Case Report
Povidone-iodine-related burn under the tourniquet of a child – a case report and literature review

https://doi.org/10.1016/j.bjps.2010.04.032Get rights and content

Summary

Chemical burn under pneumatic tourniquet caused by povidone-iodine is an iatrogenic injury and is rarely reported in the literature. It is even rarer in paediatric cases. We report a case of 2-year-old female patient who underwent excision and reconstruction of bilateral radial polydactylies. She was found with chemical burns over posterior aspect of both arms later. These wounds healed secondarily within 4 weeks. This morbidity is relatively under-recognised. Special attention should be paid to paediatric patients, whose skins are more delicate and vulnerable.

Section snippets

Case report

A 2-year-old young girl presented with bilateral radial polydactylies. Her parents denied any other disease in this patient, except for history of uncertain dermatitis. She underwent sequential excision and reconstruction of both thumbs. Both arms were under tourniquet control of 220 mmHg pressure and with adequate wool padding. Her skin was then prepared with 70% alcohol-based PI solution. The operation lasted for 2.5 h. When the tourniquets were removed, two patches of darkly discoloured skin

Discussion

PI has been widely used as a disinfectant for about 50 years.15 It is a water-soluble compound consisting of iodine and a surface-active agent – polyvinylpyrrolidone. Several commercial preparations of PI were developed for different usage, including solution, scrub, ointment, tincture and foam.6 Among these, the 10% aqueous and the 70% alcohol PI solutions are most commonly used in the operating room. A PI solution with a high alcohol content is manufactured for better bacteriocidal effect and

Conflict of interest

There is no related Conflict of Interest in preparation of this manuscript.

Funding

No author of the manuscript received funding, grants, or in-kind support in support of the preparation of the manuscript.

References (16)

There are more references available in the full text version of this article.

Cited by (18)

  • Clinical and forensic signs related to chemical burns: A mechanistic approach

    2015, Burns
    Citation Excerpt :

    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]. The chemical burn resulting from tourniquet application may even cause more in-depth injury to the skin than the abrasion wound because there is a longer exposure and the anesthesia prevents the patient pain reaction [136–138].

  • Antiseptic drugs and disinfectants

    2014, Side Effects of Drugs Annual
    Citation Excerpt :

    Skin A chemical burn occurred on the buttocks of an eight-year-old boy after application of 10% povidone-iodine solution [51A]. In another case a 2-year-old girl developed a chemical burn under a pneumatic tourniquet [52A]. This reaction occurs when the solution pools under a dependent body part or is placed under an occlusive device and is attributable to irritation from iodine coupled with maceration, pressure, and friction.

  • Acute skin lesions after surgical procedures: A clinical approach

    2013, Actas Dermo-Sifiliograficas
    Citation Excerpt :

    These cuffs are usually placed around the proximal part of the limb to block the blood flow (Fig. 8). Swabs and cotton wool are placed between the tourniquet and the skin; if these become impregnated with povidone iodine, lesions can develop at the borders of the cuff.4,11,12,21 The fourth recognized pattern is random and occurs in the dependent areas of the patient during the operation, with the appearance of runs caused by dripping of the liquid or impregnation of the surgical drapes (Fig. 9).

View all citing articles on Scopus
View full text