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ceration, vascularization, symblepharon), and less often of the inner eye (retinitis) have been described.

Phenol

Phenol, also known as carbolic acid, hydroxybenzene or phenylic acid is a toxic, white crystalline solid with the chemical formula C6H5OH. Its structure is that of a hydroxyl group (-OH) bonded to a phenyl ring, making it an aromatic compound. The boiling and melting points are 182 and 41 °C respectively [21]. Nowadays it is used in the manufacture of plastics, explosives, fertilizers, paint or textiles [24], but its disinfectant properties were investigated and used already 1867 by Lister in aseptic surgery. Since that time, phenol is used widely in medical and pharmaceutical properties.

Phenol is corrosive to human skin, but due to its local anesthetic properties, extensive damage may occur before pain is recognized. Dependent on its concentration, dermal contact with phenolic compunds result in irritation, dermatitis, abnormal pigmentation and burns. Up to secondor third degree burns may be caused by the concentrated phenol because of its caustic and defatting (hydrophobic effect of phenol) properties [21]. Prolonged contact elicits denaturation, necrosis and gangrene. However, systemic toxicity and poisoning usually occur by skin absorption with a possibly lethal result. It is reported that the application of a 1% lotion for 7–17 days will result in seizures and coma [33]. Chemical burns from skin exposures with phenol must be decontaminated by washing with polyethylene glycol 300 or 400 [5] isopropyl alcohol [13] or water [28]. Removal of contaminated clothing is required, as well as immediate hospital treatment for large splashes. This is particularly important if the phenol is mixed with chloroform (commonly used mixture in molecular biology for DNA & RNA purification from proteins). It is essential to obtain blood count, electrolytes, urinanalysis and baseline renal and liver measurements after phenol exposure. The acid-base balance of blood should be monitored closely. The normal blood concentration of total phenol is 0.15–7.96 mg/100 mL. The normal range of phenol in urine is 0.5–81.5 mg/L. The highest level of phenol is detected in urine 8–10h after initial exposure [21].

In case of pulmonary exposure, tachypnea, stridor, pulmonary edema and bronchospasm may occur. However, phenol is not considered a serious respiratory hazard in the workplace because of its low volatility [21]. In case of inhalation a cardio-vas- cular monitoring and administration of symptomatic treatment is necessary. Endotracheal intubation and assisted ventilation should be provided as required, as phenol-induced pulmonary trauma being consistent with adult respiratory distress syndrome.

Phenol and its vapor are irritating and corrosive to the eyes with resulting tearing, conjunctivitis and corneal/conjunctival edema. Severe corneal injury may result in white and hypesthetic corneas or corneal necrosis [29]. Again, irrigation of the eyes with copious amounts of water or 0.9% saline solution, local anesthesia application and ophthalmologic examination should be performed.

The substance can cause harmful effects on the central nervous system and heart, such as dysrhythmia, seizures, and coma [33]. In cases of long-term or repeated exposure of phenol effects on the liver and kidneys are reported [34]. Exposure may result in death and the effects can be delayed. The substance is a suspected carcinogen. Besides its hydrophobic effects, another mechanism for the toxicity of phenol may be the formation of phenoxyl radicals [10].

Summary

Chemical burn traumata usually occur in chemical industry, during transportation and handling of hazardous materials or at home. The acids or bases cause protein denaturation in tissues, resulting in cell damage and apoptosis with subsequent necrosis. The extent of damage depends on the type, amount, and concentration of the caustic substances, but also on the duration of exposure. Disrupting the pathophysiological mechanism of the chemical reaction at an early stage is therefore the foremost goal of any medical treatment. In the skin, acids causes coagulation necroses that in most cases keep the acids from penetrating into deeper-lying tissue. Bases cause colliquative necroses that permit diffusion and penetration into underlying tissues with a subsequent more extensive corrosive effect. Firstto

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third-degree burns with their respective subsequent scarring result and treatment can occur according to thermal burns. All other possibly affected organ systems must be examined. Pulmonary emergency diagnostics and therapy are preeminent: monitoring of peripheral oxygenation, thoracic x-rays, oxygen donation and periodical steroid application. Inoculation traumata are to be rinsed out extensively, decontaminated with diphoterines / chelates and treated with panthenol-containing gel after ophthalmologic consultation. In the case of oral ingestion regurgitation is contraindicated to avoid another contact of the acid with the oesophageal mucosa. Application of any liquid for dilution and of proton pump inhibitors to prevent inflammation and strictures is necessary as well as a gastroduodenoscopy. To reduct Met-Hb in case of a methemoglobinaemia application of toluidin-blue, methylen-blue, thionine or ascorbic acid is recommended. A renal affection requires forced diuresis, if necessary supported by mannitol and bicarbonate.

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Correspondence: Leila Kolios, M.D., Clinic for Hand-, Plastic & Reconstructive Surgery – Burn Center – Clinic for Plastic & Hand Surgery at Heidelberg University Hospital, BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Straße 13, 67071 Ludwigshafen, Germany, E-mail: [e-mail]

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