Source (Springer)

Fig 1: Three months later. Skin graft on penis and scrotum took. The thigh is scarred.
Fig 2: After enzymatic debridement. Put a dermal substitute on the scrotum to prevent adhesion, elevated the penis and put a paper cup over it. Thigh burns were could be closed primarily.
Fig 3: (A) Clinical photograph showing active bilateral epistaxis upon arrival at the emergency department. (B) Three-dimensional CT of the skull. Arrows indicate fractures.
Fig 4: Deep dermal and full thickness burns to the penis, scrotum and thigh. Burned cell phone is completely adherent to the pants pocket.

A 47-year-old man presented to the emergency department approximately 30 min after being involved in a motorcycle accident. He reported sustaining injuries when his motorcycle, traveling at approximately 40 km/h, collided with a parked car due to inattentive riding. He called an ambulance after experiencing bilateral epistaxis and upper limb pain. He further reported that his cell phone (brand and model unknown, but described as a smartphone less than 1 year old) had suddenly ignited while in the left front pocket of his trousers. He immediately felt intense heat and pain in his groin area. Upon removing the trousers, he observed flames and smoke emanating from the phone and a developing burn on his skin, which was extinguished spontaneously (Fig. 1A–C).

Upon arrival, vital signs were as follows: temperature, 36.6 °C; heart rate, 65 beats/min with regular rhythm; respiratory rate, 18 breaths/min; blood pressure, 141/99 mmHg; and oxygen saturation, 100% on room air. Glasgow Coma Scale (GCS) score on arrival was 15 (E4V5M6).

Physical examination revealed active bilateral epistaxis (Fig. 2A). Deep dermal burns and full-thickness (third-degree) burns were estimated to cover 2% of the total body surface area (TBSA), involving the left anterior thigh and extending to the penis and scrotum (Fig. 1A–C). The affected skin was charred, with loss of sensation to light touch, and demonstrated coagulative necrosis. No active bleeding or blistering was observed on the burn area at the time of presentation. The patient did not report pain related to his facial injuries or the perineal burn. The remainder of the physical examination was unremarkable, except for right elbow pain upon bending. The patient reported no significant past medical history or allergies.

The patient received immediate first aid, including insertion of a urinary catheter and application of sterile dressings. Computed tomography (CT) revealed multiple facial fractures, specifically involving the anterior wall of the frontal bone, the nasal bone, and a Le Fort I fracture (Fig. 2B). Intravenous fluid resuscitation was initiated and broad-spectrum antibiotics were administered to treat multiple facial fractures. Whole-body CT did not show any other traumatic changes. Due to the full-thickness nature of the burns and the involvement of a sensitive location, surgical debridement and skin grafting were deemed necessary. Topical bromelain ointment was initiated on the day following admission to facilitate enzymatic debridement of devitalized tissue, serving as an early intervention prior to surgical excision.

Under general anesthesia, necrotic tissue was excised on day 14 after admission. The thigh burn was amenable to primary closure. After undermining, the wound was approximated using 3 − 0 polydioxanone sutures for the subcutaneous tissue, 4 − 0 polydioxanone sutures for the dermis, and 5 − 0 Nylon for the epidermis. A split-thickness skin graft (STSG) was harvested from the left thigh and meticulously applied to the debrided areas of the scrotum and penis. For small thermal burn ulcers on the left side that did not require skin grafting, a dermal substitute was applied to promote epithelialization and suppress scar formation. After applying antiseptic gauze dressing, the penis and glans were surrounded with cotton, and the penis was elevated and secured with a paper cup. The same day, the facial fractures were also operated on with titanium plate fixation. Postoperatively, the patient received cefazolin and daily wound care. Pain was managed with opioid analgesics on the day of the operation, but the patient reported no pain the next day and did not require further analgesics (Fig. 3).

Graft viability was first assessed on postoperative day 5, in accordance with standard practice. Following confirmation of graft adherence, compressive dressing with cotton was reapplied and maintained for an additional two weeks. The urethral catheter was removed on day 22 post-admission. The patient was discharged on day 28 post-admission with instructions for continued wound care and follow-up. At the 3-month follow-up, the graft remained viable and the patient had regained full range of motion in the left hip. He reported no residual discomfort or altered sensation in the grafted area and was able to resume normal daily activities. Scarring was evident, but functional outcomes were good (Fig. 4). Urological and sexual function had recovered to pre-injury states. The patient did not attend the 7-month follow-up appointment.