Chemical Burn Injury Research Articles

Conjunctival Squamous Cell Carcinoma Presenting after Chemical Burn Injury

Conjunctival Squamous Cell Carcinoma Presenting after Chemical Burn Injury

Chemical Burn Injury on the Cornea Following Skin Preparation With Chlorhexidine in Tonsillectomy and Adenoidectomy.

This article report discusses a pediatric patient who suffered a corneal chemical burn injury after tonsillectomy and adenoidectomy surgery due to skin preparation with chlorhexidine. In this case, inadequate sealing of the eye shield during skin preparation allowed the chlorhexidine-alcohol solution to accumulate at its edge and gradually penetrate, resulting in the corneal injury. Prompt ophthalmological intervention and appropriate eye care treatment led to a gradual improvement in the patient's symptoms. The authors aim to present the case, share the revisions made to our skin preparation policy, and emphasize the importance of cautious antiseptic use to minimize the risk of adverse events. Adverse effects of chlorhexidine, such as hypersensitivity reactions and burns, including corneal damage, are highlighted. Health care providers should exercise caution when selecting and applying antiseptics, considering patient-specific factors, and comprehensive training should be provided to promote adherence to safe antiseptic practices during surgical procedures.

Bleach-Induced Chemical Sinusitis and Orbital Cellulitis Following Root Canal Treatment

The authors describe an unusual case of chemical sinusitis and orbital cellulitis secondary to a sodium hypochlorite accident in a patient who had just undergone root canal treatment. The patient presented with acute, progressive symptoms of unilateral maxillary sinusitis, facial cellulitis and orbital cellulitis which began hours after root canal treatment on the ipsilateral side. He was admitted to hospital under the care of the Otorhinolaryngology team and reviewed regularly by the Ophthalmologists. He underwent Endoscopic Sinus Surgery during his hospital stay. The intraoperative findings revealed necrotic sinus mucosa and slough within the involved maxillary sinus, which were suggestive of chemical burn injury induced by the highly alkaline sodium hypochlorite solution used during root canal treatment. He was treated postoperatively with regular nasal toilet, culture-directed antibiotics and topical ocular pressure-lowering eyedrops. He displayed a slow recovery with eventually no orbital sequelae, but experienced persistent cheek numbness three months post-injury. Severe chemical sinusitis with orbital cellulitis secondary to sodium hypochlorite accident is a rare complication of root canal treatment, with potentially severe consequences. It can present with symptoms similar to complicated acute bacterial sinusitis. Otorhinolaryngologists and dental surgeons should maintain a high index of suspicion when managing a patient post-root canal treatment with symptoms of unilateral sinusitis, facial cellulitis, orbital cellulitis and even airway compromise. This would allow prompt intervention before sight or life-threatening complications set in.

A Rare Case of a Second-Degree Chemical Burn due to Successive Contacts of Acidic Wart Removal Solution and Paint Solution

Introduction: Chemical burns are an uncommon form of burn injury, accounting for 2.1% to 6.5% of all burn centre admissions. We presented one rare case of a second degree chemical burn due to successive contacts of acidic wart removal solution and paint mixture solution. Case: A 38-year-old male with chemical burn on both feet due to reckless usage of a self-purchased wart removal solution, and accidental contact with paint mixture solution. Our surgeon author diagnosed a superficial partial thickness (second-degree) chemical burn on this patient, and performed surgical debridement followed by hyaluronic-enhanced silver sulfadiazine topical dressing to provide antimicrobial protection to the wound and topical petrolatum-based ointment to maintain moist environment for the wound and the periwound. Our team also gave Ceftaroline, a cephalosporin for serious infections of the skin and tissues below the skin, intravenously. Result: One day after the surgical procedure, the wound dimensions were slightly more extensive than the initial size due to extensive debridement and necrotomy. All wounds produced no or minimal exudate, showed no slough nor pus inside the granulation area, and no swelling nor maceration in the periwound area. The fifth day after the surgical procedure, the wound on the lateral side of patient’s right foot was almost completely covered by epithelialization. The wound on the sole of patient’s right foot was about 70-80% covered by epithelialization, and the wound on the sole of patient’s left foot was also about 70% covered by epithelialization. Discussion: Topical solution for wart removal consists of many chemicals agents (i.e. salicylic acid and acetic acid) and its application should strongly be under guidance and monitoring by physician due to its potential to harm human bodies and trigger chemical burn injury in varying degrees. Paint mixture is usually safe, risks no or minimal harms when in contact with skin, however it can provide a more difficult scenario and consequently a more extensive cleansing during the wound debridement procedure. Immediate decontamination and adequate dilution through massive irrigation is a major determinant of burn severity after chemical injury. Application of 1% silver sulfadiazine topical antibiotics enhanced with 0.2% hyaluronic acid for moisturizer displayed significant improvement for the burn wound healing. Conclusion: Knowing exactly what type of chemical substance in contact with the skin and tissues that caused the chemical burn injury is as equally important as the comprehensive management itself. For acidic burn injuries, a proper and sometimes extensive necrotomy procedure is mandatory to provide a good tissue regeneration.

Children ages one to four are disproportionally affected by chemical burns in a cross-sectional analysis of NEISS 2012–2021

BackgroundHousehold cleaning and personal care products (HC&PCPs) are irreplaceable in most daily routines. However, data are sparse on chemical burns caused by HC&PCPs. MethodsWe queried the National Electronic Injury Surveillance System (NEISS) from 2012 to 2021 to characterize chemical burns caused by HC&PCPs as well as the most common causative categories of HC&PCPs responsible for chemical burns. ResultsWe found 2729 total emergency department (ED) visits due to chemical burn injuries within the years 2012–2021 due to HC&PCPs. Chemical burns disproportionally affect children ages four and under, accounting for 36.4% of all patients. Within this subpopulation, boys were more frequently affected by chemical burns and the eyes were the most affected area. The most common HC&PCPs involved in chemical burns in individuals ages one to four were laundry soaps and detergents (22.0%) and bleaches (21.3%). ConclusionChildren ages four and under are disproportionately affected by chemical burns due to non-intentional exposure of HC&PCPs, with laundry detergents and bleaches being the most common causative agents. Adequate storage of all HC&PCPs and improved parental supervision are paramount in preventing chemical burns in this age group.

Epidemiology of chemical burns: An 11-year retrospective study of 126 patients at a referral burn centre in the north of Iran.

The etiology and outcomes of chemical burns vary worldwide, influenced by the local population structure, industry distribution, and geographical and social environments. The aim of this study was to evaluate the epidemiology of chemical burns among patients referred to a burn centre in the north of Iran. A single-centre, retrospective study was conducted on patients with chemical burns between 2011 and 2021. Data collection was carried out using the hospital information system (HIS), and data collected from medical records included gender, age, marital status, occupations, burn season, place of residence, intention to burn, location of the accident, percent of total body surface area (%TBSA), the primary cause of burns, the body region of the burn, length of hospital stay (days), infection, and discharge status. The data were analysed using descriptive statistical methods and SPSS 24.0 software. Of the 10 133 burn patients treated in a burn centre in the north of Iran between 2011 and 2021, 1.2% had chemical burns. The average age of patients was 34.45 (SD=22.16) years, and most chemical burns cases were male (70.6%, n=89). Chemical burns occurred most frequently in patients aged 20 to 49 years (69.8%, n=107), and most of the burns were accidental (84.9%, n=107). The home was the most common place of chemical burn injury, accounting for 49.2% (62 cases), followed by the workplace (43.7%, n=55), respectively. Most chemical burns occurred in the summer season (36.5%, n=46), and acid (74.6%, n=94) was the most common cause of chemical burns. The mean TBSA was 16.41 (SD=15.10). The most common burn area was the lower limb (34.9%, n=44), and the overall mortality rate was 4.8%. The average length of stay in the hospital was 6.53 (SD=5.57) days. Community education on household safety, restricting non-specialists' access to chemical substances, and the promotion of early consultation could reduce chemical burn prevalence and improve outcomes.

An in silico derived dosage and administration guide for effective thermochemical ablation of biological tissues with simultaneous injection of acid and base

Background and objectives: Thermochemical ablation (TCA) is a thermal ablation technique involving the injection of acid and base, either sequentially or simultaneously, into the target tissue. TCA remains at the conceptual stage with existing studies unable to provide recommendations on the optimum injection rate, and reagent concentration and volume. Limitations in current experimental methodology have prevented proper elucidation of the thermochemical processes inside the tissue during TCA. Nevertheless, the computational TCA framework developed recently by Mak et al. [Mak et al., Computers in Biology and Medicine, 2022, 145:105494] has opened new avenues in the development of TCA. Specifically, a recommended safe dosage is imperative in driving TCA research beyond the conceptual stage.Methods: The aforesaid computational TCA framework for sequential injection was applied and adapted to simulate TCA with simultaneous injection of acid and base at equimolar and equivolume. The developed framework, which describes the flow of acid and base, their neutralisation, the rise in tissue temperature and the formation of thermal damage, was solved numerically using the finite element method. The framework will be used to investigate the effects of injection rate, reagent concentration, volume and type (weak/strong acid-base combination) on temperature rise and thermal coagulation formation.Results: A higher injection rate resulted in higher temperature rise and larger thermal coagulation. Reagent concentration of 7500 mol/m3 was found to be optimum in producing considerable thermal coagulation without the risk of tissue overheating. Thermal coagulation volume was found to be consistently larger than the total volume of acid and base injected into the tissue, which is beneficial as it reduces the risk of chemical burn injury. Three multivariate second-order polynomials that express the targeted coagulation volume as functions of injection rate and reagent volume, for the weak-weak, weak-strong and strong-strong acid-base combinations were also derived based on the simulated data.Conclusions: A guideline for a safe and effective implementation of TCA with simultaneous injection of acid and base was recommended based on the numerical results of the computational model developed. The guideline correlates the coagulation volume with the reagent volume and injection rate, and may be used by clinicians in determining the safe dosage of reagents and optimum injection rate to achieve a desired thermal coagulation volume during TCA.

792 Exoskeleton Robot Using 3-Dimensional Modeling in Burn Patient

IntroductionHands are the part of the body that are most commonly involved in burns, and the main complications are finger joint contractures and nerve injuries. Hypertrophic scarring cannot be avoided despite early management of acute hand burn injuries, and some patients may need application of an exoskeleton robot to restore hand function. To do this, it is essential to individualize the customization of the robot for each patient. Three-dimensional (3D) technology, which is widely used in the field of implants, anatomical models, and tissue fabrication, makes this goal achievable.MethodsTherefore, this report is a study on the usefulness of an exoskeleton robot using 3D technology for patients who lost bilateral hand function due to burn injury. Five burn patients with upper limb dysfunction after a flame and chemical burn injury, with resultant impairment of manual physical abilities.ResultsAfter wearing an exoskeleton robot made using 3D printing technology, the patients could handle objects effectively and satisfactorily.ConclusionsThis innovative approach provided considerable advantages in terms of customization of size and reduction in manufacturing time and costs, thereby showing great potential for use in patients with hand dysfunction after burn injury.

Management of chemical burns.

Chemical burns represent a small number of burn injuries in the UK. They have the potential to be life-threatening with serious aesthetic and functional consequences, accounting for 30% of all deaths from burns. Chemical burns are caused by corrosive agents (acids and alkali) leading to extensive tissue damage. Understanding the pathophysiology of a chemical burn injury and identifying the nature of the offending agent is important for effective management. Prompt assessment and management of chemical injuries is vital to reduce the deleterious effect of the compound involved. This article reviews the pathophysiology of a chemical injury and the management of these burns.

Chemical Burn and Found Down Crush Injury: A Dual Cause of Upper Extremity Compartment Syndrome

Chemical Burn and Found Down Crush Injury: A Dual Cause of Upper Extremity Compartment Syndrome

49 Comparing Intravenous & Subcutaneous Insulin Regimens for Management of Hyperglycemia in Adult Burn Patients

Abstract Introduction Burn patients are at an increased risk of hyperglycemia due to metabolic, anabolic, and treatment-related factors. Studies in burn patients have targeted goal blood glucose (BG) values ranging from 80–140 mg/dL. Our study aimed to evaluate current management of hyperglycemia in burn patients and to develop a treatment protocol in this population. Methods A retrospective study of patients admitted between 10/2016 - 8/2019 was conducted. Eligible patients were at least 18 years old, admitted within 48 hours following injury, and admitted for either thermal, chemical, or electrical burn, frostbite, or inhalation injury. The primary outcome was glycemic control, defined as percent of time spent within our predefined BG goal range of 90–130 mg/dL using a time-weighted BG (TWBG) level. Insulin regimens were compared to determine the most effective modality for achieving this goal. Additional secondary outcomes included consequences of hypoglycemia, complications of poor glycemic control, length of stay, and in-hospital mortality. Results A total of 68 patients were evaluated, and 48 met inclusion criteria. Majority of patients were male (73%), with a mean (SD) age 60 (16) years, median (IQR) TBSA 10% (4,19), and median (IQR) baseline HbA1c 6.6% (5.6,8.2). Twenty-four (50%) patients did not have a history of diabetes. Patients spent a median (IQR) 38% (20,61) of days in goal range. Twelve patients (25%) had a TWBG level between 90–130 mg/dL. Overall, the median (IQR) TWBG level for all 48 patients was 140 mg/dL (132,160). Majority of patients were either on an insulin infusion (60%) or basal + sliding scale insulin (SSI) (51%). Patients that were on insulin infusions were controlled for a median (IQR) 75% (50,83) of days compared to patients treated using basal + SSI 20% (0,40) of days (p< 0.01). Other regimens are included in the table below. No patients were hypoglycemic (BG less than 70 mg/dL) based on TWBG. Conclusions The majority of patients in this study were not within goal BG range during their hospitalization. Patients were primarily managed by an insulin infusion or basal + SSI. However, the most appropriate regimen appears to be an insulin infusion or basal + bolus + SSI.

Macroscopical and Biochemical differentiation between cutaneous thermal, scald, chemical and electrical burn injuries with forensic significance in rats

Burn is a cutaneous injury in the skin tissue that is caused by heat, freezing, chemical, electrical or radiation. This study was designed to differentiate between thermal cutaneous burn injury and other common cutaneous burn injuries. Twenty-five rats were divided randomly into five groups (n =5) as follows: control, thermal burned, scalding, chemical burned and electrical burned group. After five minutes from burn induction, rats were euthanized, and skin tissue was collected for biochemical assays. Each treated group has its unique macroscopic appearance. GST activity of skin tissue was significant decrease in all treated group. All groups showed significantly increase in MDA (LPO bio-indicator) level. while, MDA level was highest increase in chemical burn group. Also, pro-inflammatory cytokine (Il-6) level was increase in all groups. However, the highest IL-6 level was observed in electrical burn one. It could be concluded that different cutaneous burn injuries can differentiated from each other through their macroscopical examination. But the tested biochemical parameters did not exhibit a significance in differentiation between the selected types of the burns.

Accidental chemical burn injury associated with recreational thinner inhalation

Inhalation of thinners is known to have systemic toxic effects on the human body. Despite this, thinners have been abused for mood alteration. Accidental injury following thinner inhalation includes burns from the ignition of volatile substance or secondary trauma (as the patient loses consciousness). Chemical burn from prolonged contact with thinner-containing toluene may occur, although rare. We present a case of accidental burn injury resulting from prolonged contact with spilled thinner.

Characteristic Of Hospitalized Burn Injury Patients In Zainoel Abidin General Hospital Year 2016-2017

Background: The epidemiology pattern of patients with burn injury varies widely in different parts of the world. This study aimed to identify epidemiological data from hospitalized burn injury patients in Zainoel Abidin General Hospital, a referral Hospital in Aceh. Methods: All hospitalized burn injury patient data from January 2016 to December 2017 were collected from the medical record. Data taken included Gender, age, length of stay (LOS), mortality, severity, and extent of the burn, and etiology of burn. Results: From all hospitalized patients with burn injury, the male to female ratio is 1,6:0,9. The mortality rate is 9%, while the others survive. From all etiology of burn, 57% is flame injury, 19% is electrical injury, 18% is scald burn injury, 4% is contact burn injury, and 1% is a chemical burn injury. No patient with first-degree burns was hospitalized, while 13 patients had third-degree burn injuries, and the rest had second-degree burn injuries. Conclusion: An increasing number of hospitalized patients from 2016 to 2017, from 25 patients to 42 patients. It might happen because of increasing knowledge about burn injury in society and physicians in rural areas to refer patients to the hospital with better facilities.

Chemical Burn Injury in the Scrotal Area Caused by Button Cell Battery: A Case Report

: Here we reported a one-year-old infant with tissue damage in the scrotum area, in which a small button cell battery had been found in his diaper. Evidence suggested that the lesion was caused by contact with the leaky battery with the scrotal skin. The treatment procedure was prescribed by a dermatologist. The healing process was tracked over the examination times. After two months, the site of the lesion showed complete remission. The findings suggested that in such cases, after removing the chemical agent, blisters, and necrotic tissues, therapeutic measures should be performed similarly to the thermal burns.

547 Long-term Outcomes of Chemical Burn Injuries: A Burn Model System National Database Study

Abstract Introduction Information on long-term outcomes following chemical burn injury is sparse. This study aims to examine whether or not there are differences in long-term outcomes for individuals with chemical burn injuries compared to those with fire/flame injuries. Methods Data from the Burn Model System (BMS) National Database (1997–2019) were used for analysis. Demographic and clinical characteristics of adult burn survivors with chemical injuries and fire/flame injuries were compared. Regression analyses for the Mental Health Composite Scale (MCS) and the Physical Health Composite Scale (PCS) of the Short Form Health Survey-12, employment status, and Satisfaction with Life Scale (SWLS) were conducted at 12 and 24 months post-burn, adjusting for age, gender, race, and burn size. Results A total of 2,522 database participants (96 with chemical burns; 2,426 with fire/flame injuries) were included in the analyses. Those with chemical injuries had smaller burn sizes, shorter hospital stays, and fewer ventilator days (p< 0.0001, p=0.0034, and p=0.0005, respectively). Chemical burn survivors were more likely to be employed at the time of the burn (p< 0.0001), to have sustained an employment-related injury (p< 0.0001), and to have been discharged to their own home following their acute stay (p< 0.0001). No significant differences in the MCS, PCS, employment status or SWLS were found at either 12 or 24 months post-burn between groups in the regression analyses. Conclusions Chemical burn injuries were not found to have a significant difference on mental health, physical health, employment status, and satisfaction with life outcomes compared to fire/flame injuries. However, the effects of chemical burn injury on long-term outcomes may be difficult to detect due to the relatively small sample size of this population. Applicability of Research to Practice Further investigation is needed to better understand long-term outcomes following chemical injuries. Individuals with chemical burn injuries may require more specific assessment tools to improve how these types of injuries are studied.

626 Causes and Injury Patterns of Elderly Burn Patients

Abstract Introduction Older patients are a particularly vulnerable population with respect to burn injuries. The American Burn Association has invested resources in improving burn care and burn prevention within this age group, recognizing the difficulties in both the identification and subsequent modification of risk factors. The National Electronic Injury Surveillance System (NEISS) is maintained by the Consumer Product Safety Commission to surveil for injury trends and is populated with data from a representative group of approximately 100 emergency departments in the United States. This database could serve as a useful tool to evaluate burn injury patterns in elderly patients with an eye toward targeted prevention measures. Methods The NEISS was queried for patients aged 55 years and older with a diagnosis of scald, thermal, chemical, electrical, or unspecified burn injuries for the years 2008 - 2017. Each injury was classified by body part(s) burned, causative product, gender, and age group of patient (55–64, 65–74, 75–84, 85 and older). The ten most commonly burned sites as well as the ten most common causative products were determined for each gender and age group and in aggregate. Weighted estimates from the NEISS data were utilized to calculate injury numbers across the population. Results The most common etiology of burn injuries for all patients aged 55 and older was hot water. Men were most commonly injured by gasoline, a product which did not rank in the top ten for women in any age group. Additionally, within each age group, gasoline was among the top 4 products that was associated with burn injuries in men. Cookware was the second most common cause of burn injury among women aged 55 and older and was the sixth most common cause among men. For women, the combination of cookware and ranges/ovens was among the top 2 products associated with burn injury within each age group. The most commonly injured body part for all patients was the face. This held across most age and gender groupings except for women aged 75 to 84 (upper trunk), and women 85 and older (foot). Men were more likely to injure their hands than women. Conclusions The most common cause of burn injuries in older adults is hot water, and the most common body part affected is the face. Women are more likely to be injured by cookware and ranges/ovens. Men are more likely to be injured secondary to gasoline and are more likely to injure their hands. Applicability of Research to Practice NEISS data could be useful in the development of targeted prevention campaigns, such as focused education about the dangers of hot liquids, cooking, and accelerants.

PROPOFOL EXTRAVASATION: A CASE OF SOFT TISSUE INJURY

SESSION TITLE: Wednesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: A complication of any medication given via a peripheral intravenous catheter (IV) is the administration of the medication into the surround perivascular tissue. This can be associated with adverse events such as tissue necrosis, increased risk of infection, and acute compartment syndrome. Propofol is a sedative-hypnotic IV anesthetic that has a rapid onset of action, rapid recovery, neutral pH, and is isotonic. Due to these properties, adverse events related to the use of propofol are relatively rare. We report a case of propofol extravasation resulting in prolonged sedation requiring mechanical ventilation and soft tissue injury. CASE PRESENTATION: A 51-year-old female with past medical history of cervical stenosis underwent an elective anterior cervical discectomy and fusion. During the procedure, she was noted to require increasing amounts of sedation and received approximately 700 mL of propofol (10mg/ml concentration). After surgery, extravasation of the propofol was noted in the left forearm with significant edema, erythema, and warmth from the elbow to the wrist. Scattered superficial skin wounds with superficial partial thickness depth were present on the elbow, forearm, and wrist. There was no evidence of necrosis with a palpable distal radial pulse. Post-operatively, the patient remained unresponsive and required prolonged mechanical ventilation for an additional 12 hours. She was initially managed with broad spectrum antibiotics and 1% silver sulfadiazine; however, antibiotics were quickly discontinued as her condition improved and there was no suspicion of underlying infection. She was discharged in stable condition on hospital day 4. DISCUSSION: Despite the favorable chemical properties of propofol, there have been recent case reports of tissue necrosis related to propofol extravasation. Patient co-morbidities such as malnutrition, peripheral vascular disease, and diabetes may predispose to tissue necrosis secondary to poor vascular supply and delayed healing. Moreover, propofol is an excellent culture medium for bacterial growth secondary to its high lipid content. Extrinsic contamination's of propofol preparations have been reported in literature resulting in post-operative septic shock and wound infections. Increased pressure within a closed fascial compartment can lead to compartment syndrome. Management involves immediate termination of the propofol infusion. A surgical consult should be obtained for the management of tissue necrosis and chemical burn injury. Some authors advocate for aspiration of propofol before withdrawing the infusion needle and washing the area with isotonic fluids. CONCLUSIONS: Even though propofol is a fairly benign anesthetic, physicians need to be aware of the complications associated with its use. There needs to be a high index of suspicion for IV infiltration in patients requiring increasing doses of sedation for any procedure. Reference #1: Leblanc JM, Lalonde D, Cameron K, Mowatt JA. Tissue necrosis after propofol extravasation. Intensive Care Medicine. 2013;40(1):129-130. https://doi.org/10.1007/s00134-013-3137-z. Reference #2: Kalraiya AJ, Madanipour S, Colaco H, Cobiella C. Propofol extravasation: a rare cause of compartment syndrome. BMJ Case Rep. 2015;2015:bcr2015209360. Published 2015 May 7. https://doi.org/10.1136/bcr-2015-209360. Reference #3: Sharma R, Yoshikawa H, Abisaab J. Chemical burn secondary to propofol extravasation. West J Emerg Med. 2012;13(1):121-2. DISCLOSURES: No relevant relationships by Abdullah Al Twal, source=Web Response No relevant relationships by Jason Cohen, source=Web Response No relevant relationships by Kristin Fless, source=Web Response No relevant relationships by Sasa Ivanovic, source=Web Response No relevant relationships by Nirav Mistry, source=Web Response No relevant relationships by Vagram Ovnanian, source=Web Response No relevant relationships by Fariborz Rezai, source=Web Response No relevant relationships by Paul Yodice, source=Web Response

OXA-48 carbapenemase-mediated ceftazidime-avibactam resistance; first reported case in Saudi Arabia’s western region and review of literature

Introduction: The emergence of carbapenemaseresistant Enterobacteriaceae (CRE) is an imminent threat to public health obligating, the development of novel β-lactam/β-lactamase inhibitors to combat its relentless spread, an example of which is ceftazidime-avibactam (CAZAVI). Since its introduction in 2015, worldwide data continues to pour in describing different mechanisms of treatment failure, primarily mediated by members of metallo-β-lactamase (MBL), Klebsiella pneumoniae carbapenemase (KPC), and oxacillinase (OXA) enzymes. Case Report: We report a case of a previously healthy 22-year-old male who was admitted to the critical care burn unit as a case of third-degree chemical burn injury involving 80% of his body surface area. His tissue cultures grew Klebsiella pneumoniae which was resistant to CAZ-AVI. Further analysis of resistance patterns by Xpert® Carba-R detected the presence of both NDM (New Delhi metallo-β-lactamase) and OXA-48 mutation genes. Conclusion: OXA-48-mediated carbapenemase resistance is a regional threat in the Middle East and it is increasingly expanding in terms of its epidemiology and activity against novel antimicrobials. This activity is primarily mediated by mutant doubling and plasmid adaptation and can be horizontally acquired by coexistence with other resistant genes. We are reporting the first OXA-48-mediated CAZ-AVI resistance in the western region of Saudi Arabia which raises the concern about CRE spread in the country. Necessitating wiser use of available genotypic testing coupled with strict adherence of infection control protocols and antimicrobial stewardship programs.

Complex Intraoral Reconstruction Using a Single Free Anterolateral Thigh Flap and Supermicrosurgery After Corrosive Ingestion in a 14-Month-Old Child

Oral chemical burn injuries induce more damage to the underlying tissues with extensive scarring. It is very well known that alkali causes severe liquefaction necrosis and injury to the deeper tissues. Pediatric facial burns must be managed thoroughly and always require complex reconstruction, which is a challenging process. So, any reconstructive surgeon must be aware of all the deformities that may have significant functional and aesthetic impact on the burn survivors especially children. Few medical studies addressed pediatric microsurgical reconstruction for oral burn injuries induced by chemical materials. Anterolateral thigh (ALT) free flap is a common flap with a multitude of indications. The purpose of this article is to present the youngest case in the medical literature of caustic intraoral scarring managed with a very thin free anterolateral thigh flap in a 14-month-old child who underwent reconstruction of his inner cheek, the angle of the mouth and tongue using supermicrosurgery techniques. Further development of the surgical techniques is required to establish early and safe intraoral pediatric microsurgery with a long-term follow-up.