White phosphorus burn: A clinical report by Palestinian physicians

This report made by Palestinian doctors was published on The Lancet

In January, 2009, an 18-year-old man presented to the emergency department after suffering an attack with an incendiary shell. He had many painful patches of full-thickness burns, which were surrounded by sloughed tissue. His wounds covered 30% of his body surface area, and were distributed on both upper and lower limbs, and his right shoulder. There were no signs of inhalation burns. After a clinical diagnosis of white phosphorus burns was made, the airway was secured, resuscitation fluid was initiated, and wounds were irrigated with diluted sodium bicarbonate solution before wet dressing.

One day after admission to the burns unit, white smoke was noticed emanating from the wounds, which now contained extensive necrotic tissue and had extended into the underlying tissue. He was urgently transferred to the operating room for debridement and excision of necrotic tissue, and removal of white phosphorus particles. During debridement, a white phosphorus particle was accidentally dislodged resulting in a superficial burn on a nurse's neck. We transferred our patient to the intensive care unit for monitoring of vital signs, electrolyte disturbance (in particular hypocalcaemia), and electrocardiogram (ECG) changes. After 8 days in hospital, our patient was relatively well, and was discharged without any systemic complications. At 16-month follow-up, our patient was well; however, hypertrophic, mildly tender scars remained on his chest, arm, and thigh.

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