Case reportPovidone-iodine related burns
Introduction
An unexpected chemical burn results not only in psychological trauma to the patient and physician but also in prolongation of hospitalisation and in possible disruption of the doctor–patient relationship.
Polyvinylpyrrolidone-iodine (PI), is a widely used antiseptic introduced by Shelanski and Shelanski in 1965 [1]. It is a water-soluble compound that results from the combination of molecular iodine and polyvinylpyrrolidone. The preparations of commercially available PI are povidone-iodine solution, scrub, ointment, tincture and foam; of these, the solution is the most commonly used. The 10% PI solution generally contains 90% water, 8.5% polyvinylpyrrolidone and 1% available iodine and iodide. Chemical burns due to PI, are relatively under-recognised and potentially preventable problems that may be more frequent than believed and often misdiagnosed as electrical burns.
Section snippets
Case 1
A 24-year-old Caucasian male underwent a flexor tendon repair on his right palm. The patient's operation was performed under tourniquet control. The tourniquet cuff used was a standard arm tourniquet and was applied with adequate wool padding. The skin preparation used was a tincture of povidone-iodine with an alcohol content of 70%. The operation lasted for 2 h. When the tourniquet was removed the burn was seen (Fig. 1); the preparation seemed to have run down the patient's arm and had been
Discussion
The pathogenesis of chemical burns resulting from skin preparation agents is different from that of the industrial burn because there is greater time exposure and because the anaesthesia prevents the patient from reacting to the noxious burn stimulus Undoubtedly, maceration, irritation, friction and pressure also contribute. Skin preparation burns are typical in their location. The burn is distributed over in the skin over a bony prominence or point of pressure or is seen underneath an area
Conclusions
To prevent these burns from occurring, the skin must not be abraded excessively before the final skin preparation solution is applied. The agent should not be allowed to pool and become trapped under the tourniquet or the torso of the patient. The agent should be allowed to dry before the patient is draped
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Tourniquet use in orthopaedic surgery
2017, Orthopaedics and TraumaClinical and forensic signs related to chemical burns: A mechanistic approach
2015, BurnsCitation Excerpt :Povidone–iodine is an example of an iodophor, a complex of molecular iodine and a solubilizing carrier (polyvinylpyrrolidone), which acts as a reservoir of “free” active iodine that is constantly released and remains in dynamic equilibrium with the complex [131,133]. Povidone–iodine is available in a range of antiseptic formulations (solution, scrub, ointment, tincture, and foam) [134], the aqueous solution being (10% PVP-I) the most commonly used. Although uncommon, iatrogenic chemical burns (Fig. 12) have been reported with povidone–iodine solutions [134,135].
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Aqueous based Povidone-iodine related chemical burn under the tourniquet (a case report) and literature review
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