Extensive necrosis following extravasation of alkali in the crease of the elbow after voluntary intravenous injection: A case report

Chemical burns are often deep with difficult initial clinical evaluation, especially those due to alkalic agents, which have a strong penetrating power. They therefore require specialized care in a Burn Unit. Self-inflicted burns are infrequent but their management represents a real challenge. We report the case of a 47-year-old referred to our Burn Center for the evaluation of a self-inflicted corrosion with an alkalic agent (soda), injected at the crease of the left elbow. The patient, right handed, was a nurse and had notably a psychiatric history of depressive syndrome. We observed a deep, well-defined necrosis area, associated with intense peri-lesional inflammation and extensive cellulitis. Faced with this unusual clinical appearance for a chemical burn, the patient's questioning was repeated and the patient finally admitted to having injected himself with a basic caustic product intravenously. Surgical treatment was carried out in two stages: debridement with exposure of vascular and neural structures then coverage with a free anterolateral thigh flap. The postoperative consequences were uneventful with a satisfactory functional result. Factitious disorders are underestimated and often misleading. Among factitious disorders, self-inflicted wounds remain a real challenge requiring multidisciplinary management. Many etiologies exist, among which injection of drugs or substances, in any anatomical localization, leading to variable loss of substance. The use of a free flap for acute extravasation is rare but sometimes essential. The anterolateral thigh flap allows good resurfacing on areas with important functional requirements. Les brûlures chimiques sont souvent des brûlures profondes, dont l’évaluation clinique initiale est difficile, en particulier pour les brûlures causées par des agents chimiques basiques, ayant un fort pouvoir pénétrant. Elles nécessitent une prise en charge spécialisée dans un centre de traitement des brûlés. Les brûlures auto-infligées sont peu fréquentes et leur prise en charge représente un véritable challenge. Nous rapportons le cas d’un patient de 47 ans adressé initialement dans notre centre pour une brûlure chimique basique du pli du coude gauche suite à un contact accidentel avec de la soude. Le patient droitier et infirmier présentait, notamment comme antécédent, un syndrome dépressif. Nous avons observé une zone nécrotique bien délimitée au niveau du pli du coude associée à une inflammation péri-lésionnelle intense. De