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Chlorhexidine-Gluconate-Related Burns Under a Tourniquet: A Report of Two Cases.

Pneumatic tourniquets and chlorhexidine-gluconate (CHG) solution are used in extremity surgery to provide an aseptic, bloodless surgical field. The superiority of CHG over other skin preparation solutions has been demonstrated in randomized controlled trials1,2. While the complication rate from surgical preparations is low, chemical burns can occur under a tourniquet. Previous reports have identified povidine-iodine chemical burns, but there are no documented CHG-associated cases3,4. We report two cases of CHG-alcohol chemical burns under a pneumatic tourniquet in pediatric extremity surgery and discuss possible preventative strategies. The patients and their families were informed that data concerning their cases would be submitted for publication, and they provided consent.

Case 1. A six-year-old white girl underwent corrective osteotomy and tendon transfer for a recurrent equinovarus clubfoot deformity. The operation was performed under a tourniquet pressure of 250 mm Hg with adequate cotton padding under the tourniquet, but no occlusive skin barrier. The skin preparation was a 2% CHG solution in 70% isopropyl alcohol, and the tourniquet was inflated for 100 minutes. The 2% CHG solution was a new colorless preparation with low viscosity, which had recently been acquired by the hospital. The patient was positioned prone, and the operation proceeded uneventfully. When the tourniquet was removed, the cotton padding was saturated with CHG-alcohol solution and there was a 10 cm × 15-cm indurated area on the posterior aspect of the thigh (Fig. 1). The initial diagnosis, based on intraoperative consultation with a plastic surgeon, was contact dermatitis. Besides skin cleansing, no other immediate treatment was performed. The area blistered over a twenty-four hour period and developed into a deep partial-thickness burn. Early consideration was given for mechanical debridement and split-thickness skin-grafting. However, the burn was treated nonoperatively with serial silver-based dressings, and healed secondarily …