Surgical Management of a Plutonium-Contaminated Patient – Percy Military Hospital, France 2010

Professor & Vice Director Pierre LaRoche MD PhD
Jean-Christophe Amabile MD MPH, Head, Medical Division
French Defense Radiation Protection Service
Service de protection radiologique des armées (SPRA)
Clamart France

Abstract

In February 2010, a technician was contaminated with plutonium during a maintenance operation of inside a glovebox. The worker presented with a right forearm wound associated with a significant compression of the muscle mass. This industrial accident was immediately taken in charge by the Occupational Medicine Service of the facility for first external then internal decontamination. The worker was then sent to the Percy Military Hospital (Clamart, France) for a moderate compartment syndrome associated with radiological contamination of the wound.

Secondly, this radio-contaminated wounded was managed by the emergency unit crew in charge of the Center for the Treatment of Radio-Contaminated Wounded (CTBRC) of Percy, with the technical support from three experts of the French Defense Radiation Protection Service (SPRA) located at the same site. After a repeat radiological detection and a repeat clinical examination, a second decontamination process was undertaken.

As a consequence of increasing pain, paresthesias and decrease of the grip strength, the patient was admitted to a special operative room at the Percy hospital. Indications for fasciotomy was confirmed and the decision to perform an excision of the surface of the skin, which represents fixed contamination, is taken after a briefing between the surgical team and the SPRA. This surgical technique for the first time used a dermatome guided by local mapping carried out in real time with a probe and leads to a complete decontamination of the patient.