Medical Dopers, what do you make of this scary story?

Sounds pretty horrific. (Warning: Contains disturbing images.) What could cause a wound of this sort?

I’m not a doctor, but that story raised two questions in my mind. The post itself does not say, but in one of the follow-up comments, she says, “He did rinse the hand immediately after the burn.”

When I took high-school chemistry, the teacher was pretty safety-conscious. We were instructed that if we ever spilled anything dangerous on ourselves, we were to run, not walk, to the nearest water source.

So my questions are–

  1. What does “immediately” mean? As fast as humanly possible, or within a few minutes?
  2. How long and how vigorously did he rinse?

For some chemicals, a proper response can make a great deal of difference in the outcome. She also says in the comments, “The active ingredients in the cleaner were sodium hydroxide and potassium hydroxide.” Those are very powerful chemicals, and an improper response will likely do considerable damage.

Right, but why hasn’t the wound healed over these years, and does this seem bacterial, fungal, etc.?

From out of right field:

Some sort of allergy to any of those chemicals?

I’m pretty sure he’s got some kind of mystery infection from when the chemical caused an open wound. I don’t see how exposure to caustic chemicals would case the pattern of seems OK - back to dead that she describes,

I am not a doctor, but this is a fascinating story. As I read through, I kept wondering why they didn’t eventually amputate, only to learn that they had, and that the necrosis had returned anyway. Ugh!

In reading the comments, it does sound like white clot syndrome, a serious side effect of the heparin treatment he is receiving, could be the answer.

I will continue to follow to see if they are able to crowdsource a solution. It looks like a lot of very experienced, well-qualified doctors are responding.

Any wound can, theoretically, lead to amputation and death. I too want to know what drain cleaner. I’m certain I’ve gotten Drano Max on my skin, and it did me no damage. Not so much as a rash. But chemical burns are common, and there’s ample opportunity for them to become infected.

It’s a tragic story either way. I’ve seen people go through similar situations with diabetic and venous stasis wounds, eventually leading to the amputation of feet and legs.

Wow. That is a weird story.

My money’s on an autoimmune vasculitis of some sort. Those things can be weird.

The time course is too long for the chemicals, and a classical allergy shouldn’t cause necrosis. To me, necrosis implies two things:

  1. Insufficient blood supply to the tissue

  2. Infection.

I don’t think it’s infection for a couple of reasons. One - the time course. Much too long - necrotizing fasciitis is a rapid aggressive infection. It doesn’t really wax and wane. Also, the typical bugs are generally susceptible to antibiotics. You are looking at Group A Strep, Clostridium or polymicrobial (rarely pseudomonas in a compromised host or other weird stuff). I’m guessing that during the period at the “research hospital” in WI, they got antibiotics as part of the 20-odd meds they were on. I think she alluded to them somewhere in the article too, and that they were ineffective.

Second reason it’s not infection? They did source control. They did the ultimate in source control - they amputated. I’ve never seen infection come back like that after an amputation.

So, that leaves us with insufficient blood flow, and I’m guessing a weird vasculitis that is perhaps destroying local blood vessels? Taking off the medical hat for a moment, my grandmother had an odd localized cases of vasculitis when I was a child. Not nearly as severe as this, but she remained on steroids until the day she died because of it’s recurrent nature.

I’d want to see the biopsy results to be sure (and I’m sure there are biopsy results somewhere) - I would see a rheumatologist if I were them. If they haven’t already.

incidental, do you think it’s possible this could eventually take the entire arm? Or worse? Gak!

My grade school science teacher told us to get her right away in this scenario. She demonstrated this by pouring something (don’t remember what it was) on a rag, then running it under water, then showing us how the chemical and the water had reacted and the rag had disintegrated (or maybe they didn’t react, but the water just didn’t do anything, it was a long time ago).

I’m reminded of that every time I watch Fight Club.

I don’t believe that two drops of drain cleaner should be blamed here. This is an after effect that could have happened from all sorts of injuries. Drain cleaners are strong bases or acids and I am told that they quickly react with human tissue and form neutral compounds. This has to be something that happened to the damaged tissue following that. Maybe my information is wrong, I’m no chemist.

I’m not a medical doctor but I do have a PhD in chemistry. My money is on hydrofluoric acid. It is a weak acid, in terms of the chemical definition of the term. It is EXTREMELY dangerous. You can also buy it at Wal-Mart. It’s used for etching glass and similar arts and crafts type projects. It will dissolve glass, so it needs to be stored in plastic.

The danger is due to the small F- ion that can penetrate tissue quite easily. Unlike other acids that will burn the skin, HF can penetrate the skin and attack fatty issues and bone. It will bind the calcium ions in your blood and can cause a heart attack if enough touches the skin. Since it doesn’t immediately burn the skin, the danger of exposure to it are not always immediately obvious. It is a chemical to be feared.

Don’t know - maybe? I’m guessing they’ll be able to stop it, but perhaps with a big hammer (steroids, immunomodulators, etc.). Honestly, I’d need to see the entire chart to guess one way or the other.

I agree it’s not the chemical. The chemical may have been the first domino to fall, but I doubt it’s responsible this far down the line. Sometimes infection or other external insults turn the immune system on, and then it doesn’t turn off like it’s suppose to.

Again - I’m just guessing based on limited data. This sounds like a case that would merit publication somewhere.

But even years later, still causing this?

The part about the patient’s hand being sewn into his stomach - doesn’t that risk transferring an infection from hand to abdomen?