 08.12.14].

D.A.A. Verkuylab* Refaja Hospital, Stadskanaal, The Netherlands b CASA Clinics, Leiden, The Netherlands

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*Correspondence to: Leinweberlaan 16, 3971 KZ Driebergen, The Netherlands. Tel.: +31(0)343520344; fax: +31(0)847131843 E-mail address: [email protected] (D.A.A. Verkuyl) http://dx.doi.org/10.1016/j.burns.2014.12.010 0305-4179/# 2014 Elsevier Ltd and ISBI. All rights reserved.

Fig. 1 – View of the male patient.

Long shot suggestion for the treatment of extensive burns.

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