Ns. Gibran et al., ENGINE BLOCK BURNS - DUPUYTREN 4TH-DEGREE, 5TH-DEGREE, AND 6TH-DEGREEBURNS, The journal of trauma, injury, infection, and critical care, 37(2), 1994, pp. 176-181
We recently treated two patients with engine block-muffler contact bur
ns and greatly underestimated the devastating injuries to bone, deep f
ascia, and muscle. As a result, each patient required multiple procedu
res to close their burn wounds. Ten-year data from the University of W
ashington Burn Unit confirmed our observation that these burns tend to
be considerably deeper than suspected. Eighteen patients with contact
burns from engine parts were identified from 1980 through 1990. Nine
(50%) of these were initially recognized to be fourth-degree and five
(28%) were third-degree thermal injuries, showing that these are deep
burns. Eight patients required fascial excisions and four required deb
ridement of devascularized bone. The mean burn size was only 6% total
body surface area; however, the patients with fourth-degree burns had
an average graft take of only 56% and required a mean hospital stay of
44 days. Patients with third-degree burns also had suboptimal graft t
ake and some required prolonged hospitalization. Thirty-six percent of
patients required flaps either as the initial procedure or as a secon
d procedure following an autograft. The four patients with partial-thi
ckness burns healed without surgery and their average length of hospit
al stay was 3 days. Of the entire group, only four healed without surg
ery and only five healed with a single operation. Our 10-year data ind
icate that engine block contact burns are usually small, but most are
deceptively deep, involving tendon, muscle, or bone. If the burn appea
rs full thickness, suspicion must be very high at the initial surgical
procedure that there is deep tissue destruction. We propose that burn
s from engine block or muffler contact are the fourth, fifth, and sixt
h-degree injuries described by Dupuytren in 1832. They behave like and
should be handled more like electrical burns than other contact injur
ies.