- Email: [email protected]
Response to: Foot gangrene: An unusual cause [Burns 00 (0) (20XX) 00-00]
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burns 36 (2010) 732–740
patients: a systematic review and meta-analysis. Crit Care 2006;10:R55. [2] Oliver ER, Gist A, Gillespie MB. Percutaneous versus surgical tracheotomy: an updated meta-analysis. Laryngoscope 2007;117:1570–5. [3] Aslam S, Dziewulski P, Butterworth M, Bell D, Settle JAD.In: Abstract, British burn association annual scientific meeting; Percutaneous tracheostomy – our experience in the burned patient 1994.
Shweta Aggarwal* Peter Dziewulski St Andrews Centre for Plastic Surgery and Burns, Chelmsford, Essex, UK *Corresponding author E-mail address: [email protected] 0305-4179/$36.00. Crown Copyright # 2009 Published by Elsevier Ltd and ISBI. All rights reserved. doi:10.1016/j.burns.2009.11.005
Generally the ischemic gangrene by compression is usually thought to be developed in ICU patients who keeps the probe for a long time, or in patients with hypotension or hypoxemia. However, in this case, there may have been a technical mistake when the probe was attached. Also as shown on the photograph of patient, it seems that the compression on the distal plantar area by the strap gave the compartment syndrome in which the ischemic state of the foot could have been detected earlier through the physical examination of foot by blanching, whitish color change etc., and it could have been prevented. Also even if the patient’s hypotensive state or arterial spasm demonstrated hypoxia on saturation during the surgery, it could have been differentiated from the usual low saturation percentage oximeter since the pressure was enough to compress the artery. Regardless the foot gangrene might be caused by mechanical compression rather than electrical or thermal injury. Although it is not mentioned in the article, I am concerned how the foot has been managed and followed up. In conclusion, in young patients with relatively insufficient blood flow on the extremities, frequent inspection and monitoring of oximeter probe is the only way to prevent such catastrophe [2–4] and I agree with the author’s opinion.
Response to the Letter to the Editor Response to: Foot gangrene: An unusual cause [Burns 00 (0) (20XX) 00-00] I reviewed the article that Anil submitted with much of interest and I am grateful that my article was mentioned. Complications related to the use of the pulse oximeter probe include compression injuries and burns to the area contacting the probe. Such types of burns are rare, but recently a few cases have been reported [1–4] In my case, the burn lesion developed in another site from where the probe attached thus was probably caused by electrical burn rather than the pressure by probe. Usually the electric current developed from monopolar coagulator flows through the conductor where the resistance is minimal. On the other hand, the skin that contacts with pulse oximetry detector develops high resistance and causes burn. [2] It is reported that such cases are more frequent in children [2]. This is because the area of oximetry detector for children is smaller than that of the adults, resulting in the same amount of current in smaller area and thus, higher frequency of burn. In my case, the site other than where the probe was attached showed a lesion of current output which raises the possibility of electrical burn [2,3]. On the other hand, in Anil’s case, the point that circulation of the whole distal part of the foot from where probe was attached was decreased, and the point that it was developed after 4 h which is longer than in the electrical burn, seems to raise the possibility of ischemic injury by mechanical compression which I agree with the author’s opinion.
Conflict of interest I have no conflict of interest or nor any financial relationship with any person to disclose.
references
[1] Baruchin AM, Nahleili O, Shapira Y. Finger injury from a pulse oximeter sensor during orthoonathic surgery. Ann Mediterr Burns Club 1993;6:41–3. [2] Jeon DG, Kim SK, Lee GW, Hong SH, Kim SH. Skin burn associated with pulse oximeter: a case report. Korean J Anesthesiol 2007;52:228–30. [3] Jung SN, Hwang DY, Kim J, Kwon H, Yim YM. Pulse oximeter probe-induced electrical burn. Burns 2009;35:751–3. [4] Ghai B, Naik A, Rupal S, Madan R. Toe gangrene in an infant subsequent to use of pulse oximeter for short duration. Anesth Analg 2005;100:602.
Sung-No Jung* Won-il Sohn Department of Plastic Surgery, College of Medicine, Catholic University of Korea, Uijongbu, Republic of Korea *Corresponding author. Tel.: +82 31 820 3576; fax: +82 31 847 0301 E-mail address: [email protected] 0305-4179/$36.00. # 2009 Elsevier Ltd and ISBI. All rights reserved. doi:10.1016/j.burns.2009.10.024
burns 36 (2010) 732–740
patients: a systematic review and meta-analysis. Crit Care 2006;10:R55. [2] Oliver ER, Gist A, Gillespie MB. Percutaneous versus surgical tracheotomy: an updated meta-analysis. Laryngoscope 2007;117:1570–5. [3] Aslam S, Dziewulski P, Butterworth M, Bell D, Settle JAD.In: Abstract, British burn association annual scientific meeting; Percutaneous tracheostomy – our experience in the burned patient 1994.
Shweta Aggarwal* Peter Dziewulski St Andrews Centre for Plastic Surgery and Burns, Chelmsford, Essex, UK *Corresponding author E-mail address: [email protected] 0305-4179/$36.00. Crown Copyright # 2009 Published by Elsevier Ltd and ISBI. All rights reserved. doi:10.1016/j.burns.2009.11.005
Generally the ischemic gangrene by compression is usually thought to be developed in ICU patients who keeps the probe for a long time, or in patients with hypotension or hypoxemia. However, in this case, there may have been a technical mistake when the probe was attached. Also as shown on the photograph of patient, it seems that the compression on the distal plantar area by the strap gave the compartment syndrome in which the ischemic state of the foot could have been detected earlier through the physical examination of foot by blanching, whitish color change etc., and it could have been prevented. Also even if the patient’s hypotensive state or arterial spasm demonstrated hypoxia on saturation during the surgery, it could have been differentiated from the usual low saturation percentage oximeter since the pressure was enough to compress the artery. Regardless the foot gangrene might be caused by mechanical compression rather than electrical or thermal injury. Although it is not mentioned in the article, I am concerned how the foot has been managed and followed up. In conclusion, in young patients with relatively insufficient blood flow on the extremities, frequent inspection and monitoring of oximeter probe is the only way to prevent such catastrophe [2–4] and I agree with the author’s opinion.
Response to the Letter to the Editor Response to: Foot gangrene: An unusual cause [Burns 00 (0) (20XX) 00-00] I reviewed the article that Anil submitted with much of interest and I am grateful that my article was mentioned. Complications related to the use of the pulse oximeter probe include compression injuries and burns to the area contacting the probe. Such types of burns are rare, but recently a few cases have been reported [1–4] In my case, the burn lesion developed in another site from where the probe attached thus was probably caused by electrical burn rather than the pressure by probe. Usually the electric current developed from monopolar coagulator flows through the conductor where the resistance is minimal. On the other hand, the skin that contacts with pulse oximetry detector develops high resistance and causes burn. [2] It is reported that such cases are more frequent in children [2]. This is because the area of oximetry detector for children is smaller than that of the adults, resulting in the same amount of current in smaller area and thus, higher frequency of burn. In my case, the site other than where the probe was attached showed a lesion of current output which raises the possibility of electrical burn [2,3]. On the other hand, in Anil’s case, the point that circulation of the whole distal part of the foot from where probe was attached was decreased, and the point that it was developed after 4 h which is longer than in the electrical burn, seems to raise the possibility of ischemic injury by mechanical compression which I agree with the author’s opinion.
Conflict of interest I have no conflict of interest or nor any financial relationship with any person to disclose.
references
[1] Baruchin AM, Nahleili O, Shapira Y. Finger injury from a pulse oximeter sensor during orthoonathic surgery. Ann Mediterr Burns Club 1993;6:41–3. [2] Jeon DG, Kim SK, Lee GW, Hong SH, Kim SH. Skin burn associated with pulse oximeter: a case report. Korean J Anesthesiol 2007;52:228–30. [3] Jung SN, Hwang DY, Kim J, Kwon H, Yim YM. Pulse oximeter probe-induced electrical burn. Burns 2009;35:751–3. [4] Ghai B, Naik A, Rupal S, Madan R. Toe gangrene in an infant subsequent to use of pulse oximeter for short duration. Anesth Analg 2005;100:602.
Sung-No Jung* Won-il Sohn Department of Plastic Surgery, College of Medicine, Catholic University of Korea, Uijongbu, Republic of Korea *Corresponding author. Tel.: +82 31 820 3576; fax: +82 31 847 0301 E-mail address: [email protected] 0305-4179/$36.00. # 2009 Elsevier Ltd and ISBI. All rights reserved. doi:10.1016/j.burns.2009.10.024