Case Report: Ultra-early tangential excision combined with negative pressure wound therapy as a novel surgical detoxification strategy for severe hydrofluoric acid burns complicated by intractable hypocalcemia.

INTRODUCTION: Severe hydrofluoric acid (HF) burns are life-threatening due to the rapid systemic absorption of fluoride ions, which precipitate profound hypocalcemia and fatal arrhythmias. Traditional conservative neutralization therapies often fail to halt the continuous absorption of toxins from deep necrotic tissues in high-concentration exposures.

CASE PRESENTATION: We report a 40-year-old male presenting with severe HF burns (20% total body surface area) following exposure to 40% HF. The patient rapidly developed intractable hypocalcemia (Ca2+ 0.48 mmol/L) and experienced 12 episodes of ventricular fibrillation within 8 h. Alongside intensive medical resuscitation, an emergency tangential excision of the burn eschar was performed merely 2 h post-injury to achieve immediate "source control", synergistically coupled with Negative Pressure Wound Therapy (NPWT). Dynamic urinary fluoride monitoring confirmed a rapid decline in the systemic toxic load following the surgical intervention. The patient survived the critical phase, underwent staged skin grafting, and was discharged with complete clinical recovery and fully preserved physical mobility at the 1-year follow-up.

CONCLUSION: Proactive surgical source control through extremely early tangential excision, combined with NPWT, serves as a novel surgical detoxification strategy that effectively severs the continuous systemic absorption of fluoride. This strategy, validated by dynamic urinary fluoride monitoring, significantly improves survival in severe HF burns and warrants broader clinical adoption.