Abstract：
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.
摘要：
化学烧伤通常很深，初步临床评估困难，尤其是那些由于碱性剂，具有很强的穿透力。因此，他们需要烧伤单位的专门护理。自己造成的烧伤很少见，但其管理代表了真正的挑战。我们报告了一个47岁的案例，该案例转介给我们的烧伤中心，以评估使用碱性剂（苏打）的自我腐蚀，在左肘折痕处注射。病人,右撇子,是一名护士，有抑郁症的精神病史。我们观察到一个很深的，明确的坏死区域，伴有强烈的病灶周围炎症和广泛的蜂窝织炎。面对这种不寻常的化学烧伤临床表现，患者的询问被重复，患者最终承认自己静脉注射了碱性腐蚀性产品。手术治疗分两个阶段进行：清除血管和神经结构，然后用游离的股前外侧皮瓣覆盖。术后效果顺利，功能效果满意。人为障碍被低估，往往会产生误导。在人为障碍中，自伤仍然是一个需要多学科管理的真正挑战。存在许多病因，其中注射药物或物质，在任何解剖学定位中，导致物质的可变损失。使用游离皮瓣治疗急性外渗是罕见的，但有时是必要的。股前外侧皮瓣可以在具有重要功能要求的区域进行良好的表面修复。
